腕管综合征手术适应证：临床质量评价指标。

Indications for performing carpal tunnel surgery: clinical quality measures.

机构信息

Los Angeles, Sylmar, Fontana, Yorba Linda, and Santa Monica, Calif. From the Department of Surgery and the Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA; Olive View-UCLA; the Department of Hand Surgery, Kaiser Permanente, Fontana Medical Center; the Department of Hand Surgery, Kaiser Permanente, Yorba Linda Medical Offices; the RAND Corporation; and the Veterans Affairs Greater Los Angeles Healthcare System.

出版信息

Plast Reconstr Surg. 2010 Jul;126(1):169-179. doi: 10.1097/PRS.0b013e3181da8685.

DOI:10.1097/PRS.0b013e3181da8685

PMID:20595866

Abstract

BACKGROUND

Rates of carpal tunnel surgery vary for unclear reasons. In this study, the authors developed measures determining when surgery is necessary (benefits exceed risks), inappropriate (risks outweigh benefits), or optional.

METHODS

Measures were developed using a modified-Delphi panel. Clinical scenarios were defined incorporating symptom severity, symptom duration, clinical probability of carpal tunnel syndrome, electrodiagnostic testing, and nonoperative treatment response. A multidisciplinary panel of 11 carpal tunnel syndrome experts rated appropriateness of surgery for each scenario on a scale ranging from 1 to 9 scale (7 to 9, surgery is necessary; 1 to 3, surgery is inappropriate).

RESULTS

Of 90 scenarios (36 for mild, 36 for moderate, and 18 for severe symptoms), panelists judged carpal tunnel surgery as necessary for 16, inappropriate for 37, and optional for 37 scenarios. For mild symptoms, surgery is generally necessary when clinical probability of carpal tunnel syndrome is high, there is a positive electrodiagnostic test, and there has been unsuccessful nonoperative treatment. For moderate symptoms, surgery is generally necessary with a positive electrodiagnostic test involving two or more of the following: high clinical probability, unsuccessful nonoperative treatment, and symptoms lasting longer than 12 months. Surgery is generally inappropriate for mild to moderate symptoms involving two or more of the following: low clinical probability, no electrodiagnostic confirmation, and nonoperative treatment not attempted. For severe symptoms, surgery is generally necessary with a positive electrodiagnostic test or unsuccessful nonoperative treatment.

CONCLUSIONS

These are the first formal measures assessing appropriateness of carpal tunnel surgery. Applying these measures can identify underuse (failure to provide necessary care) and overuse (providing inappropriate care), giving insight into variations in receipt of this procedure.

摘要

背景

腕管综合征手术的比率因不明原因而有所不同。在这项研究中，作者制定了一些衡量标准，以确定何时需要手术（收益超过风险）、何时不适合手术（风险大于收益）或何时可选择手术。

方法

该衡量标准是使用改良 Delphi 小组制定的。临床情况定义为纳入症状严重程度、症状持续时间、腕管综合征的临床可能性、电诊断测试和非手术治疗反应。一个由 11 名腕管综合征专家组成的多学科小组根据从 1 到 9 的量表对每个情况进行手术的适当性进行评分（7 到 9，手术是必要的；1 到 3，手术是不适当的）。

结果

在 90 种情况下（轻度 36 种，中度 36 种，重度 18 种），小组成员认为 16 种情况下腕管综合征手术是必要的，37 种情况下手术是不适当的，37 种情况下手术是可选择的。对于轻度症状，当腕管综合征的临床可能性高、电诊断测试阳性且非手术治疗不成功时，手术通常是必要的。对于中度症状，当电诊断测试涉及以下两个或更多方面时，手术通常是必要的：高临床可能性、非手术治疗不成功以及症状持续时间超过 12 个月。对于涉及以下两个或更多方面的轻度到中度症状，手术通常是不适当的：低临床可能性、无电诊断确认以及未尝试非手术治疗。对于重度症状，手术通常是必要的，要么是电诊断测试阳性，要么是非手术治疗不成功。