Graham Jack G, Plusch Kyle J, Hozack Bryan A, Ilyas Asif M, Matzon Jonas L
Division of Hand & Wrist Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
J Hand Surg Glob Online. 2023 Feb 20;5(3):277-283. doi: 10.1016/j.jhsg.2023.01.010. eCollection 2023 May.
The published revision rates after carpal tunnel release (CTR) vary from 0.3% to 7%. The explanation for this variation may not be fully apparent. The purpose of this study was to determine the rate of surgical revision within 1-5 years following primary CTR at a single academic institution, compare it with rates reported in the literature, and attempt to provide explanations for these differences.
We identified all patients who underwent primary CTR at a single orthopedic practice by 18 fellowship-trained orthopedic hand surgeons from October 1, 2015, through October 1, 2020, using a combination of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD), 10th Revision, codes. Patients who underwent CTR because of a diagnosis other than primary carpal tunnel syndrome were excluded. Patients who required revision CTR were identified using a practice-wide database query using a combination of CPT and ICD-10 codes. Operative reports and outpatient clinic notes were reviewed to determine the cause of revision. Data on patient demographics, surgical technique (open vs single-portal endoscopic), and medical comorbidities were collected.
A total of 11,847 primary CTR procedures were performed during the 5-year period on 9,310 patients. We found 24 revision CTR procedures among 23 patients, resulting in a revision rate of 0.2%. Of 9,422 open primary CTRs performed, 22 cases (0.23%) went on to undergo revision. Endoscopic CTR was performed in 2,425 cases, with 2 cases (0.08%) ultimately undergoing revision. The average length of time from primary CTR to revision was 436 days (range, 11-1,647 days).
We noted a substantially lower rate of revision CTR within 1-5 years of primary release (0.2%) in our practice than that noted in previously published studies, although we accept that this does not account for out-of-area migration. There was no significant difference in the revision rates between open and single-portal endoscopic primary CTR.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
腕管松解术（CTR）后已公布的翻修率在0.3%至7%之间。这种差异的原因可能并不完全清楚。本研究的目的是确定在单一学术机构中，初次CTR术后1至5年内的手术翻修率，将其与文献报道的比率进行比较，并试图解释这些差异。
我们通过使用当前手术操作术语（CPT）和国际疾病分类（ICD）第10版编码，确定了2015年10月1日至2020年10月1日期间，18名接受过专科培训的骨科手外科医生在单一骨科诊所进行初次CTR的所有患者。因原发性腕管综合征以外的诊断而接受CTR的患者被排除。使用CPT和ICD-10编码组合，通过全科室数据库查询确定需要翻修CTR的患者。查阅手术报告和门诊病历以确定翻修原因。收集患者人口统计学数据、手术技术（开放手术与单通道内镜手术）和合并症数据。
在5年期间，对9310例患者进行了总共11847例初次CTR手术。我们在23例患者中发现了24例翻修CTR手术，翻修率为0.2%。在9422例开放式初次CTR手术中，有22例（0.23%）继续接受翻修。内镜CTR手术共进行了2425例，其中2例（0.08%）最终接受了翻修。从初次CTR到翻修的平均时间为436天（范围为11至1647天）。
我们注意到，在我们的实践中，初次松解术后1至5年内CTR的翻修率（0.2%）显著低于先前发表的研究报告，不过我们承认这并未考虑区域外的转诊情况。开放式和单通道内镜初次CTR的翻修率没有显著差异。
研究类型/证据水平：治疗性III级。
