Weber Robert A, DeSalvo Daniel J, Rude Malcolm J
Division of Plastic Surgery, Scott and White Memorial Hospital, Temple, TX 76508, USA.
J Hand Surg Am. 2010 Feb;35(2):207-11. doi: 10.1016/j.jhsa.2009.10.020. Epub 2010 Jan 8.
In 2005, a prospective clinical trial with a 6-month follow-up demonstrated the efficacy of carpal tunnel release in patients 65 years and older and showed that age is not a contraindication to surgery. The purpose of this study was to determine whether there was any further improvement, maintenance of results, or recurrence of carpal tunnel symptoms 5 years after surgery.
We contacted all 66 patients (with a total of 92 hands involved) from the original study to be enrolled for re-evaluation. Of the original cohort, 12 were unavailable because of death or severe neurologic impairment. Of the remaining 54 patients, 19 agreed to participate in this follow-up study of their 29 hands. For the 5-year follow-up, patients underwent a repeat history and physical examination with particular emphasis on the status of their hands over the past 5 years. The Michigan Hand Outcome Questionnaire was again used to determine overall hand function, activities of daily living, work performance, pain, aesthetics, and satisfaction with hand function.
The mean age of patients available for 5-year follow-up was 78 +/- 3 years. The patients maintained their symptom improvement, demonstrating no significant difference between the 6-month and 5-year follow-up data; their physical findings, except for grip strength, were likewise unchanged. The patients also retained their improved 2-point discrimination. Scar tenderness decreased over the 5 years. The Michigan Hand Outcome Questionnaire confirmed the fact that initial postoperative improvement in all parameters persisted at least 5 years. One patient underwent repeat carpal tunnel release of 1 hand for recurrent symptoms. Overall, 94% of patients were either very or completely satisfied with their results.
Patients who were 65 years of age or older at the time of surgery maintained their clinical improvement for at least 5 years after surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
2005年，一项为期6个月随访的前瞻性临床试验证明了腕管松解术对65岁及以上患者的疗效，并表明年龄并非手术禁忌证。本研究的目的是确定术后5年腕管症状是否有进一步改善、结果维持情况或复发。
我们联系了原研究中的所有66例患者（共涉及92只手），邀请他们参加重新评估。在原队列中，12例因死亡或严重神经功能障碍无法参与。其余54例患者中，19例同意参与其29只手的这项随访研究。在5年随访中，患者接受了重复的病史和体格检查，特别关注其手部在过去5年的状况。再次使用密歇根手部结果问卷来确定手部整体功能、日常生活活动、工作表现、疼痛、美观度以及对手部功能的满意度。
可进行5年随访的患者平均年龄为78±3岁。患者维持了症状改善，6个月和5年随访数据之间无显著差异；除握力外，他们的体格检查结果同样未变。患者还保持了改善的两点辨别觉。瘢痕压痛在5年中有所减轻。密歇根手部结果问卷证实了所有参数术后初期的改善至少持续5年这一事实。1例患者因症状复发接受了1只手的再次腕管松解术。总体而言，94%的患者对结果非常满意或完全满意。
手术时年龄在65岁及以上的患者术后至少5年保持了临床改善。
研究类型/证据水平：治疗性IV级。
