Schmelzer Rodney E, Della Rocca Gregory J, Caplin David A
Plast Reconstr Surg. 2006 Jan;117(1):177-85. doi: 10.1097/01.prs.0000194910.30455.16.
Endoscopic carpal tunnel release is gaining increasing acceptance relative to the standard open carpal tunnel release for the treatment of carpal tunnel syndrome. Concerns about endoscopic carpal tunnel release include effectiveness of therapy and complication rates. This study attempted to evaluate outcomes of endoscopic carpal tunnel release in a large patient cohort.
Four hundred eighty-six patients (753 hands) with carpal tunnel syndrome who underwent endoscopic carpal tunnel release by a single surgeon were reviewed retrospectively. Data included demographics, subjective complaints, prior interventions, preoperative examination findings, and postoperative follow-up. All follow-up data were obtained from a single, independent, occupational therapy clinic.
Median patient age was 48 years. Three hundred seventy-seven patients were gainfully employed at presentation, and 206 filed a worker's compensation claim. Median symptom duration was 2 years. Nonoperative therapy was ineffective in 151 patients. Preoperative nerve conduction studies were consistent with carpal tunnel syndrome in 472 patients (97 percent); all patients had either physical examination findings or nerve conduction studies consistent with carpal tunnel syndrome. Four hundred eighty-six patients (100 percent) obtained symptom relief. Complications included one transient median nerve neurapraxia, six complaints of residual pain, and one complaint of hypersensitivity. Worker's compensation patients and non-worker's compensation patients returned to work full-duty at similar times postoperatively. Ninety percent of employed patients returned to their original occupation.
The authors' data indicate that an endoscopic approach for the treatment of carpal tunnel syndrome is safe and effective. Patients demonstrated a high return-to-work rate and an extremely low complication rate. The data challenge the belief that endoscopic carpal tunnel release results in higher complication rates.
相对于治疗腕管综合征的标准开放性腕管松解术，内镜下腕管松解术越来越被广泛接受。对内镜下腕管松解术的担忧包括治疗效果和并发症发生率。本研究试图评估在一大群患者中进行内镜下腕管松解术的结果。
回顾性分析了由一名外科医生实施内镜下腕管松解术的486例腕管综合征患者（753只手）。数据包括人口统计学资料、主观症状、既往治疗、术前检查结果及术后随访情况。所有随访数据均来自一家独立的职业治疗诊所。
患者的中位年龄为48岁。377例患者就诊时仍在工作，206例提出了工伤赔偿申请。症状持续时间的中位数为2年。151例患者非手术治疗无效。472例患者（97%）术前神经传导检查结果符合腕管综合征；所有患者均有体格检查结果或神经传导检查结果符合腕管综合征。486例患者（100%）症状得到缓解。并发症包括1例短暂性正中神经失用、6例残留疼痛主诉和1例感觉过敏主诉。工伤赔偿患者和非工伤赔偿患者术后恢复全职工作的时间相近。90%的在职患者回到了原工作岗位。
作者的数据表明，内镜治疗腕管综合征的方法安全有效。患者的工作恢复率高，并发症发生率极低。这些数据对内镜下腕管松解术并发症发生率更高的观点提出了挑战。
