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CNAA / Theses / 2017 / July /

Clinical and imaging evaluation of the surgical treatment of carpal and Guyon tunnel syndrome


Author: Ursu Sergiu
Degree:doctor of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2018
Scientific adviser: Nicolae Caproş
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Grigore Zapuhlih
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 7 July, 2017
Approved by NCAA on the 11 May, 2018

Abstract

Adobe PDF document – 13.71 Mb / in romanian

Thesis

CZU [617.575+616.833.35/36]-073-089(043)

Adobe PDF document 6.99 Mb / in romanian
169 pages

Keywords

carpal tunnel syndrome, Guyon's canal syndrome, neuropathy, wrist, ligament, ultrasonography

Summary

Research area. The study included 350 patients with carpal and Guyon tunnel syndrome with various stages of the tunnel neuropathy, including at 146 patients was applied the surgical method of the treatment excision through approach in crescent moon of the anterior transverse carpal ligament and at 130 patients were applied microsurgical procedure of the neurolysis.

Aim of research. It was to develop a clinical diagnostic and imaging algorithm based on the evidence and the complex treatment of patients with carpal and Guyon tunnel syndrome. The main objective of the research was to evaluate and improve the effectiveness of imaging diagnosis and surgical treatment of the carpal tunnel syndrome and Guyon by implementing a protocol of the diagnosis and treatment of early and advanced stages of the disease depending on the presence or absence of traumatic factor.

Novelty and scientific originality. Clinical and imaging has been substantiated and confirmed the possibility of determining the degree of compression ultrasonography of the median nerve and the selection method of the treatment in patients with carpal and Guyon tunnel syndrome. Histological examination found the presence of advanced tissue damage at the level anterior transverse carpal ligament already in the early stages of carpal tunnel syndrome and Guyon by traumatic etiology, which imposes the need for ligament excision and determining the type of neurolysis.

Scientific problem resolved in thesis is to evaluate and implement new methods of diagnosis carpal and Guyon tunnel syndrome to establish specific indications to the selection method of the treatment of the disease based on the etiology (idiopathic or traumatic), the degree of compression and damage of median and ulnar nerve.

The theoretical significance of the research. The study confirmed that the practice of sonographic index of the median nerve of the wrist improves the diagnosis of carpal and Guyon tunnel syndrome. They were substantiated and confirmed the usefulness and priority surgical method (excision through approach in crescent moon of the anterior transverse carpal ligament with the median nerve decompression) and the efficiency of neurolysis in the treatment of the carpal and Guyon tunnel syndrome.

The application value of the study consists in the development of a diagnostic algorithm and complex treatment of patients with carpal and Guyon tunnel syndrome which allows objective determination of indications, improving surgical treatment according to etiology (traumatic or idiopathic), the degree of compression and damage to the median nerve and nerve ulnar in the carpal tunnel and Guyon's canal.

Scientific results implementation. The main research results are applied in the teaching process at the Department of Traumatology and Orthopedics IP Medical University „Nicolae Testemiţanu” and are implemented in practice of Public Health Care Institutions Hospital of Traumatology and Orthopedics and Public Health Care Institutions Emergency Medicine Institute from Chișinău.