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关节镜下肩关节手术后腕管综合征诊断的发生率增加。

The Incidence of Carpal Tunnel Syndrome Diagnosis Increases after Arthroscopic Shoulder Surgery.

作者信息

Medvedev Gleb, Collins Lacee K, Cole Matthew W, Weldy John M, George Eric R, Sherman William F

机构信息

Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.

Hand Center of Louisiana, Metairie, LA.

出版信息

J Hand Surg Glob Online. 2023 Jun 6;5(5):624-629. doi: 10.1016/j.jhsg.2023.05.005. eCollection 2023 Sep.

Abstract

PURPOSE

Arthroscopic shoulder surgery has been identified as a potential risk factor for carpal tunnel syndrome (CTS). The purposes of this study were as follows: to (1) examine the percentage of patients who underwent arthroscopic shoulder procedures and later developed ipsilateral CTS within 1 year of the procedure, (2) determine the percentage of those patients with CTS who subsequently underwent an injection or release, and (3) examine comorbidities associated with developing CTS after surgery.

METHODS

Patients who underwent arthroscopic rotator cuff repair (RCR), labral repair, or biceps tenodesis were retrospectively identified in a national database. Within 1 year, we compared the rates of ipsilateral CTS diagnoses versus the contralateral side. The rates of comorbidities between those who did and did not develop CTS were also compared.

RESULTS

Within 1 year, arthroscopic RCR patients (1.47% vs 1.00%; odds ratio [OR], 1.48; < .001) and arthroscopic labral repair patients (0.76% vs 0.52%; OR, 1.47; < .001) had a significantly higher rate of ipsilateral carpal tunnel diagnosis versus contralateral side diagnosis. Arthroscopic RCR patients were also significantly more likely to have ipsilateral carpal tunnel injection (0.16% vs 0.11%; OR, 1.45; < .001) and release (0.46% vs 0.37%; OR, 1.24; < .001). Patients who had an ipsilateral carpal tunnel diagnosis following arthroscopic RCR and labral repair were both significantly older (both < .001), a higher percentage of women (both <.001), and more likely to have had a preoperative nerve block (both < .05). Both cohorts had significantly higher mean Elixhauser comorbidity Index ( < .001) and more comorbidities.

CONCLUSIONS

This study demonstrated a significantly higher incidence of operative side CTS within 1 year following arthroscopic RCR and labral repairs. Arthroscopic RCR was also demonstrated to result in significantly higher rates of injections and carpal tunnel release. The cohort that developed ipsilateral CTS was older, had higher percentage of women, and had more comorbidities.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.

摘要

目的

关节镜下肩部手术已被确定为腕管综合征(CTS)的一个潜在风险因素。本研究的目的如下:(1)检查接受关节镜下肩部手术且在术后1年内同侧发生CTS的患者百分比;(2)确定那些患有CTS的患者随后接受注射或松解手术的百分比;(3)检查与术后发生CTS相关的合并症。

方法

在一个全国性数据库中对接受关节镜下肩袖修复(RCR)、盂唇修复或肱二头肌固定术的患者进行回顾性识别。在1年内,我们比较了同侧CTS诊断率与对侧的诊断率。还比较了发生CTS和未发生CTS的患者之间的合并症发生率。

结果

在1年内,关节镜下RCR患者(1.47%对1.00%;优势比[OR],1.48;P <.001)和关节镜下盂唇修复患者(0.76%对0.52%;OR,1.47;P <.001)同侧腕管诊断率显著高于对侧诊断率。关节镜下RCR患者同侧腕管注射(0.16%对0.11%;OR,1.45;P <.001)和解松手术(0.46%对0.37%;OR,1.24;P <.001)的可能性也显著更高。关节镜下RCR和盂唇修复术后同侧腕管诊断的患者均显著年龄更大(均P <.001),女性比例更高(均P <.001),且术前更可能接受过神经阻滞(均P <.05)。两个队列的平均埃利克斯豪泽合并症指数均显著更高(均P <.001),合并症更多。

结论

本研究表明,关节镜下RCR和盂唇修复术后1年内手术侧CTS的发生率显著更高。还表明关节镜下RCR导致注射和解开腕管的发生率显著更高。发生同侧CTS的队列年龄更大,女性比例更高,合并症更多。

研究类型/证据水平:预后性研究III级

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