Özkan Sezai, Mudgal Chaitanya S, Evans Brady T, Watkins Colyn J, Heng Marilyn M, Bloemers Frank W
Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Trauma Surgery, VU University Medical Center, VU University, Amsterdam, The Netherlands.
J Wrist Surg. 2019 Oct;8(5):366-373. doi: 10.1055/s-0039-1685203. Epub 2019 Apr 22.
A lack of conclusive evidence on the treatment of acute median neuropathy (AMN) in patients with distal radius fractures has led to inconsistent surgical guidelines and recommendations regarding AMN in distal radius fractures. There is a wide variation in surgical decision-making. We aimed to evaluate international differences between surgical considerations and practices related to carpal tunnel release (CTR) in the setting of distal radius fractures. We approached surgeons who were a member of the Orthopaedic Trauma Association (United States) or of the Dutch Trauma Society (the Netherlands) and asked them to provide sociodemographic information and information on their surgical practice regarding CTR in the setting of distal radius fractures. After applying our exclusion criteria, our final cohort consisted of 127 respondents. Compared with Dutch surgeons, surgeons from the United States are more of the opinion that displaced distal radius fractures are at risk of developing acute carpal tunnel syndrome (ACTS), consider persistent paresthesia in the median nerve distribution after closed reduction to be a surgical emergency less often, and are more likely to perform a CTR if there are signs of ACTS in the setting of a distal radius fracture. A lack of conclusive evidence has led to international differences in surgical practice regarding the treatment of ACTS in the setting of distal radius fractures. Future research should guide surgeons in making appropriate evidence-based decisions when performing CTR in the setting of distal radius fractures. This is a Level V study.
关于桡骨远端骨折患者急性正中神经病变（AMN）治疗的确凿证据不足，导致了关于桡骨远端骨折中AMN的手术指南和建议不一致。手术决策存在很大差异。我们旨在评估在桡骨远端骨折情况下，腕管松解术（CTR）相关的手术考虑因素和实践的国际差异。
我们联系了美国骨科创伤协会或荷兰创伤协会的外科医生，要求他们提供社会人口学信息以及他们在桡骨远端骨折情况下进行CTR的手术实践信息。在应用我们的排除标准后，我们的最终队列由127名受访者组成。
与荷兰外科医生相比，美国外科医生更倾向于认为移位的桡骨远端骨折有发生急性腕管综合征（ACTS）的风险，较少将闭合复位后正中神经分布区域的持续感觉异常视为手术急症，并且在桡骨远端骨折伴有ACTS迹象时更有可能进行CTR。
确凿证据的缺乏导致了在桡骨远端骨折情况下治疗ACTS的手术实践存在国际差异。未来的研究应该指导外科医生在桡骨远端骨折情况下进行CTR时做出适当的基于证据的决策。
这是一项V级研究。
