Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR; Operative Care Division, Portland VA Medical Center, Portland, OR.
J Hand Surg Am. 2022 Jun;47(6):517-525.e4. doi: 10.1016/j.jhsa.2022.01.022. Epub 2022 Mar 26.
Tenosynovial biopsy during carpal tunnel release (CTR) leads to an earlier diagnosis of amyloidosis. Surgery for trigger digit-trigger release (TR)-may provide a similar opportunity. We sought to characterize the risk of amyloidosis diagnosis after TR and/or CTR.
We conducted a retrospective cohort study of adults without diagnosed amyloidosis undergoing TR and/or CTR in the Veterans Health Administration from 1999 to 2019, including matched controls. We used competing-risks methodology to estimate the cumulative incidence and adjusted subdistribution hazard ratios (sHRs) of amyloidosis, heart failure, and death after TR and/or CTR.
Among the 126,788 patients undergoing TR and/or CTR, amyloidosis was diagnosed in 52 of 26,757 patients undergoing TR alone at a median of 4.7 years after surgery (10-year cumulative incidence: 0.26%, 95% CI: 0.18% to 0.34%), 396 of 91,384 patients undergoing CTR alone at a median of 5.1 years after surgery (10-year cumulative incidence: 0.60%, 95% CI: 0.53% to 0.67%), 50 of 8,647 patients undergoing both TR and CTR at a median of 3.1 years after surgery (10-year cumulative incidence: 0.80%, 95% CI: 0.54% to 1.1%), and 54 of 113,452 controls at a median of 5.0 years after the index date (10-year cumulative incidence 0.053%, 95% CI: 0.037% to 0.070%). In the adjusted analysis, patients who underwent TR and/or CTR had a higher risk of amyloidosis (TR: sHR 4.80, 95% CI: 3.33-6.92; CTR: sHR 10.2, 95% CI: 7.74-13.6; TR and CTR: sHR 14.9, 95% CI: 9.87-22.5) and heart failure (TR: sHR 1.91, 95% CI: 1.83-1.99; CTR: sHR 2.02, 95% CI: 1.97-2.07; TR and CTR: sHR 2.18, 95% CI: 2.04-2.33) but not death compared with the controls. Among the patients who underwent TR, age, Black race, prior CTR, heart failure, and the number of digits released were independent risk factors for amyloidosis.
Patients undergoing TR and/or CTR are at increased risk of incident amyloidosis and heart failure compared to controls.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
腕管松解术中的滑膜活检可更早诊断淀粉样变性。扳机指松解术（TR）手术也可能提供类似的机会。我们旨在描述 TR 和/或 CTR 后诊断淀粉样变性的风险。
我们对退伍军人事务部 1999 年至 2019 年间接受 TR 和/或 CTR 的无淀粉样变性诊断的成年人进行了回顾性队列研究，包括匹配对照。我们使用竞争风险方法来估计 TR 和/或 CTR 后淀粉样变性、心力衰竭和死亡的累积发生率和调整后的亚分布风险比（sHR）。
在接受 TR 和/或 CTR 的 126788 名患者中，在单独接受 TR 的 26757 名患者中，有 52 名患者在手术后中位数为 4.7 年时被诊断出淀粉样变性（10 年累积发生率：0.26%，95%CI：0.18%至 0.34%），在单独接受 CTR 的 91384 名患者中，有 396 名患者在手术后中位数为 5.1 年时被诊断出淀粉样变性（10 年累积发生率：0.60%，95%CI：0.53%至 0.67%），在同时接受 TR 和 CTR 的 8647 名患者中，有 50 名患者在手术后中位数为 3.1 年时被诊断出淀粉样变性（10 年累积发生率：0.80%，95%CI：0.54%至 1.1%），在 113452 名对照者中，有 54 名患者在索引日期后中位数为 5.0 年时被诊断出淀粉样变性（10 年累积发生率为 0.053%，95%CI：0.037%至 0.070%）。在调整分析中，接受 TR 和/或 CTR 的患者发生淀粉样变性的风险更高（TR：sHR 4.80，95%CI：3.33-6.92；CTR：sHR 10.2，95%CI：7.74-13.6；TR 和 CTR：sHR 14.9，95%CI：9.87-22.5）和心力衰竭（TR：sHR 1.91，95%CI：1.83-1.99；CTR：sHR 2.02，95%CI：1.97-2.07；TR 和 CTR：sHR 2.18，95%CI：2.04-2.33），但与对照组相比，死亡风险没有增加。在接受 TR 的患者中，年龄、黑人种族、先前的 CTR、心力衰竭和释放的手指数量是淀粉样变性的独立危险因素。
与对照组相比，接受 TR 和/或 CTR 的患者发生淀粉样变性和心力衰竭的风险增加。
研究类型/证据水平：预后 II 级。
