Mathen Santosh J, Nosrati Naveed N, Merrell Gregory A
The Indiana Hand to Shoulder Center, Indianapolis, Indiana, United States.
Division of Plastic Surgery, Indiana University, Indianapolis, Indiana, United States.
J Hand Microsurg. 2018 Apr;10(1):26-28. doi: 10.1055/s-0037-1618913. Epub 2018 Mar 20.
In many procedures, both high case volumes and fellowship training have been shown to improve outcomes. One of the most common procedures performed by hand surgeons, the carpal tunnel release (CTR) is also performed by several other specialties without specialty training in a hand fellowship. This study analyzed the effect that hand fellowship training has on outcomes of CTRs.
Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates' case list submissions, a database was created for all open and endoscopic CTRs. Surgeon training, demographics, technique, and complications were recorded. Complications were then categorized and broken down by technique. Results were then analyzed for statistical significance.
A total of 29,916 cases were identified. Hand fellowship-trained surgeons performed six times more CTRs at 31 cases per surgeon compared with five for non-hand fellowship-trained surgeons. They also improved outcomes in rates of infection, wound dehiscence, and overall complications. Rates of nerve injury or recurrence showed no statistical difference. This held true for the open release subset. Endoscopically, fellowship-trained surgeons had only improved rates of overall complications.
Surgeons undergoing additional hand fellowship training may show improved outcomes in the surgical treatment of carpal tunnel syndrome. However, no effect was seen on nerve injury or recurrence of symptoms.
在许多手术中，高手术量和专科培训都已被证明能改善手术效果。腕管松解术（CTR）是手外科医生最常进行的手术之一，其他几个专科在未接受手外科专科培训的情况下也会进行该手术。本研究分析了手外科专科培训对腕管松解术手术效果的影响。
利用美国骨科医师委员会（ABOS）第二部分考生的病例清单提交信息，创建了一个关于所有开放性和内镜下腕管松解术的数据库。记录了外科医生的培训情况、人口统计学信息、手术技术和并发症。然后对并发症进行分类，并按手术技术进行细分。接着分析结果的统计学意义。
共识别出29916例病例。接受手外科专科培训的外科医生每人进行31例腕管松解术，是未接受手外科专科培训的外科医生（每人5例）的6倍。他们还降低了感染、伤口裂开和总体并发症的发生率。神经损伤或复发率无统计学差异。开放手术组也是如此。在内镜手术方面，接受专科培训的外科医生仅降低了总体并发症的发生率。
接受额外手外科专科培训的外科医生在腕管综合征的手术治疗中可能会有更好的手术效果。然而，在神经损伤或症状复发方面未观察到影响。
