Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.
Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences.
Clin Interv Aging. 2018 Jan 18;13:117-124. doi: 10.2147/CIA.S151290. eCollection 2018.
Carpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS.
We conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I-III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment.
In total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III.
Hydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation.
腕管综合征（CTS）在老年人群中较为常见，部分原因是易患合并症的存在增加以及生理变化。我们旨在比较超声引导下水分离法治疗老年 CTS 患者不同剂量类固醇的疗效。
我们对老年 CTS 患者进行了一项前瞻性、三盲、随机、对照试验。患者通过简化随机化分配到三组之一。组 I-III 分别接受 80mg 曲安奈德（2mL）和 1mL2%利多卡因、40mg 曲安奈德（1mL）、1mL2%利多卡因和 1mL 生理盐水，以及 1mL 生理盐水和 2mL 生理盐水，总容量为 3mL。然后应用腕夹板进行支撑。主要观察指标包括视觉模拟评分（VAS）和波士顿腕管问卷，以及正中神经和尺神经运动和感觉神经传导的中位数及其超声入口横截面积作为客观指标。所有数据均在基线和注射后 2、12 和 24 周记录。研究者、患者和统计学家对治疗分配均不知情。
共招募了 161 名患者，三组之间在人口统计学方面无统计学差异。除了中位运动神经远端潜伏期在所有三个随访时间点均大于组 II，以及组 I 和组 III 的基线 VAS 差异有统计学意义外，各组之间的任何结果均无统计学差异。
在这项研究中，与低剂量和高剂量类固醇药物相比，水分离联合利多卡因和生理盐水在老年 CTS 患者中同样有效，但建议进行匹配基线测量和假手术组的进一步研究，以得出明确的推荐。
