Evers Stefanie, Bryan Andrew J, Sanders Thomas L, Gunderson Tina, Gelfman Russell, Amadio Peter C
Rochester, Minn.; and Rotterdam, The Netherlands.
From the Departments of Orthopedic Surgery, Health Sciences Research, and Physical Medicine and Rehabilitation, Mayo Clinic; and the Departments of Plastic, Reconstructive and Hand Surgery and Rehabilitation Medicine, Erasmus University Medical Center.
Plast Reconstr Surg. 2017 Aug;140(2):338-347. doi: 10.1097/PRS.0000000000003511.
Corticosteroid injection is a recommended treatment option for carpal tunnel syndrome, before considering surgery. Nevertheless, injections remain controversial because there is strong evidence of only short-term benefits. This study aimed to determine the reintervention rate and to identify prognostic indicators for subsequent treatment after corticosteroid injection for carpal tunnel syndrome.
This study evaluated residents of Olmsted County treated with a corticosteroid injection for carpal tunnel syndrome between 2001 and 2010. Treatment failure was the primary outcome of interest. Two definitions for failure were examined: (1) the patient receiving subsequent procedural intervention and (2) the patient undergoing carpal tunnel release. Survival was estimated using Kaplan-Meier methods, and association of covariates with increased failure was modeled using Cox proportional hazards regression.
The study included 774 affected hands in 595 patients. The median follow-up period was 7.4 years. Reintervention was performed in 68 percent of cases, of which 63 percent resulted in eventual surgery. Injectate volume was significant for the outcome of any retreatment [hazard ratio, 0.879 (95 percent CI, 0.804 to 0.96)] and surgery [hazard ratio, 0.906 (95 percent CI, 0.827 to 0.99)]. Rheumatoid arthritis was also significant in both models, with a hazard ratio of 0.627 (95 percent CI, 0.404 to 0.97) for any retreatment and 0.493 (95 percent CI, 0.292 to 0.83) for surgery.
In this cohort, 32 percent of patients did not receive subsequent treatment after a single injection, which indicates that there is a therapeutic role for corticosteroid injections in treating carpal tunnel syndrome. Further research is necessary to identify those patients who will benefit from an injection, to provide more individually tailored treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
在考虑手术之前，皮质类固醇注射是腕管综合征推荐的治疗选择。然而，注射治疗仍存在争议，因为仅有强有力的证据表明其具有短期益处。本研究旨在确定再次干预率，并识别腕管综合征皮质类固醇注射后后续治疗的预后指标。
本研究评估了2001年至2010年间在奥尔姆斯特德县接受皮质类固醇注射治疗腕管综合征的居民。治疗失败是主要关注的结果。研究了两种失败的定义：（1）患者接受后续的手术干预；（2）患者接受腕管松解术。采用Kaplan-Meier方法估计生存率，并使用Cox比例风险回归模型分析协变量与失败增加之间的关联。
该研究纳入了595例患者的774只患手。中位随访期为7.4年。68%的病例进行了再次干预，其中63%最终接受了手术治疗。注射剂量对于任何再次治疗的结果[风险比，0.879（95%可信区间，0.804至0.96）]和手术[风险比，0.906（95%可信区间，0.827至0.99）]具有显著意义。类风湿关节炎在两个模型中也具有显著意义，任何再次治疗的风险比为0.627（95%可信区间，0.404至0.97），手术的风险比为0.493（95%可信区间，0.292至0.83）。
在这个队列中，32%的患者单次注射后未接受后续治疗，这表明皮质类固醇注射在治疗腕管综合征中具有治疗作用。有必要进行进一步研究以识别那些将从注射中获益的患者，从而提供更个性化的治疗。
临床问题/证据水平：风险，III级。
