Beck John D, Brothers Justin G, Maloney Patrick J, Deegan John H, Tang Xiaoqin, Klena Joel C
Department of Orthopaedics, Geisinger Medical Center, Danville, PA, USA.
J Hand Surg Am. 2012 Feb;37(2):282-7. doi: 10.1016/j.jhsa.2011.10.040. Epub 2011 Dec 20.
To test the hypothesis that the result of steroid injection in the carpal tunnel in a patient with recurrent carpal tunnel symptoms would serve as a good predictor of the outcome of later carpal tunnel release (CTR).
We conducted a retrospective review of all patients who underwent revision CTR for recurrent or persistent carpal tunnel syndrome over a 2-year period at our institution. A total of 28 wrists in 23 patients met inclusion criteria. We evaluated patients to determine whether preoperative factors or the result of injection predicted the outcome of revision CTR. We used a multivariate logistic regression analysis to predict surgical success when multiple preoperative findings were considered.
Of the 23 wrists that had relief from injection, 20 had symptom improvement with surgery. Although they did not reach statistical significance, the sensitivity and positive predictive value for injection alone predicted outcome of revision CTR in 87%. No patient characteristic or physical examination finding predicted successful revision CTR. Multivariate logistic regression analysis combining preoperative injection results with physical examination findings (numbness and/or motor weakness in median nerve distribution, positive Durkin test, and positive Phalen test) provided a sensitivity of 100% and a specificity of 80%.
In a small group of patients with recurrent carpal tunnel syndrome, cortisone injection into the carpal tunnel was not, by itself, a statistically significant predictor of successful revision surgery. However, relief from injection as a diagnostic test for predicting successful revision CTR was found to have both a high sensitivity and a positive predictive value. Coupled with the components of the physical examination, injection provides a good screening test to establish surgical success with revision CTR.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
检验如下假设，即对于有复发性腕管综合征症状的患者，腕管内注射类固醇的结果可作为后续腕管松解术（CTR）疗效的良好预测指标。
我们对在我院2年期间因复发性或持续性腕管综合征接受翻修CTR的所有患者进行了回顾性研究。23例患者共28侧腕关节符合纳入标准。我们评估患者以确定术前因素或注射结果是否能预测翻修CTR的疗效。当考虑多个术前发现时，我们使用多因素逻辑回归分析来预测手术成功率。
在23侧注射后症状缓解的腕关节中，20侧在手术后症状改善。尽管未达到统计学意义，但单独注射的敏感性和阳性预测值对翻修CTR疗效的预测率为87%。没有患者特征或体格检查发现可预测翻修CTR成功。将术前注射结果与体格检查发现（正中神经分布区麻木和/或运动无力、Durkin试验阳性和Phalen试验阳性）相结合的多因素逻辑回归分析的敏感性为100%，特异性为80%。
在一小群复发性腕管综合征患者中，腕管内注射可的松本身并非翻修手术成功的统计学显著预测指标。然而，发现注射缓解作为预测翻修CTR成功的诊断试验具有高敏感性和阳性预测值。结合体格检查的各项指标，注射可提供一项良好的筛查试验，以确定翻修CTR手术的成功。
研究类型/证据水平：治疗性III级。
