正中神经电生理严重程度与腕管综合征治疗建议的相关性。
The Association Between Electrodiagnostic Severity and Treatment Recommendations for Carpal Tunnel Syndrome.
机构信息
Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Chicago Medical School, Rosalind Franklin University of Medicine and Science.
出版信息
J Hand Surg Am. 2021 Feb;46(2):92-98. doi: 10.1016/j.jhsa.2020.08.020. Epub 2020 Oct 31.
PURPOSE
Our study aimed to evaluate the relationship between electrodiagnostic study (EDS) severity and utilization of treatments for carpal tunnel syndrome (CTS) as well as the duration of time between EDS and carpal tunnel release (CTR).
METHODS
We conducted a retrospective medical chart review at a single tertiary hand center to evaluate CTS-related care that patients received after EDS. We recorded patient age, sex, race/ethnicity, insurance type, CTS-related surgical and nonsurgical healthcare utilization after EDS testing, and number of days between EDS and CTR.
RESULTS
Among all patients with an eventual diagnosis of CTS who received EDS (n = 210), nearly half had normal or mild severity (23%, n = 48; and 28%, n = 58, respectively) and the other half had moderate or severe EDS findings (26%, n = 55; and 23%, n = 49, respectively). Patients with severe findings had the highest rate of receiving surgery (53%) compared with patients with mild and moderate findings (33% vs 46%, respectively). Among the patients who received CTR (n = 73), patients with severe EDS findings had the shortest time to CTR (59.5 days; interquartile range [IQR], 30-81), compared with mild severity (170 days; IQR, 87-415) and moderate severity (77 day; IQR, 42-292). Moderate and severe EDS findings were associated with significantly higher odds of receiving CTR in adjusted analyses (odds ratio, 2.48, 95% confidence interval, 1.04-5.93 and odds ratio 3.79, 95% confidence interval, 1.51-9.50, respectively) compared with patients with mild EDS findings. However, the odds of receiving steroid injection and hand therapy/orthosis were not significantly different based on severity.
CONCLUSIONS
Electrodiagnostic study severity had a direct relationship to the probability of receiving surgery but did not correlate with use of nonsurgical treatment. The study findings signal a need to evaluate the value of nonsurgical treatments in patients with severe EDS findings.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
目的
本研究旨在评估电诊断研究（EDS）严重程度与腕管综合征（CTS）治疗方法的使用之间的关系，以及 EDS 与腕管松解术（CTR）之间的时间间隔。
方法
我们在一家三级手科中心进行了回顾性病历审查，以评估 EDS 后患者接受的 CTS 相关治疗。我们记录了患者的年龄、性别、种族/民族、保险类型、EDS 检测后的 CTS 相关手术和非手术医疗保健利用情况，以及 EDS 与 CTR 之间的天数。
结果
在所有最终诊断为 CTS 并接受 EDS 的患者中（n=210），近一半患者的 EDS 严重程度为正常或轻度（分别为 23%，n=48；和 28%，n=58），另一半患者的 EDS 严重程度为中度或重度（分别为 26%，n=55；和 23%，n=49）。与轻度和中度 EDS 发现的患者相比，严重 EDS 发现的患者接受手术的比例最高（53%）。在接受 CTR 的患者中（n=73），严重 EDS 发现的患者接受 CTR 的时间最短（59.5 天；四分位间距[IQR]，30-81），与轻度严重程度（170 天；IQR，87-415）和中度严重程度（77 天；IQR，42-292）相比。在调整后的分析中，中度和重度 EDS 发现与接受 CTR 的几率显著相关（优势比，2.48；95%置信区间，1.04-5.93 和优势比，3.79；95%置信区间，1.51-9.50），与轻度 EDS 发现的患者相比。然而，根据严重程度，接受皮质类固醇注射和手部治疗/矫形器的几率并无显著差异。
结论
EDS 严重程度与手术的可能性直接相关，但与非手术治疗方法无关。研究结果表明，需要评估严重 EDS 发现患者的非手术治疗价值。
研究类型/证据水平：预后 II 级。
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