Tran Tuan A, Williams Lisa M, Bui Donna, Anthonisen Colleen, Poltavskiy Eduard, Szabo Robert M
Department of Orthopedics, University of California at Davis, Sacramento, CA.
Department of Physical Medicine and Rehabilitation, University of California at Davis, Sacramento, CA.
J Hand Surg Am. 2018 Feb;43(2):184.e1-184.e9. doi: 10.1016/j.jhsa.2017.08.015. Epub 2017 Sep 23.
The aims of this study were (1) to assess the utility of the Quality of Life in Neurological Disorder (Neuro-QoL) questionnaire in patients with carpal tunnel syndrome by comparing the validated patient-reported outcome (PRO) measure Neuro-QoL to the validated Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) before and following carpal tunnel release, (2) to compare the measurements of the median nerve cross-sectional area (CSA) using high-resolution ultrasound (HRUS) before and after surgery, and (3) to determine a correlation between HRUS and PRO.
Individuals diagnosed with carpal tunnel syndrome were evaluated using the CTSAQ, Neuro-QoL, and HRUS before surgery and at 3 months after surgery.
Twenty patients completed the study. Overwhelmingly, there was an improvement in symptoms and function assessed by patients on both the Neuro-QoL and the CTSAQ at 3 months after surgery. The Neuro-QoL Physical Function and Upper Extremity scores had strong correlation with the CTSAQ activity score but had low to moderate correlation with the CTSAQ symptoms score, before and after surgery. The HRUS measurements of the median nerve at the carpal tunnel inlet demonstrated a decrease in CSA whereas no noticeable changes were observed at mid tunnel and at the outlet (hook of hamate). The correlations between the ultrasound findings and PRO measures ranged from weak to strong.
Patients had resolution of symptoms and higher physical function following carpal tunnel release measured by both the CTSAQ and the Neuro-QoL scores. The Neuro-QoL self-assessment questionnaire, a measurement of quality of life, correlated well with the CTSAQ. Therefore, it could be used as a self-assessment outcomes tool in patients undergoing carpal tunnel release. At 3 months after surgery, HRUS measurements of the median nerve CSA showed a noticeable decrease of CSA only at the inlet of carpal tunnel. This objective improvement correlated with the improvement in CTSAQ and Neuro-QoL scores.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnosis II.
本研究的目的是：（1）通过比较经过验证的患者报告结局（PRO）指标神经疾病生活质量（Neuro-QoL）问卷与经过验证的腕管综合征评估问卷（CTSAQ）在腕管松解术前和术后的情况，评估Neuro-QoL问卷在腕管综合征患者中的效用；（2）比较手术前后使用高分辨率超声（HRUS）测量正中神经横截面积（CSA）；（3）确定HRUS与PRO之间的相关性。
对诊断为腕管综合征的个体在手术前和术后3个月使用CTSAQ、Neuro-QoL和HRUS进行评估。
20名患者完成了研究。总体而言，术后3个月患者在Neuro-QoL和CTSAQ上评估的症状和功能均有改善。术前和术后，Neuro-QoL身体功能和上肢评分与CTSAQ活动评分有很强的相关性，但与CTSAQ症状评分的相关性为低到中度。腕管入口处正中神经的HRUS测量显示CSA减小，而在腕管中部和出口（钩骨钩）未观察到明显变化。超声检查结果与PRO指标之间的相关性从弱到强不等。
通过CTSAQ和Neuro-QoL评分测量，患者在腕管松解术后症状得到缓解，身体功能得到提高。Neuro-QoL自我评估问卷作为一种生活质量测量工具，与CTSAQ相关性良好。因此，它可作为腕管松解术患者的自我评估结局工具。术后3个月，正中神经CSA的HRUS测量仅显示腕管入口处CSA明显减小。这一客观改善与CTSAQ和Neuro-QoL评分的改善相关。
研究类型/证据水平：诊断性研究II级。
