桡骨远端骨折后腕管综合征的发病率
Incidence of Carpal Tunnel Syndrome after Distal Radius Fracture.
作者信息
Cooke Margaret E, Gu Alex, Wessel Lauren E, Koo Alexander, Osei Daniel A, Fufa Duretti T
机构信息
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA.
Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
出版信息
J Hand Surg Glob Online. 2022 Aug 31;4(6):324-327. doi: 10.1016/j.jhsg.2022.08.001. eCollection 2022 Nov.
PURPOSE
Carpal tunnel syndrome (CTS) can present following distal radius fracture (DRF) and may progress to require carpal tunnel release (CTR). The primary aim of this study was to determine the incidence of CTS within 6 months of a DRF and the rate of CTR in this population.
METHODS
We used the PearlDiver national insurance database to determine the incidence of CTS after DRF. Patients were identified by International Classification of Diseases-10 codes, and treatment modalities for DRF and CTS were determined by respective Current Procedural Terminology codes. Patients with less than 6 months of follow-up, bilateral DRF, or preexisting CTS were excluded. Patient demographic characteristics were recorded. The time from DRF diagnosis to CTS diagnosis and CTR was determined. A multivariable analysis was performed to determine the differences between patients who underwent a CTR compared with those who were treated conservatively.
RESULTS
We identified 23,733 patients (6,015 men; 17,718 women) who sustained a DRF. Of these patients, 79.1% were treated nonsurgically and 20.9% underwent surgical fixation. In total, 9.2% (N = 2,179) were diagnosed with CTS in their ipsilateral extremity within 6 months of sustaining the DRF. Of the patients whose DRF was treated nonsurgically, 6.3% (N = 1,198) developed CTS and 2.9% (N = 546) required CTR. Of those patients whose DRF was treated surgically, 19.8% (N = 981) developed CTS and 13.3% (N = 661) required CTR. Of those patients with symptoms severe enough to warrant CTR, 18.5% required a second surgical intervention for the CTR.
CONCLUSIONS
Distal radius fractures severe enough to require surgical fixation are associated with a higher incidence of perioperative CTS. Accordingly, careful evaluation for and counseling on CTS during surgical fixation may decrease the chance of a second surgery. We have identified a cohort of patients with DRFs who may benefit from prophylactic CTR.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
目的
腕管综合征（CTS）可在桡骨远端骨折（DRF）后出现，并可能进展至需要进行腕管松解术（CTR）。本研究的主要目的是确定DRF后6个月内CTS的发生率以及该人群中CTR的发生率。
方法
我们使用PearlDiver国家保险数据库来确定DRF后CTS的发生率。通过国际疾病分类第10版编码识别患者，并通过各自的现行手术操作术语编码确定DRF和CTS的治疗方式。排除随访时间少于6个月、双侧DRF或既往存在CTS的患者。记录患者的人口统计学特征。确定从DRF诊断到CTS诊断和CTR的时间。进行多变量分析以确定接受CTR的患者与保守治疗的患者之间的差异。
结果
我们识别出23,733例发生DRF的患者（6,015例男性；17,718例女性）。在这些患者中，79.1%接受了非手术治疗，20.9%接受了手术固定。总共9.2%（N = 2,179）在发生DRF后6个月内在同侧肢体被诊断为CTS。在DRF接受非手术治疗的患者中，6.3%（N = 1,198）发生了CTS，2.9%（N = 546）需要进行CTR。在DRF接受手术治疗的患者中，19.8%（N = 981）发生了CTS，13.3%（N = 661）需要进行CTR。在那些症状严重到需要进行CTR的患者中，18.5%需要进行第二次CTR手术干预。
结论
严重到需要手术固定的桡骨远端骨折与围手术期CTS的较高发生率相关。因此，在手术固定期间对CTS进行仔细评估和咨询可能会减少二次手术的机会。我们已经识别出一组可能从预防性CTR中获益的DRF患者。
研究类型/证据水平：诊断性IV级。
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