Alhindi Abeer K, Ghaddaf Abdullah A, Alomari Mohammed S, Alsharef Jawaher F, Alzahrani Saleh A, Alshehri Mohammed S, Sulimani Hani
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 21589, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Arch Orthop Trauma Surg. 2023 Jan;143(1):545-561. doi: 10.1007/s00402-022-04437-x. Epub 2022 May 30.
Carpal tunnel syndrome (CTS), the commonest neuropathy of the upper limb, can be managed with different therapeutic approaches. Local corticosteroid injection has been adopted widely in clinical practice, as it showed great efficacy in treating CTS. However, the best injection technique continues to be a subject of controversy. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) corticosteroid injection on the clinical and electrophysiological outcomes in patients with CTS.
We performed a systematic literature search in Medline, Embase, and CENTRAL, from which we included randomized controlled trials (RCTs) that compared US-guided and LM-based corticosteroid injection in treating individuals with CTS. We evaluated the following outcomes: Boston carpal tunnel questionnaire functional status scale (BCTQ-FSS) and symptom severity scale (BCTQ-SSS), and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcome.
A total of 8 RCTs that enrolled 500 wrists were deemed eligible. US-guided injection showed a significantly better BCTQ-FSS (SMD = -0.22, 95% CI -0.39 to -0.04), BCTQ-SSS (SMD = -0.77, 95% CI -1.22 to -0.31), and adverse event rate (RR = 0.32, 95% CI 0.21 to 0.49) compared to LM-based injection.
This meta-analysis showed the superiority of US-guided corticosteroid injection over LM-guided corticosteroid injection in enhancing functional status, improving symptom severity, and reducing the adverse event rate in individuals with CTS.
腕管综合征（CTS）是上肢最常见的神经病变，可采用不同的治疗方法。局部皮质类固醇注射在临床实践中已被广泛采用，因为它在治疗CTS方面显示出显著疗效。然而，最佳的注射技术仍是一个有争议的话题。本系统评价和荟萃分析的目的是评估超声引导（US引导）与体表标志引导（LM引导）皮质类固醇注射对CTS患者临床和电生理结局的疗效。
我们在Medline、Embase和CENTRAL中进行了系统的文献检索，纳入了比较US引导和LM引导皮质类固醇注射治疗CTS患者的随机对照试验（RCT）。我们评估了以下结局：波士顿腕管问卷功能状态量表（BCTQ-FSS）和症状严重程度量表（BCTQ-SSS）以及不良事件发生率。标准化均值差（SMD）用于表示连续结局，而风险比（RR）用于表示二分结局。
共有8项RCT纳入了500只手腕，被认为符合条件。与LM引导注射相比，US引导注射在BCTQ-FSS（SMD = -0.22，95%CI -0.39至-0.04）、BCTQ-SSS（SMD = -0.77，95%CI -1.22至-0.31）和不良事件发生率（RR = 0.32，95%CI 0.21至0.49）方面显示出显著更好的效果。
这项荟萃分析表明，在改善功能状态、减轻症状严重程度以及降低CTS患者不良事件发生率方面，US引导的皮质类固醇注射优于LM引导的皮质类固醇注射。
