Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107.
Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA.
AJR Am J Roentgenol. 2021 Aug;217(2):460-468. doi: 10.2214/AJR.20.24383. Epub 2020 Sep 2.
Ultrasound guidance allows performance of carpal tunnel release with smaller incisions and quicker recovery than traditional open or endoscopic surgery. The purpose of this study was to evaluate the long-term effectiveness of ultrasound-guided carpal tunnel release in improving function and discomfort in patients with carpal tunnel syndrome. Retrospective review was conducted of 61 ultrasound-guided carpal tunnel release procedures performed on 46 patients (15 bilateral procedures) with clinically diagnosed carpal tunnel syndrome. The procedures were performed with a single-use transection device and local anesthesia at an outpatient radiology office. Patients answered three questionnaires (Quick Disabilities of the Arm, Shoulder, and Hand [QDASH] and two parts of the Boston Carpal Tunnel Syndrome Questionnaire-the symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS] scales) to assess the function of and discomfort in the affected wrist immediately before and 2 weeks and at least 1 year after the procedure. Higher scores indicated increasing disability. Patients also answered a global satisfaction question at follow-up. Preprocedure and postprocedure scores were compared by paired Wilcoxon signed rank tests. The 46 patients (25 women, 21 men; mean age, 60.6 years; range, 21-80 years) had median preprocedure scores of 45.4 for QDASH, 3.2 for BCTSQ-SS, and 2.5 for BCTSQ-FS. The median scores 2 weeks after the procedure were 22.5 for QDASH, 1.7 for BCTSQ-SS, and 1.9 for BCTSQ-FS. All scores decreased ( < .001) from preprocedure scores and surpassed reference standards for clinically important difference in scores. Follow-up questionnaires obtained for 90% (55/61) of wrists a median of 1.7 years (range, 1.0-2.8 years) after the procedure showed further declines ( < .001) in median scores: 2.3 for QDASH, 1.2 for BCTSQ-SS, and 1.1 for BCTSQ-FS. At long-term follow-up evaluation, 96% (52/54) of wrists had lower QDASH and 98% (53/54) had lower BCTSQ (average of BCTSQ-SS and BCTSQ-FS) scores compared with the preprocedure scores. Among the patients who participated in the survey, 93% (37/40) were satisfied or very satisfied with the long-term outcomes. No immediately postoperative complications occurred. Two patients needed surgical intervention 8 and 10 days after surgery, one for infection after injury and one for posttraumatic compartment syndrome. Ultrasound-guided carpal tunnel release quickly improves hand function and reduces hand discomfort; improvement persists beyond 1 year. Ultrasound-guided carpal tunnel release may be a safe, effective, and less invasive alternative to traditional surgery.
超声引导下腕管松解术与传统的开放式或内镜手术相比，可以通过更小的切口和更快的恢复来实现。本研究旨在评估超声引导下腕管松解术在改善腕管综合征患者手部功能和不适方面的长期效果。
对 46 例（15 例双侧手术）临床诊断为腕管综合征的患者进行了 61 例超声引导下腕管松解术的回顾性研究。在门诊放射科使用一次性切割装置和局部麻醉进行手术。患者在术前、术后 2 周和至少 1 年后回答了三个问卷（快速残疾手臂、肩部和手问卷 [QDASH] 和波士顿腕管综合征问卷的两个部分-症状严重程度 [BCTSQ-SS] 和功能状态 [BCTSQ-FS] 量表），以评估受影响手腕的功能和不适。得分越高表示残疾程度越高。患者还在随访时回答了一个总体满意度问题。通过配对 Wilcoxon 符号秩检验比较术前和术后评分。
46 例患者（25 例女性，21 例男性；平均年龄 60.6 岁；范围 21-80 岁）术前 QDASH 评分为 45.4，BCTSQ-SS 评分为 3.2，BCTSQ-FS 评分为 2.5。术后 2 周时的中位数评分分别为 22.5、1.7 和 1.9。所有评分均较术前（<0.001）下降，并超过了评分临床重要差异的参考标准。在术后中位数 1.7 年（范围 1.0-2.8 年）时获得了 90%（55/61）手腕的随访问卷，进一步下降（<0.001）中位数评分：QDASH 为 2.3，BCTSQ-SS 为 1.2，BCTSQ-FS 为 1.1。在长期随访评估中，与术前评分相比，54 个手腕中有 96%（52/54）的 QDASH 评分和 98%（53/54）的 BCTSQ（BCTSQ-SS 和 BCTSQ-FS 的平均值）评分较低。在参加调查的患者中，93%（37/40）对长期结果满意或非常满意。术后无立即发生并发症。两名患者分别在术后 8 天和 10 天需要手术干预，一名是因受伤后感染，另一名是创伤后筋膜间室综合征。
超声引导下腕管松解术可迅速改善手部功能，减轻手部不适；改善持续超过 1 年。超声引导下腕管松解术可能是传统手术的一种安全、有效、创伤较小的替代方法。
