Wei Ruihong, Chen Chao, Liu Yingnan, Liu Zhaokang, Xiong Hongtao, Zhang Xu, Zhuang Yongqing
Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery; Shenzhen Key Laboratory of Musculoskeletal Tissue Reconstruction and Function Restoration, Shenzhen People's Hospital, Second Clinical Medicine College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong.
Hand Surgery Department, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei China.
Arthroscopy. 2023 Apr;39(4):963-970.e2. doi: 10.1016/j.arthro.2022.09.013. Epub 2022 Oct 5.
To determine the endoscopic release superficially rather than deep to the transverse carpal ligament to reduce the incidence of transient symptomatic exacerbation and postoperative absence from work in patients with carpal tunnel syndrome.
From January 2012 to January 2018, patients with idiopathic carpal tunnel syndrome who underwent one-portal endoscopic release superficial to the transverse carpal ligament (ERSTCL) were analyzed. For comparison, a cohort treated with the conventional Chow endoscopic release between February 2008 and October 2013 were included. Transient worsening of symptoms, discrimination sensation, and days off work were assessed. The minimal clinically important difference was calculated for discrimination sensation. Severity of symptom and functional status also were assessed using the Levine-Katz Questionnaire. Significance was set at P < .05.
There was a significant difference between the ERSTCL group and the control group regarding the incidence of symptomatic exacerbation 1 week after surgery (2% vs 9%; P = .003) but no difference in other time intervals within the initial 3 months. There was a significant difference in 2-point discrimination 1 week (mean change = -0.13, 95% confidence interval [CI] -0.30 to 0.04, P = .01) and 2 weeks after surgery (mean change = -0.18, 95% CI -0.36 to -0.01, P = .033). Postoperative 1 and 2 weeks, 28% and 35% patients in ERSTCL group achieved a minimal clinically important difference, respectively. Compared with control group, the difference in frequencies was statistically significant (28% vs 45%; P = .027; 35% vs 57%; P = .015). The difference between the 2 groups in postoperative absence from work was statistically significant (95% CI 1.083-4.724; P = .002), with an average reduction in sick leave of 3 days in ERSTCL group. At a mean follow-up of 3 years, no significant difference was found between the groups regarding symptom and function statuses.
Endoscopic release superficial rather than deep to transverse carpal ligament for carpal tunnel syndrome improves immediate postoperative transient symptomatic exacerbation, which allows the patients to return to work earlier.
Level III, retrospective comparative study.
确定在腕横韧带浅层而非深层进行内镜下松解，以降低腕管综合征患者短暂症状加重的发生率和术后缺勤率。
分析2012年1月至2018年1月期间接受单通道内镜下腕横韧带浅层松解术（ERSTCL）的特发性腕管综合征患者。为作比较，纳入2008年2月至2013年10月期间接受传统Chow内镜下松解术治疗的一组患者。评估症状的短暂恶化、两点辨别觉和缺勤天数。计算两点辨别觉的最小临床重要差异。还使用Levine-Katz问卷评估症状严重程度和功能状态。显著性设定为P < .05。
ERSTCL组与对照组在术后1周症状加重发生率方面存在显著差异（2% 对9%；P = .003），但在最初3个月内的其他时间段无差异。术后1周（平均变化 = -0.13，95%置信区间[CI] -0.30至0.04，P = .01）和2周（平均变化 = -0.18，95% CI -0.36至 -0.01，P = .033）时两点辨别觉有显著差异。术后1周和2周，ERSTCL组分别有28%和35%的患者达到最小临床重要差异。与对照组相比，频率差异具有统计学意义（28% 对45%；P = .027；35% 对57%；P = .015）。两组术后缺勤率差异具有统计学意义（95% CI 1.083 - 4.724；P = .002），ERSTCL组平均病假减少3天。平均随访3年时，两组在症状和功能状态方面未发现显著差异。
对于腕管综合征，在腕横韧带浅层而非深层进行内镜下松解可改善术后即刻短暂症状加重情况，使患者能更早返回工作岗位。
III级，回顾性比较研究。
