Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, USA.
BMC Musculoskelet Disord. 2014 Jan 8;15:4. doi: 10.1186/1471-2474-15-4.
Musculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery. The objective of our study was to assess the overall and age-adjusted utilization rates of rotator cuff repair, shoulder arthroscopy performed for indications other than rotator cuff repair, carpal tunnel release, and wrist arthroscopy performed for indications other than carpal tunnel release in the United States. We also compared demographics, indications, and operating room time for these procedures.
We used the 2006 National Survey of Ambulatory Surgery to estimate the number of procedures of interest performed in the United States in 2006. We combined these data with population size estimates from the 2006 U.S. Census Bureau to calculate rates per 10,000 persons.
An estimated 272,148 (95% confidence intervals (CI) = 218,994, 325,302) rotator cuff repairs, 257,541 (95% CI = 185,268, 329,814) shoulder arthroscopies excluding those for cuff repairs, 576,924 (95% CI = 459,239, 694,609) carpal tunnel releases, and 25,250 (95% CI = 17,304, 33,196) wrist arthroscopies excluding those for carpal tunnel release were performed. Overall, carpal tunnel release had the highest utilization rate (37.3 per 10,000 persons in persons of age 45-64 years; 38.7 per 10,000 persons in 65-74 year olds, and; 44.2 per 10,000 persons in the age-group 75 years and older). Among those undergoing rotator cuff repairs, those in the age-group 65-74 had the highest utilization (28.3 per 10,000 persons). The most common indications for non-cuff repair related shoulder arthroscopy were impingement syndrome, periarthritis, bursitis, and instability/SLAP tears. Non-carpal tunnel release related wrist arthroscopy was most commonly performed for ligament sprains and diagnostic arthroscopies for pain and articular cartilage disorders.
Our data shows substantial age and demographic differences in the utilization of these commonly performed upper extremity ambulatory procedures. While over one million upper extremity procedures of interest were performed, evidence-based clinical indications for these procedures remain poorly defined.
上肢肌肉骨骼疾病是患者寻求治疗和接受门诊手术的常见原因。我们研究的目的是评估美国肩袖修复、肩袖修复以外的其他适应证关节镜检查、腕管松解和腕管松解以外的其他适应证腕关节镜检查的总体和年龄调整利用率。我们还比较了这些手术的人口统计学、适应证和手术室时间。
我们使用 2006 年国家门诊手术调查来估计 2006 年在美国进行的感兴趣手术的数量。我们将这些数据与 2006 年美国人口普查局的人口规模估计值相结合，以计算每 10000 人发病率。
估计有 272148 例（95%置信区间（CI）=218994，325302）肩袖修复术、257541 例（95%CI=185268，329814）肩袖修复术以外的关节镜检查、576924 例（95%CI=459239，694609）腕管松解术和 25250 例（95%CI=17304，33196）腕管松解术以外的腕关节镜检查。总体而言，腕管松解术的利用率最高（45-64 岁人群中每 10000 人 37.3 例；65-74 岁人群中每 10000 人 38.7 例；75 岁及以上人群中每 10000 人 44.2 例）。在接受肩袖修复的患者中，65-74 岁年龄组的利用率最高（每 10000 人 28.3 例）。非肩袖修复相关肩关节镜检查最常见的适应证为撞击综合征、肩周炎、滑囊炎和不稳定/ SLAP 撕裂。非腕管松解相关腕关节镜检查最常因韧带扭伤和疼痛和关节软骨疾病的诊断性关节镜检查而进行。
我们的数据显示，这些常见的上肢门诊手术的利用率存在显著的年龄和人口统计学差异。虽然进行了超过 100 万例上肢手术，但这些手术的循证临床适应证仍未得到明确界定。
