Baker Nancy A, Livengood Heather M
Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA.
Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA.
J Hand Surg Am. 2014 Sep;39(9):1792-8. doi: 10.1016/j.jhsa.2014.04.034. Epub 2014 Jun 6.
To study the relationship between the severity of carpal tunnel syndrome (CTS) symptoms and surgery for CTS and the relationship between conservative treatments and surgery for CTS.
A secondary analysis of baseline to 6-month data from a randomized controlled trial, which examined the effectiveness of orthosis/stretch combinations on the symptoms of CTS, was conducted for a total of 96 participants with CTS. Participants completed the Carpal Tunnel Questionnaire and posttreatment surveys. Statistical analyses included exploration of correlates of progression to surgery for CTS and logistical regression to examine the association between conservative treatments and CTS symptoms and progression to surgery for CTS.
Twenty-one participants received surgery for their CTS, and 31 participants received 1 or more conservative treatments. Severity of baseline CTS symptoms and additional treatments were indicators of progression to surgery. The randomized controlled trial intervention was inversely associated with progression to surgery.
CTS that does not respond to an initial course of conservative treatment may not improve with additional treatments. More than half of the participants who received additional conservative treatment still progressed to surgery. Current intervention guidelines for CTS provide limited guidance as to the best methods to efficiently treat CTS.
CTS is a costly and high-burden disorder, resulting in reduced quality of life. Research should examine when and for whom conservative care is an effective choice and the association between conservative care and the eventual need for CTS surgery.
研究腕管综合征（CTS）症状的严重程度与CTS手术之间的关系，以及CTS保守治疗与手术之间的关系。
对一项随机对照试验中从基线到6个月的数据进行二次分析，该试验研究了矫形器/伸展组合对CTS症状的有效性，共有96名CTS患者参与。参与者完成了腕管问卷和治疗后调查。统计分析包括探索CTS进展至手术的相关因素，以及进行逻辑回归分析以检验保守治疗与CTS症状及CTS进展至手术之间的关联。
21名参与者接受了CTS手术，31名参与者接受了1种或更多种保守治疗。基线CTS症状的严重程度和额外治疗是进展至手术的指标。随机对照试验干预与进展至手术呈负相关。
对初始保守治疗疗程无反应的CTS，额外治疗可能无法改善。接受额外保守治疗的参与者中，超过一半仍进展至手术。当前CTS的干预指南对于有效治疗CTS的最佳方法提供的指导有限。
CTS是一种成本高昂且负担沉重的疾病，会导致生活质量下降。研究应探讨何时以及对谁而言保守治疗是一种有效的选择，以及保守治疗与CTS手术最终需求之间的关联。
