Castillo Tiffany N, Yao Jeffrey
Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94063, USA.
J Hand Surg Am. 2010 Nov;35(11):1813-9. doi: 10.1016/j.jhsa.2010.08.027.
This study analyzes the long-term postoperative symptoms and functional outcomes of patients who underwent either traditional open (single-incision) or 2-incision carpal tunnel release (CTR). Because 2-incision CTR preserves the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences, it may account for fewer postoperative symptoms and improved functional recovery.
A retrospective chart review identified patients who underwent either open or 2-incision CTR for isolated carpal tunnel syndrome between 2005 and 2008 by a single surgeon. Patients with a history of hand trauma or confounding comorbidities were excluded. We mailed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire and a Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ) to all eligible participants. Data from the completed questionnaires were analyzed using independent t-tests and Pearson's correlation. Significance was set at p = .05.
A total of 82 patients (106 hands; 27 men and 55 women; mean age, 60.5 y) were eligible to participate. Of these, 51 patients (63 hands; 20 men and 31 women; mean age, 61.1 y) responded (62% response rate). The mean duration of follow-up was 22 months (range, 12-37 mo; SD 7.3 mo). The 2-incision group mean BWCTQ Symptom Severity Scale score (1.13, SD 0.25) was significantly lower than the open group mean Symptom Severity Scale score (1.54, SD 0.70, p = .001). The 2-incision group mean BWCTQ Functional Status Scale score (1.24, SD 0.51) was significantly lower than the open group mean Functional Status Scale score (1.71, SD 0.76, p = .008). The 2-incision group mean DASH score (5.10, SD 12.03) was significantly lower than the open group mean DASH score (16.28, SD 19.98, p = .01).
Patients treated with 2-incision CTR reported statistically significantly less severe long-term postoperative symptoms and improved functional status compared with patients treated with traditional open CTR. Future prospective studies with objective measures are needed to further investigate the difference in outcomes found between these 2 CTR techniques.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
本研究分析了接受传统开放性（单切口）或双切口腕管松解术（CTR）患者的术后长期症状及功能结果。由于双切口CTR保留了大鱼际和小鱼际隆起之间的浅表神经和皮下组织，其术后症状可能较少，功能恢复也更好。
通过回顾性病历审查，确定了2005年至2008年间由同一位外科医生进行开放性或双切口CTR治疗孤立性腕管综合征的患者。排除有手部创伤史或复杂合并症的患者。我们向所有符合条件的参与者邮寄了手臂、肩部和手部功能障碍（DASH）问卷以及布莱根妇女医院腕管问卷（BWCTQ）。对完成问卷的数据进行独立t检验和Pearson相关性分析。显著性设定为p = 0.05。
共有82例患者（106只手；男性27例，女性55例；平均年龄60.5岁）符合参与条件。其中，51例患者（63只手；男性20例，女性31例；平均年龄61.1岁）进行了回复（回复率62%）。平均随访时间为22个月（范围12 - 37个月；标准差7.3个月）。双切口组的平均BWCTQ症状严重程度量表评分（1.13，标准差0.25）显著低于开放组的平均症状严重程度量表评分（1.54，标准差0.70，p = 0.001）。双切口组的平均BWCTQ功能状态量表评分（1.24，标准差0.51）显著低于开放组的平均功能状态量表评分（1.71，标准差0.76，p = 0.008）。双切口组的平均DASH评分（5.10，标准差12.03）显著低于开放组的平均DASH评分（16.28，标准差19.98，p = 0.01）。
与接受传统开放性CTR治疗的患者相比，接受双切口CTR治疗的患者术后长期症状在统计学上显著较轻，功能状态更好。未来需要进行有客观测量指标的前瞻性研究，以进一步调查这两种CTR技术在结果上的差异。
研究类型/证据水平：治疗性III级。
