Rivlin Michael, Kachooei Amir R, Wang Mark L, Ilyas Asif M
Department of Hand and Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
Department of Hand and Wrist Surgery, Rothman Institute, Bryn Mawr, PA.
J Hand Surg Am. 2018 May;43(5):425-431. doi: 10.1016/j.jhsa.2017.12.002. Epub 2018 Feb 1.
The value of electrodiagnostic (EDX) study grades as a prognostic indicator of clinical results after carpal tunnel release (CTR) remains controversial. In this study, we tested the primary null hypothesis that symptom relief after CTR would not differ based on EDX grade. Secondarily, we evaluated the degree of symptomatic and functional postoperative improvement relative to preoperative EDX grade.
We prospectively evaluated 199 consecutive patients with 256 hands after CTR confirmed with EDX. Data were collected before surgery and patients were observed at 2 weeks and 3 months after surgery. There were 20 hands with mild, 126 with moderate, and 110 with severe involvement in the preoperative EDX. Demographic, EDX grade (mild, moderate, or severe); surgical parameters; Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire; symptom severity scale, functional status scale, pain catastrophizing scale, and visual analog scale data were collected and analyzed.
There was significant improvement in Quick-Disabilities of the Arm, Shoulder, and Hand, symptom severity scale, and functional status scale scores from the preoperative to 2-week and 3-month postoperative visits in all categories of EDX grade. There was no significant difference in the extent of recovery by the 2-week and 3-month visits relative to EDX grade. Catastrophic thinking did not have a significant effect on any of the 3 groups. Pain decreased dramatically at 2 weeks after surgery but there was no additional significant difference in visual analog scale scores between the 2-week and 3-month postoperative visits. Postoperative pain improvement occurred regardless of EDX grade. There were no major complications or reoperations in any group.
Carpal tunnel release demonstrated consistently significant improvement in outcomes regardless of EDX grade at initial and final follow-up. The extent of postoperative improvement after CTR overall was also not statistically different between groups with differing EDX severity. Older patients with severe CTS achieved more modest gains.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
电诊断（EDX）研究分级作为腕管松解术（CTR）后临床结果的预后指标，其价值仍存在争议。在本研究中，我们检验了主要无效假设，即CTR术后症状缓解情况不会因EDX分级而有所不同。其次，我们评估了术后症状和功能改善程度与术前EDX分级的相关性。
我们对199例连续接受CTR且经EDX确诊的患者的256只手进行了前瞻性评估。在手术前收集数据，并在术后2周和3个月对患者进行观察。术前EDX显示轻度受累的手有20只，中度受累的有126只，重度受累的有110只。收集并分析了人口统计学资料、EDX分级（轻度、中度或重度）、手术参数、手臂、肩部和手部快速残疾问卷、症状严重程度量表、功能状态量表、疼痛灾难化量表和视觉模拟量表数据。
在所有EDX分级类别中，从术前到术后2周和3个月随访时，手臂、肩部和手部快速残疾问卷、症状严重程度量表和功能状态量表评分均有显著改善。相对于EDX分级，术后2周和3个月随访时的恢复程度没有显著差异。灾难化思维对这3组中的任何一组均无显著影响。术后2周疼痛显著减轻，但术后2周和3个月随访时视觉模拟量表评分没有额外的显著差异。无论EDX分级如何，术后疼痛均有改善。任何一组均未出现重大并发症或再次手术。
无论初始和最终随访时的EDX分级如何，腕管松解术均显示出结果持续显著改善。不同EDX严重程度组之间，CTR术后总体改善程度在统计学上也没有差异。老年重度腕管综合征患者的改善程度较小。
研究类型/证据水平：预后性研究II级
