Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Int J Gen Med. 2010 Aug 30;3:255-61. doi: 10.2147/ijgm.s7682.
In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS) published a guideline for treatment of carpal tunnel syndrome (CTS) in 2009 based on review of the literature up to April 6, 2007. We have now reviewed the material published since then. Through reviewing evidence-based articles published during this period, this paper examines the current options and trends for treating CTS. We performed a systematic review of the randomized controlled trials, meta-analyses, systematic reviews, and practice guidelines to present the outcomes of current treatments for this disease. Twenty-five studies met our inclusion criteria. Thirteen randomized, controlled trials and 12 systematic reviews, including three Cochrane database systematic reviews, were retrieved. Our review revealed that most of the recent studies support the AAOS guideline. However, the recent literature demonstrates a trend towards recommending early surgery for CTS cases with or without median nerve denervation, although the AAOS guideline recommends early surgical treatment only for cases with denervation. The usefulness of splinting and steroids as initial treatments for improving patients' symptoms are also supported by the recent literature, but these effects are temporary. The evidence level for ultrasound treatment is still low, and further studies are needed to determine the effectiveness of this treatment. Finally, our review revealed a paucity of articles comparing the costs of CTS diagnosis and treatment. With the recent focus on health care reform and rising costs, attention to the direct and indirect costs of health care is important for all conditions. Future well designed studies should include cost analyses to help determine the cost burden of CTS.
为了提高医疗保健的效率和效果，治疗应该以合理的成本提供疾病的改善或解决。美国骨科医师学会（AAOS）于 2009 年根据截至 2007 年 4 月 6 日的文献综述发布了腕管综合征（CTS）治疗指南。我们现在已经审查了自那时以来发表的材料。通过审查这期间发表的基于证据的文章，本文探讨了治疗 CTS 的当前选择和趋势。我们对随机对照试验、荟萃分析、系统评价和实践指南进行了系统评价，以展示当前治疗这种疾病的结果。有 25 项研究符合我们的纳入标准。检索到 13 项随机对照试验和 12 项系统评价，包括 3 项 Cochrane 数据库系统评价。我们的综述结果表明，最近的大多数研究都支持 AAOS 指南。然而，最近的文献表明，倾向于推荐对有或没有正中神经失神经支配的 CTS 病例进行早期手术，尽管 AAOS 指南仅建议对失神经支配的病例进行早期手术。夹板和类固醇作为改善患者症状的初始治疗方法的有效性也得到了最近文献的支持，但这些效果是暂时的。超声治疗的证据水平仍然较低，需要进一步研究来确定这种治疗的效果。最后，我们的综述发现比较 CTS 诊断和治疗成本的文章很少。随着最近对医疗保健改革和成本上升的关注，关注所有疾病的医疗保健的直接和间接成本非常重要。未来精心设计的研究应包括成本分析，以帮助确定 CTS 的成本负担。
