Katz J N, Losina E, Amick B C, Fossel A H, Bessette L, Keller R B
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Arthritis Rheum. 2001 May;44(5):1184-93. doi: 10.1002/1529-0131(200105)44:5<1184::AID-ANR202>3.0.CO;2-A.
To identify factors that are predictive of the outcomes of greatest importance to patients-i.e., symptom relief, functional improvement, and satisfaction with the outcomes of surgery-following carpal tunnel release.
We analyzed data from the Maine Carpal Tunnel Study, a community-based study of the outcomes of treatment for carpal tunnel syndrome. In a cohort of patients who underwent carpal tunnel release, a preoperative physical examination was performed and questionnaires were completed preoperatively and at 6, 18, and 30 months postoperatively. The questionnaires assessed symptom severity, upper extremity functional limitations, mental health, general physical health status, the relative severity of individual symptoms, satisfaction with the results of surgery, sociodemographic factors, and for those subjects who were in the workforce, aspects of the work environment. The associations between preoperative factors and the 3 principal outcomes (symptom severity, upper extremity functional limitations, and satisfaction with the results of surgery, all evaluated at 18 months postoperatively) were assessed with bivariate and multivariate linear regression and logistic regression analyses.
Two hundred forty-one subjects were enrolled and 188 (78%) completed followup surveys 18 months postoperatively. Two-thirds of the patients reported being completely or very satisfied with the outcomes of surgery at 6, 18, and 30 months postoperatively. A range of clinical and work-related variables were associated with outcomes. In multivariate analyses, greater preoperative upper extremity functional limitation was predictive of greater functional limitations postoperatively. Worse mental health status was significantly associated with more severe symptoms and lower satisfaction. Alcohol use was also associated with more severe symptoms and lower satisfaction. Among workers, involvement of an attorney was significantly associated with greater functional limitation, more severe symptoms, and lower satisfaction. Recipients of worker's compensation who did not hire an attorney had generally good outcomes. Of note, physical examination parameters were not predictive of the outcomes of surgery.
The outcomes of carpal tunnel release in community-based practices are excellent. Predictors of the outcomes of surgery are disease-specific and generic clinical factors as well as work-related factors. The strongest predictors of less favorable outcomes are worse scores on patient-reported measures of upper extremity functional limitation and mental health status, alcohol use, and the involvement of an attorney. Clinicians should carefully evaluate patients' functional status, mental health status, health habits, and attorney involvement prior to performing carpal tunnel release, and discuss with patients the prognostic implications of these parameters.
确定对患者最重要的手术结果（即症状缓解、功能改善以及对腕管松解术手术结果的满意度）的预测因素。
我们分析了缅因州腕管研究的数据，这是一项基于社区的腕管综合征治疗结果研究。在一组接受腕管松解术的患者中，进行了术前体格检查，并在术前以及术后6个月、18个月和30个月完成问卷调查。问卷评估了症状严重程度、上肢功能受限情况、心理健康、总体身体健康状况、个体症状的相对严重程度、对手术结果的满意度、社会人口学因素，对于在职人员，还评估了工作环境方面的情况。通过双变量和多变量线性回归以及逻辑回归分析评估术前因素与3个主要结果（均在术后18个月评估的症状严重程度、上肢功能受限情况以及对手术结果的满意度）之间的关联。
共纳入241名受试者，188名（78%）在术后18个月完成了随访调查。三分之二的患者报告在术后6个月、18个月和30个月时对手术结果完全或非常满意。一系列临床和工作相关变量与结果相关。在多变量分析中，术前上肢功能受限程度越高，术后功能受限程度越高。心理健康状况越差与症状越严重及满意度越低显著相关。饮酒也与症状越严重及满意度越低相关。在在职人员中，聘请律师与功能受限程度更高、症状更严重及满意度更低显著相关。未聘请律师的工伤赔偿受益者通常手术结果良好。值得注意的是，体格检查参数并不能预测手术结果。
在基于社区的医疗实践中，腕管松解术的手术结果良好。手术结果的预测因素包括疾病特异性和一般临床因素以及工作相关因素。预后较差结果的最强预测因素是患者报告的上肢功能受限和心理健康状况评分较低、饮酒以及聘请律师。临床医生在进行腕管松解术前应仔细评估患者的功能状态、心理健康状况、健康习惯以及律师介入情况，并与患者讨论这些参数的预后意义。
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