Grandizio Louis C, Beck John D, Rutter Michael R, Graham Jove, Klena Joel C
Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
J Hand Surg Am. 2014 Feb;39(2):280-5. doi: 10.1016/j.jhsa.2013.10.023. Epub 2013 Dec 20.
To determine whether patients with diabetes mellitus (DM) are at greater risk for developing postoperative trigger digits (TD) after carpal tunnel release (CTR) compared with patients without diabetes.
A retrospective review of our electronic medical records identified all patients who had undergone CTR by a single hand fellowship-trained surgeon from September 2007 through May 2012. For patients with DM, additional information regarding method of disease control and hemoglobin A1c (HbA1c) level was recorded. We recorded HbA1c levels 3 months before and 3 months after CTR. The location and time to development of postoperative, new-onset TD were recorded for each case. Statistical testing included chi-square or Student t test and multivariate logistic regression analysis.
Of the 1,217 CTRs, 214 had DM. Of the 1,003 CTRs in cases without DM, 3% developed TD within 6 months of CTR and 4% within 1 year of CTR, compared with 8% and 10%, respectively, for diabetic cases. A multivariate regression analysis revealed DM as a significant risk factor for developing TD after CTR at 6 and 12 months. We found no significant association between HbA1c level at the time of CTR and the likelihood of developing TD.
The incidence of TD after CTR was higher in the diabetic population compared with a nondiabetic cohort. The presence of DM rather than its severity was the most important factor for developing TD. Preoperative counseling for patients with DM undergoing CTR may alert them to the possibility of developing TD.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
确定与非糖尿病患者相比，糖尿病（DM）患者在腕管松解术（CTR）后发生术后扳机指（TD）的风险是否更高。
对我们的电子病历进行回顾性分析，确定了2007年9月至2012年5月间由一位接受过单手专科培训的外科医生进行CTR手术的所有患者。对于糖尿病患者，记录了有关疾病控制方法和糖化血红蛋白（HbA1c）水平的额外信息。我们记录了CTR术前3个月和术后3个月的HbA1c水平。记录每例患者术后新发TD的位置和发生时间。统计检验包括卡方检验或学生t检验以及多因素逻辑回归分析。
在1217例CTR手术中，214例患有DM。在非糖尿病患者的1003例CTR手术中，3%在CTR后6个月内发生TD，4%在CTR后1年内发生TD，而糖尿病患者分别为8%和10%。多因素回归分析显示，DM是CTR后6个月和12个月发生TD的显著危险因素。我们发现CTR时的HbA1c水平与发生TD的可能性之间无显著相关性。
与非糖尿病队列相比，糖尿病患者CTR术后TD的发生率更高。DM的存在而非其严重程度是发生TD的最重要因素。对接受CTR手术的糖尿病患者进行术前咨询可能会使他们警惕发生TD的可能性。
研究类型/证据水平：预后性IV级。
