Tuppin P, Blotière P-O, Weill A, Ricordeau P, Allemand H
Caisse nationale de l'assurance maladie des travailleurs salariés (CNAMTS), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
Rev Neurol (Paris). 2011 Dec;167(12):905-15. doi: 10.1016/j.neurol.2011.05.010. Epub 2011 Oct 28.
Carpal tunnel syndrome (CTS) is the most common upper limb neuropathy. There has been a dramatic increase in CTS surgery since the 1990s. This study focuses on changing incidence of CTS surgery in France and associated factors.
Cases of CTS surgery were identified using the national hospital discharge database for persons living in metropolitan France. Patient characteristics, comorbidities and care management were studied using the reimbursement database of the beneficiaries covered by the general health insurance scheme (76% of the 64-million French population) comparing those with or without CTS surgery in 2008.
In 2008, hospital admissions for CTS surgery were identified in 127,269 patients aged 20 years and older, giving an overall incidence of 2.7/1000 (females 3.6/1000, males 1.7/1000) in metropolitan France. Between 1999 and 2008, the number of patients with CTS surgery increased 25%. Half of this increase was directly related to increasing demographics. For people in the 20 to 59-year age range, incidences were respectively 2.5/1000, 3.6/1000 and 1.3/1000 with high regional variations (1.1/1000-5.5/1000). Individuals aged 60 years and older accounted for 36% of the patients. Using a negative binomial regression, regional incidence variation was significantly and positively associated with the regional density of surgeons practising CTS surgery, proportion of manual workers in the population and proportion of employment in the industrial sector and negatively associated with densities of primary care physicians, rheumatologists and physiotherapists. Certain comorbidities were found to be significantly associated with CTS surgery: diabetes mellitus (Relative Risk [RR]=1.6), hypothyroidism (RR=1.3), end-stage renal disease treated with dialysis (RR=3.3), depression (RR=1.5), hereditary metabolic disease (RR=1.3), ankylosing spondylosis (RR=1.5). Interestingly, a significant negative association was found for full healthcare coverage linked with very low income (RR=0.7) and certain chronic diseases: Alzheimer's disease (RR=0.3), Parkinson's disease (RR=0.7), neuroleptic medications (RR=0.4), multiple sclerosis (RR=0.7). This could be associated with lower frequency of occupational risk factors and a lack of complaint or investigation. After surgery, 55.0% of the patients in the 18 to 59 years age range had a period of sick leave and 36.8% returned to work later than the upper limit of the recommended recovery period of 56 days. The annual cost of sick leaves was estimated at 81 million euros for the general health insurance scheme.
The number of CTS surgical procedures is increasing in France. Prevention of CTS in the workplace must be sustained and encouraged. Recommendations for sick leave periods should be followed.
腕管综合征（CTS）是最常见的上肢神经病变。自20世纪90年代以来，CTS手术数量急剧增加。本研究聚焦于法国CTS手术发生率的变化及相关因素。
利用法国本土居民的国家医院出院数据库确定CTS手术病例。通过一般健康保险计划覆盖的受益人的报销数据库（占6400万法国人口的76%），研究2008年接受或未接受CTS手术患者的特征、合并症及护理管理情况。
2008年，在法国本土确定了127269例年龄20岁及以上的CTS手术住院患者，总体发生率为2.7/1000（女性为3.6/1000，男性为1.7/1000）。1999年至2008年期间，接受CTS手术的患者数量增加了25%。其中一半的增长直接与人口统计学变化有关。对于20至59岁年龄段的人群，发生率分别为2.5/1000、3.6/1000和1.3/1000，存在较大的地区差异（1.1/1000 - 5.5/1000）。60岁及以上的个体占患者总数的36%。采用负二项回归分析，地区发生率差异与实施CTS手术的外科医生地区密度、人口中体力劳动者比例以及工业部门就业比例呈显著正相关，与初级保健医生、风湿病学家和物理治疗师的密度呈负相关。发现某些合并症与CTS手术显著相关：糖尿病（相对风险[RR]=1.6）、甲状腺功能减退（RR=1.3）、接受透析治疗的终末期肾病（RR=3.3）、抑郁症（RR=1.5）、遗传性代谢疾病（RR=1.3）、强直性脊柱炎（RR=1.5）。有趣的是，发现与极低收入相关的全面医保覆盖以及某些慢性病存在显著负相关：阿尔茨海默病（RR=0.3）、帕金森病（RR=0.7）、抗精神病药物治疗（RR=0.4）、多发性硬化症（RR=0.7）。这可能与职业风险因素频率较低以及缺乏投诉或检查有关。手术后，18至59岁年龄段的患者中有55.0%有一段病假，36.8%的患者返回工作岗位的时间晚于建议恢复期56天的上限。一般健康保险计划的病假年度成本估计为8100万欧元。
法国CTS手术数量在增加。必须持续并鼓励在工作场所预防CTS。应遵循病假期限建议。
