Míšní léze představuje komplikovaný stav spojený se závažnými následky jak pro pacienta, tak pro společnost. Regenerační schopnosti míchy jsou značně omezené. Z tohoto pohledu je důležitá rychlá diagnostika následovaná odpovídající léčbou v závislosti na příčině léze. Etiologii míšní léze lze v zásadě rozdělit na traumatickou a netraumatickou. Traumatické míšní léze jsou nejčastěji spojené s poraněním páteře. Nádory, degenerativní změny a různé typy krvácení jsou nejčastější příčinou netraumatických míšních lézí. Včasná dekomprese představuje spolu s odpovídající konzervativní léčbou v současné době jedinou šanci na možné zlepšení klinického stavu. U déletrvající kompletní míšní léze je i přes značné úsilí na experimentální úrovni prognóza pacientů nepříznivá a zlepšení těžkého neurologického deficitu je spíše výjimečné.
Spinal cord lesions represent a complicated clinical problem connected with serious consequences both for the patient andthe society. Regenerative potential of spinal cord is extremely limited. From this point of view, fast diagnostics followed by anappropriate treatment based on the etiology of the lesion is fundamental. Etiology of spinal cord lesions can be traumatic andnon-traumatic. Traumatic spinal cord lesions are most often connected with spine injuries. Tumors, degenerative diseases andvarious hemorrhages are the most common cause of non-traumatic spinal cord lesions. Early decompression along with anadequate conservative treatment currently represents the only therapy with prospect of clinical improvement. In prolongedcomplete spinal cord lesions, the patient prognosis is, in spite of significant efforts in experimental research, still unfavourableand the improvement of a serious neurological deficit is rather exceptional.
- Klíčová slova
- míšní léze,
- MeSH
- akutní nemoc MeSH
- časové faktory MeSH
- chirurgická dekomprese MeSH
- fraktury páteře chirurgie komplikace MeSH
- lidé MeSH
- nádory míchy * chirurgie MeSH
- poranění míchy * etiologie chirurgie MeSH
- poranění páteře komplikace MeSH
- prognóza MeSH
- spinální epidurální hematom * diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE OF THE STUDY The aim of the study was to evaluate a group of patients treated for Guyon's canal syndrome with analysis of the cause for and outcome of surgery. MATERIAL AND METHODS The group comprised 13 patients operated on for compressive neuropathies of the ulnar nerve in the canal of Guyon in the period from 2007 to 2010. The clinical parameters evaluated were the adduction strength of the fifth digit, degree of interosseous primus muscle hypotrophy and degree of hypoesthesia in the area innervated by the ulnar nerve. EMG parameters included motor and sensory nerve conduction through Guyon's canal. Patients' subjective evaluations of the treatment outcomes were also recorded. The results were not compared with a control group. RESULTS Post-operative improvements in all clinical and EMG parameters were significant (p=0.02-0.003). All but one patient (90%) reported an improved subjective condition after surgery; on the other hand, pre-operative severe impairment of motor nerve conduction highly affected the post-operative motor function. Guyon's canal syndrome accounted for 0.8% of all compressive neuropathies of the upper extremity in our patients. DISCUSSION Ulnar nerve compression at the wrist is a relatively rare condition amongst the compressive neuropathies of the upper extremity, and literature data concerning this disease are very few. Although many causes of ulnar nerve compression at the wrist have been reported, only one of our patients had ganglion. We conclude that the majority of cases can be diagnosed as a "neuritis" due to chronic microtrauma produced by pressure of a hypertrophic palmar ligament. CONCLUSIONS Syndrome of Guyon's canal can easily be treated by surgery. As in other compression syndromes, the sooner a surgical decompression is performed, the better outcomes are achieved.
