1. Clinical and radiologic Improvement of Clinical
A-0987 Effects of a temperature-sensitive, anti-adhesive agent on the clinical outcome of carpal tunnel release surgery
Soo Min Cha, Hyun Dae Shin
Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Korea
Introduction
Clinical items by Graham
Preoperative state/
final follow-up
Group 1
Group 2 P
Numbness or tingling (n)
(+) / (+) 6 1
0.08
(+) / (-) 41 49
(-) / (-)
Nocturnal numbness (n)
0.23 45 51 2
Thena atrophy (n) 14 9
0.37 4 5 29 37
Tinel (n) 18
0.06 21 34 8 3
Phalen (n) 20 17
0.49 19 13
Improvement of two-point discrimination
(Preoperative TPD – final TPD)
Thumb (mm)
0.94±0.82
1.25±1.28
0.14
Index (mm)
1.11±0.91
1.43±0.85
0.07
Long finger (mm)
1.04±1.04
1.37±1.17
Ring finger (mm)
0.86±0.12
1.00±0.75
0.33
We observed a unsatisfactory results after carpal tunnel release surgery.
Especially, postoperative adhesions is a major concern in many types of sugery.
So, we inject the Guardix-SG®(temporature-sensitive anti adhegisve agent, TSAA) into the intracarpal tunnel space just after TCL. And we evaluated the results radiologically and clinically
Methods
March 2014 to April 2016, 107 patients were enrolled
53 patients were infused with Guardix and 54 patients were not infused
We evaluated six clinical items(numbness or tingling in the median nerve distribution, nocturnal numbness, thenar atrophy, tinel sign, phalen test, loss of two-point discrimination(TPD), and Boston carpal tunnel questionnaire(BCTQ) scores. After accurate reduction of the distal fragment, a cortical screw was inserted in the proximal diaphysis until the maximum compressive force was obtained against the distal fragment. Then, one or two locking screws were added adjacent to the initial cortical screw. No screw fixation was performed in the distal fragment area.
Clinical and radiologic
outcomes
Group 1
Group 2 P
Improvement of Clinical
(Preoperative scores –
final scores)
Boston Symptom Scores
17.16 ± 6.41
18.58 ± 3.64
0.19
Boston Function Scores
9.16 ± 4.08
8.93 ± 2.77
0.11
Sonographic measurement at final follow-up (mm)
Maximal distance of
median Nerve
16.2 ± 8.4
16.4 ± 7.1
0.25
Minimal distance of
12.9 ± 11.6
15.2 ± 8.5
< 0.001
Movements of median
Nerve
3.3 ± 1.1
1.2 ± 7.7
* Evaluation of adhesion around median nerve
Results
Variables
Group 1
(Infusion)
Group 2 P
Age at diagnosis (y)
58.21±10.84
56.75±7.89
0.44
Gender (Male/Female, n)
16:31
9:42
0.07
Onset period of symptoms or signs (mo)
15.30±3.49
15.90±2.48
0.32
The time from the diagnosis to the surgery (mo)
6.72±0.80
6.73±0.72
0.99
Site of the lesion (Dominant/Non-dominant, n)
26:21:00
22:29
0.31
All evaluations were done at least 3 years postoperatively with a mean follow-up of 53.2 months. In adolescents with a closed physis (n=8), the mean radial inclination, volar tilting, and ulna variance were 21.1 ± 1.64°, 11.5 ± 1.07°, and –0.25 ± 0.71 mm, respectively.
Conclusion
A temperature-senstivie poloxamer/alginate mixture(Guardix-SG®) effectively prevented postoperative neural adhesions as assessed at 18 months during carpal tunnel release
However, short term follow-up period results were not a significant clinical difference
For more full evaluation the clinical benefits of this treatment, we need further studies with longer follow-up periods.
Category
(Major SOC2010 groups and example occupations) P 1 2 3 4 5 6 7 8 9
Group 1 (n) 11 13
0.14
Group 2 (n)
Bland Scale 　 P 2 3 4
Group 1 (n) 7 26 14
0.77
Group 2 (n) 9 30 12