Logli Anthony L, Bear Brian J, Schwartz Edric G, Korcek Kenneth J, Foster Brian J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Hand, Wrist & Elbow Service, OrthoIllinois, Inc., Rockford, IL; University of Illinois, College of Medicine at Rockford, Rockford, IL.
J Hand Surg Am. 2018 Aug;43(8):775.e1-775.e8. doi: 10.1016/j.jhsa.2018.01.016. Epub 2018 Feb 24.
To determine if any significant differences exist in patient-reported or clinical outcomes among 3 different postoperative orthotic regimens: no orthosis, removable orthosis, and plaster nonremovable orthosis-following miniopen carpal tunnel release (CTR) surgery for symptomatic isolated carpal tunnel syndrome.
A total of 249 patients received a miniopen CTR and were subsequently randomized into 1 of 3 orthotic regimens: 80, no orthosis; 83, removable orthosis; and 86, nonremovable orthosis-to be removed at the first postoperative visit 10 to 14 days later. Patient-reported outcomes included the quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) surveys, Levine-Katz Symptom Severity and Functional Status Scales, and Pain at Rest and in Action using the Numerical Pain Rating Scale. Clinical outcomes included wrist range of motion, grip, and lateral pinch strengths. All outcomes were evaluated bilaterally at 10 to 14 days, 6 weeks, and 3, 6, and 12 months after surgery by evaluators blinded to the assigned regimen. Demographic information was obtained before surgery, and complications were recorded throughout the study.
There were no statistically significant differences in any patient-reported or clinical outcomes at any follow-up period except at 6 and 12 months: the lateral pinch strength of the nonremovable orthosis group with CTR in the dominant hand was weaker than both of the other groups. Patient demographic characteristics did not significantly influence the outcomes at any time. Scar tenderness was the most commonly observed complication followed by stiffness. There were 2 cases each of complex regional pain syndrome and superficial wound dehiscence and 1 case of wound infection that resolved with oral antibiotics.
The postoperative orthotic regimen does not change any patient-reported outcome up to at least 12 months following miniopen CTR. Lateral pinch strength was weaker in the nonremovable orthosis group at 6 and 12 months. Our data do not support the use of any postoperative orthosis following routine miniopen CTR.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
确定在症状性孤立性腕管综合征的小切口腕管松解术（CTR）后，三种不同的术后矫形方案（无矫形器、可摘除矫形器和不可摘除石膏矫形器）在患者报告结局或临床结局方面是否存在显著差异。
共有249例患者接受了小切口CTR手术，随后被随机分为三种矫形方案之一：80例不使用矫形器；83例使用可摘除矫形器；86例使用不可摘除矫形器，在术后10至14天的首次随访时拆除。患者报告结局包括手臂、肩部和手部功能障碍快速评估问卷（QuickDASH）、莱文-卡茨症状严重程度和功能状态量表，以及使用数字疼痛评分量表评估的静息和活动时疼痛。临床结局包括腕关节活动范围、握力和侧捏力。所有结局均由对分配方案不知情的评估人员在术后10至14天、6周以及3、6和12个月时进行双侧评估。术前获取人口统计学信息，并在整个研究过程中记录并发症。
除6个月和12个月时外，在任何随访期，患者报告结局或临床结局均无统计学显著差异：不可摘除矫形器组优势手行CTR后的侧捏力弱于其他两组。患者人口统计学特征在任何时候均未对结局产生显著影响。瘢痕压痛是最常见的并发症，其次是僵硬。复杂性区域疼痛综合征和浅表伤口裂开各有2例，伤口感染1例，经口服抗生素治疗后痊愈。
小切口CTR术后至少12个月内，术后矫形方案不会改变任何患者报告结局。不可摘除矫形器组在6个月和12个月时侧捏力较弱。我们的数据不支持在常规小切口CTR术后使用任何术后矫形器。
研究类型/证据水平：治疗性I级。
