从内镜到开放式腕管松解术中的术中转换：系统评价和病例系列。
Intraoperative Conversion From Endoscopic to Open Carpal Tunnel Release: A Systematic Review and Case Series.
机构信息
Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
出版信息
J Hand Surg Am. 2023 Dec;48(12):1244-1251. doi: 10.1016/j.jhsa.2022.06.020. Epub 2022 Aug 13.
PURPOSE
The purpose of this study was to assess the incidence, outcomes, and complications associated with conversion from endoscopic carpal tunnel release (ECTR) to open carpal tunnel release (OCTR).
METHODS
A retrospective case review of all patients who underwent ECTR over 4 years by 2 fellowship-trained hand surgeons at a single academic center was performed. We recorded outcomes and the reason for conversion in patients who underwent conversion to an OCTR. Baseline demographics and surgical complications were compared between the 2 groups. A systematic review was performed to define the incidence and reasons for conversion from ECTR to OCTR. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included clinical studies of ECTR from 2000 to 2021.
RESULTS
In the retrospective series, 9 of 892 (1.02%) ECTR cases underwent conversion to an OCTR at the time of the index procedure. One of 9 converted cases had transient neurapraxia involving the recurrent motor branch after surgery compared with 0 cases in the group that underwent ECTR without conversion. Improvements in the visual analog scale for pain and QuickDASH were noted at a mean of 46 weeks after surgery in the group that underwent conversion to OCTR. The systematic review identified an incidence of conversion of 0.62%. The most common reasons for conversion to OCTR in the case series and systematic review were poor visualization due to hypertrophic tenosynovium and aberrant nerve anatomy.
CONCLUSIONS
The overall incidence of intraoperative conversion from ECTR to OCTR during the index procedure was 1.02%, with the most common reasons for conversion being poor visualization due to hypertrophic tenosynovium and aberrant nerve anatomy. Patients who undergo conversion from ECTR to OCTR demonstrate improvements in pain and disability, similar to patients who undergo ECTR without conversion.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
目的
本研究旨在评估内镜腕管松解术（ECTR）转为开放腕管松解术（OCTR）的发生率、结局和相关并发症。
方法
对 2 名在手外科专业培训的 fellowship医生在一家学术中心进行的 4 年内所有 ECTR 患者进行回顾性病例分析。我们记录了在转为 OCTR 的患者中手术转换的原因和结局。比较了两组患者的基线人口统计学数据和手术并发症。采用系统评价方法，根据 PRISMA 指南，纳入了 2000 年至 2021 年的 ECTR 临床研究。
结果
在回顾性系列中，892 例 ECTR 中有 9 例（1.02%）在初次手术时转为 OCTR。与未行 ECTR 转换的患者相比，在转为 OCTR 的患者中，有 1 例术后出现短暂的运动神经分支感觉神经麻痹。转为 OCTR 的患者在手术后平均 46 周时，疼痛的视觉模拟评分和快速残疾指数（QuickDASH）都有改善。系统评价确定了 0.62%的转换发生率。在病例系列和系统评价中，转为 OCTR 的最常见原因是肥厚性腱鞘导致的可视化不佳和神经解剖异常。
结论
在初次手术中，ECTR 转为 OCTR 的总体发生率为 1.02%，最常见的原因是肥厚性腱鞘导致的可视化不佳和神经解剖异常。与未行 ECTR 转换的患者相比，转为 OCTR 的患者的疼痛和残疾都有改善。
研究类型/证据水平：治疗性 IV 级。
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