Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Hand Surg Rehabil. 2024 Feb;43(1):101615. doi: 10.1016/j.hansur.2023.10.009. Epub 2023 Nov 7.
Carpal tunnel syndrome is the most common compressive neuropathy. There is limited evidence to support endoscopic compared to open carpal tunnel release according to the 2016 American Academy of Orthopaedic Surgeons Clinical Practice Guideline on carpal tunnel syndrome. The purpose of the present study was to assess differences between the two procedures by comparing 30- and 90-day complications and mean hospital costs in a large patient population.
Using the national Mariner15 Database by PearlDiver Technologies, we retrospectively studied 27,192 carpal tunnel syndrome patients who received carpal tunnel release using an endoscopic or open surgical approach from 2010 to 2019. Patients who met the inclusion criteria were grouped and case-matched at a 1:1 ratio through the corresponding International Classification of Diseases codes (n = 13,596) and assessed for 30- and 90-day complications such as median nerve injury, superficial palmar arch injury, and revision carpal tunnel release surgery. Univariate analysis was used to compare outcomes and a multivariate regression was performed to identify risk factors associated with each outcome.
Endoscopic carpal tunnel release was associated with a higher rate of median nerve injury than open release at 30 days (0.3% vs. 0.1% odds ratio, 2.21; 95% confidence interval, 1.29-3.81; p < 0.05) and 90 days (0.4% vs. 0.3%; odds ratio, 1.77; 95% confidence interval, 1.16-2.70; p < 0.05). Endoscopic release was also associated with a higher rate of superficial palmar arch injury (0.1% vs. 0%; odds ratio, 25.02; 95% confidence interval, 1.48-423.0; p < 0.05).
In the present study, risk of median nerve injury and vascular injury was higher after endoscopic than open carpal tunnel release. At 90 days, all-cause revision rates were similar between techniques. Surgeons should understand these differences, to optimize surgical decision-making.
Therapeutic, IIIa.
腕管综合征是最常见的压迫性神经病变。根据 2016 年美国矫形外科医师学会的腕管综合征临床实践指南，与开放式腕管松解术相比，内镜下腕管松解术的证据有限。本研究的目的是通过比较两种手术在大样本患者中 30 天和 90 天并发症和平均住院费用的差异来评估两种手术的效果。
使用 PearlDiver Technologies 的全国 Mariner15 数据库，我们回顾性研究了 2010 年至 2019 年间接受内镜或开放式手术治疗的 27192 例腕管综合征患者。符合纳入标准的患者通过相应的国际疾病分类代码（n=13596）进行分组和 1:1 病例匹配，并评估 30 天和 90 天的并发症，如正中神经损伤、掌浅弓损伤和腕管松解术翻修。采用单因素分析比较结果，并进行多变量回归分析，以确定与每种结果相关的危险因素。
与开放式腕管松解术相比，内镜下腕管松解术在 30 天（0.3%比 0.1%，优势比 2.21；95%置信区间 1.29-3.81；p<0.05）和 90 天（0.4%比 0.3%，优势比 1.77；95%置信区间 1.16-2.70；p<0.05）时发生正中神经损伤的风险更高。内镜下松解术也与掌浅弓损伤（0.1%比 0%；优势比 25.02；95%置信区间 1.48-423.0；p<0.05）的发生率更高。
在本研究中，与开放式腕管松解术相比，内镜下腕管松解术发生正中神经损伤和血管损伤的风险更高。90 天时，两种技术的总修正率相似。外科医生应了解这些差异，以优化手术决策。
治疗性，IIIa 级。
