Sasson Daniel C, Yuksel Selcen S, Shah Nikhil D, Kearney Aaron M, Kalliainen Loree K, Gosain Arun K
From the Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital; Division of Plastic Surgery, The Warren Alpert Medical School of Brown University; and American Board of Plastic Surgery.
Plast Reconstr Surg. 2022 Jun 1;149(6):1140e-1148e. doi: 10.1097/PRS.0000000000009117. Epub 2022 Apr 11.
The American Board of Plastic Surgery has been collecting practice data on carpal tunnel syndrome treatment since 2004 as part of its Continuous Certification Program. These data allow plastic surgeons to compare their surgical experience to national trends and analyze those trends in relation to current evidence-based medicine.
Data on carpal tunnel syndrome treatment from 2004 to 2014 were compared to those from 2015 to 2020. National practice trends observed in these data were evaluated relative to current literature regarding evidence-based practices.
A total of 11,090 carpal tunnel syndrome cases were included from 2004 to 2020. Electrodiagnostic and imaging studies were performed on most patients despite adding little sensitivity and specificity when physical examination tests are performed and not being considered cost-effective. An open "mini" approach has remained the most common surgical technique in carpal tunnel release for the last 15 years, with growing usage (53 percent versus 59 percent, p < 0.001). Splinting has decreased significantly over the last 15 years, from usage in 39 percent of patients to 28 percent (p < 0.001). Formal postoperative hand therapy has declined from 27 percent of patients to 22 percent (p < 0.001). Despite their low efficacy, 63 percent of patients received one or more perioperative doses of antibiotics.
Analysis of the Continuous Certification Program tracer data from the American Board of Plastic Surgery provides an excellent overview of current practice and its development over the 15 years since its inception. This analysis provides insight into how effectively plastic surgeons have remained aligned with developments in best practices in treating carpal tunnel syndrome.
自2004年起，美国整形外科委员会在其持续认证项目中收集腕管综合征治疗的实践数据。这些数据使整形外科医生能够将他们的手术经验与全国趋势进行比较，并根据当前的循证医学分析这些趋势。
将2004年至2014年腕管综合征治疗数据与2015年至2020年的数据进行比较。根据当前关于循证实践的文献，对这些数据中观察到的全国实践趋势进行评估。
2004年至2020年共纳入11090例腕管综合征病例。尽管在进行体格检查时增加的敏感性和特异性很小，且不被认为具有成本效益，但大多数患者仍进行了电诊断和影像学检查。在过去15年中，开放式“迷你”手术方法一直是腕管松解术中最常用的手术技术，其使用率呈上升趋势（从53%升至59%，p<0.001）。在过去15年中，夹板固定的使用率显著下降，从39%的患者使用降至28%（p<0.001）。正式的术后手部治疗从27%的患者减少到22%（p<0.001）。尽管疗效不佳，但63%的患者接受了一剂或多剂围手术期抗生素治疗。
对美国整形外科委员会持续认证项目追踪数据的分析，很好地概述了自项目启动以来15年的当前实践及其发展情况。该分析深入了解了整形外科医生在治疗腕管综合征方面与最佳实践发展保持一致的有效程度。
