Pace Gregory I, Zale Connor L, Gendelberg David, Taylor Kenneth F
1 Penn State Hershey Medical Center, Department of Orthopaedics and Rehabilitation, Hershey, PA, USA.
Hand (N Y). 2018 May;13(3):292-295. doi: 10.1177/1558944717701243. Epub 2017 Mar 27.
Carpal tunnel surgery is the most common surgical procedure performed on the hand. Although complications are rare, recurrent or persistent carpal tunnel syndrome can be a significant problem after primary decompression. Various procedures have been described for the treatment of these patients including repeat decompression and hypothenar fat pad transposition. The purpose of this study is to compare the outcomes of patients undergoing revision carpal tunnel decompression with and without hypothenar fat pad transposition.
We performed a retrospective review of all patients undergoing revision carpal tunnel surgery at our institution between 2002 and 2014. Identified patients were contacted by telephone. A Boston Carpal Tunnel Questionnaire (BCTQ) was administered to all participants.
Seventy-six patients underwent revision carpal tunnel surgery over the study period. Twenty-nine of 45 potential participants provided a survey response (64.9%) representing a total of 33 carpal tunnel revision surgeries. Seventeen hands underwent repeat decompression alone, and 16 hands underwent repeat decompression with hypothenar fat pad transposition. A trend toward improved overall BCTQ score was noted for patients undergoing decompression alone; however, no significant difference was determined for total survey score by procedure type. Similarly, total symptom severity and functional scores were not statistically significant between groups; however, a trend toward significance for improved symptom severity score was observed in patients undergoing decompression alone.
Our results reveal no difference in self-reported symptom severity and functional scores between patients undergoing revision carpal tunnel surgery with repeat decompression alone or decompression with fat pad transposition.
腕管手术是手部最常见的外科手术。尽管并发症很少见，但复发性或持续性腕管综合征在初次减压后可能是一个严重问题。已经描述了各种治疗这些患者的手术方法，包括再次减压和小鱼际脂肪垫移位术。本研究的目的是比较接受再次腕管减压且有或没有小鱼际脂肪垫移位术的患者的治疗效果。
我们对2002年至2014年间在本机构接受再次腕管手术的所有患者进行了回顾性研究。通过电话联系已确定的患者。对所有参与者进行了波士顿腕管问卷（BCTQ）调查。
在研究期间，76例患者接受了再次腕管手术。45名潜在参与者中有29名提供了调查回复（64.9%），共代表33例腕管翻修手术。17只手仅接受了再次减压，16只手接受了再次减压并进行了小鱼际脂肪垫移位术。单独接受减压的患者总体BCTQ评分有改善的趋势；然而，按手术类型划分的总调查评分没有显著差异。同样，两组之间的总症状严重程度和功能评分在统计学上没有显著差异；然而，单独接受减压的患者在症状严重程度评分改善方面有显著趋势。
我们的结果显示，单独接受再次减压或减压并进行脂肪垫移位术的再次腕管手术患者在自我报告的症状严重程度和功能评分方面没有差异。
