ﻣﺤﻞ آﻧﺎﺗﻮﻣﻴﻚ ﻓﺸﺎر ﺑﺮ ﻋﺼﺐ ﻣﺪﻳﺎن در ﺑﻴﻤﺎران ﺑﺎ ﺳﻨﺪروم ﺗﻮﻧﻞ ﻛﺎرپ اﻳﺪﻳﻮﭘﺎﺗﻴﻚ ﺷﺪﻳﺪ

The Anatomical Site of Compression of the Median Nerve in Patients with Severe Idiopathic Carpal Tunnel Syndrome

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻣﻄﺎﻟﻌﻪ ﺁﻧﺎﺗﻮﻣﻲ ﻣﺤﻞ ﮐﻤﭙﺮﺷﻦ ﻋﺼﺐ ﻣﺪﻳﺎﻥ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺳﻨﺪﺭﻭﻡ ﺗﻮﻧﻞ ﮐﺎﺭﭖ ﻣﻲ ﺗﻮﺍﻧﺪ ﺑﻪ ﺩﺭﮎ ﺑﻬﺘﺮ ﺍﺯ ﺁﻧﺎﺗﻮﻣﻲ ﺗﻮﻧﻞ ﮐﺎﺭﭖ ﻭ ﺗﻨﮓ ﺗﺮﻳﻦ ﻣﺤﻞ ﺍﻳﻦ ﺗﻮﻧﻞ ﻣﻨﺠﺮ ﺷﻮﺩ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺩﺭ ﺟﻬﺖ ﮐﻤﮏ ﺑﻪ ﺭﻭﺷﻦ ﺷﺪﻥ ﺑﻴﺸﺘﺮ ﺁﻧﺎﺗﻮﻣﻲ ﺗﻮﻧﻞ ﮐﺎﺭﭖ ﻃﺮﺍﺣﻲ ﻭ ﺍﺟﺮﺍ ﺷﺪﻩ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺗﻌﺪﺍﺩ ﭼﻬﻞ ﺑﻴﻤﺎﺭ ﮐﻪ ﺑﺎ ﺗﺸﺨﻴﺺ ﺳﻨﺪﺭﻭﻡ ﺗﻮﻧﻞ ﮐﺎﺭﭖ ﺍﻳﺪﻳﻮﭘﺎﺗﻴﮏ ﻭ ﺷﺪﻳﺪ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺁﺯﺍﺩ ﮐﺮﺩﻥ ﻋﺼﺐ ﻣﺪﻳﺎﻥ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ، ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﮔﻨﺠﺎﻧﺪﻩ ﺷﺪﻩ ﺍﻧﺪ. ﻃﻮﻝ ﻧﺎﺣﻴﻪ ﮐﻤﭙﺮﺷﻦ ﻋﺼﺐ، ﻓﺎﺻﻠﻪ ﻭﺳﻂ ﻧﺎﺣﻴﻪ ﮐﻤﭙﺮﺷﻦ ﻋﺼﺐ ﺗﺎ ﭼﻴﻦ ﺩﻳﺴﺘﺎﻝ ﻣﭻ ﺩﺳﺖ ﺍﻧﺪﺍﺯﻩ ﮔﻴﺮﻱ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ ﺗﻌﺪﺍﺩ 40 ﺑﻴﻤﺎﺭ، ﺳﻲ ﻭ ﻫﺸﺖ ﻧﻔﺮ ﺯﻥ ﻭ ﺩﻭ ﻧﻔﺮ ﻣﺮﺩ ﺑﻮﺩﻧﺪ. ﻣﻴﺎﻧﮕﻴﻦ ﺳﻦ ﺑﻴﻤﺎﺭﺍﻥ )37-76( 54±6/5 ﺳﺎﻝ ﺑﻮﺩ. ﻃﻮﻝ ﻣﺘﻮﺳﻂ ﻧﺎﺣﻴﻪ ﺑﺎ ﮐﻤﭙﺮﺷﻦ ﻳﺎ ﺍﺛﺮ ﻓﺸﺎﺭﻱ )3-10( 6±1 ﻣﻴﻠﻲ ﻣﺘﺮ ﻭ ﻣﺘﻮﺳﻂ ﻃﻮﻝ ﻭﺳﻂ ﻧﺎﺣﻴﻪ ﮐﻤﭙﺮﺷﻦ ﺗﺎ ﭼﻴﻦ ﺩﻳﺴﺘﺎﻝ ﻣﭻ ﺩﺳﺖ )18-26( 23±3/5 ﻣﻴﻠﻲ ﻣﺘﺮ ﺑﻮﺩ. ﮐﻪ ﺍﻳﻦ ﻣﺤﻞ ﺩﺭ ﻣﺤﺎﺫﺍﺕ ﺯﺍﻳﺪﻩ ﻗﻼﺑﻲ ﺷﮑﻞ ﺍﺳﺘﺨﻮﺍﻥ ﻫﻤﻴﺖ ﻗﺮﺍﺭ ﺩﺍﺭﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺮ ﺍﺳﺎﺱ ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺁﻧﺎﺗﻮﻣﻲ ﻋﺼﺐ ﻣﺪﻳﺎﻥ ﺩﺭ ﺗﻮﻧﻞ ﮐﺎﺭﭖ ﺑﻴﺸﺘﺮﻳﻦ ﻣﺤﻞ ﺗﻨﮕﻲ ﮐﺎﻧﺎﻝ ﮐﺎﺭﭖ ﻭ ﺑﻴﺸﺘﺮﻳﻦ ﻓﺸﺎﺭ ﺑﺮ ﺭﻭﻱ ﻋﺼﺐ ﻣﺪﻳﺎﻥ ﺩﺭ ﻣﺤﺎﺫﺍﺕ ﺯﺍﻳﺪﻩ ﻗﻼﺑﻲ ﺷﮑﻞ ﺍﺳﺘﺨﻮﺍﻥ ﻫﻤﻴﺖ ﻗﺮﺍﺭ ﺩﺍﺭﺩ.

Introduction & Objective: The anatomical study of the compression site of median nerve in patients with carpal tunnel syndrome can result in to better understanding of carpal tunnel anatomy and the narrowest location of carpal tunnel. This study was performed to have a better understanding of the carpal tunnel anatomy. Materials & Methods: Forty patients with severe idiopathic carpal tunnel syndrome, who had undergone carpal tunnel release, were entered in this study. The length of compression area in median nerve, the distance between the middle of compression area and distal wrist crease were determined. Results: From these 40 patients 38 were women and 2 were men. The mean age of these patients was 54± 6.5(37-76) years. The mean length of compression area was 6±1 (3-10) millimeter and the mean distance between the middle of compression area and distal wrist crease was 23±3.5 (18-26) millimeter. This area was adjacent to the hook of the hamate. Conclusions: According to the results of present study on the anatomy of median nerve in carpal tunnel, the location of the narrowest area and the site with most compression correspond to the location of the hook of the hamate bone.