Aguila Demetrio, Kirsch Matthew, Kindle Brett, Paterson Paul
Total Pain Solutions, Papillion, NE.
Olmsted Medical Center, Rochester, MN.
J Hand Surg Glob Online. 2023 Nov 22;6(1):79-84. doi: 10.1016/j.jhsg.2023.10.001. eCollection 2024 Jan.
The purpose of this study was to report the 1-year clinical outcomes of carpal tunnel release using ultrasound guidance (CTR-US) performed in a large, real-world population of patients enrolled in a multicenter registry.
All patients who participated in a postmarket registry study of CTR-US outcomes and provided both preoperative and 1-year postoperative data were included. Main outcomes were the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QDASH), Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS), and Boston Carpal Tunnel Functional Status Scale (BCTQ-FSS) scores at 1 year. Subgroup analysis was performed to assess the effect of patient and procedural factors on 1-year outcomes.
A total of 300 patients (341 hands) were treated by 25 different physicians, including 41 (13.7%) treated with simultaneous bilateral procedures. Mean patient age was 54.2 years, 63% were women, 24% had ≥2 comorbidities, and 54% had symptoms for >2 years. Mean QDASH scores decreased from 40.6 ± 20.6 to 12.2 ± 18.3 at 1 year, BCTQ-SSS scores decreased from 3.0 ± 0.7 to 1.5 ± 0.7 at 1 year, and BCTQ-FSS scores decreased from 2.4 ± 0.8 to 1.4 ± 0.6 at 1 year. Women improved more than men at 1 year for QDASH, BCTQ-SSS, and BCTQ-FSS. Patients treated with simultaneous bilateral procedures had similar 1-year outcomes to those treated with unilateral procedures. Multiple other factors including high body mass index, diabetes status, current tobacco use, rheumatoid/inflammatory arthritis, operation in the dominant hand, higher comorbidity burden, and concurrent ipsilateral procedures did not significantly affect 1-year outcomes. Two patients had revision surgeries in addition to one patient with an infection, and one with a suspected small finger tendon injury.
Patients treated with CTR-US in real-world conditions report significant and clinically meaningful improvements in symptoms and function that are maintained at 1 year. The results are consistent across broad patient demographics and are not affected by performing simultaneous bilateral procedures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究的目的是报告在一个多中心登记处登记的大量真实世界患者中，采用超声引导下腕管松解术（CTR-US）的1年临床结果。
纳入所有参与CTR-US结果的上市后登记研究并提供术前和术后1年数据的患者。主要结局指标为1年时的手臂、肩部和手部快速残疾问卷（QDASH）、波士顿腕管问卷症状严重程度量表（BCTQ-SSS）以及波士顿腕管功能状态量表（BCTQ-FSS）评分。进行亚组分析以评估患者和手术因素对1年结局的影响。
共有300例患者（341只手）由25位不同的医生进行治疗，其中41例（13.7%）接受了同期双侧手术。患者平均年龄为54.2岁，63%为女性，24%患有≥2种合并症，54%的患者症状持续时间>2年。1年时，平均QDASH评分从40.6±20.6降至12.2±18.3，BCTQ-SSS评分从3.0±0.7降至1.5±0.7，BCTQ-FSS评分从2.4±0.8降至1.4±0.6。在1年时，女性在QDASH、BCTQ-SSS和BCTQ-FSS方面的改善比男性更明显。同期双侧手术治疗的患者与单侧手术治疗的患者1年结局相似。包括高体重指数、糖尿病状态、当前吸烟情况、类风湿性/炎性关节炎、优势手手术、更高的合并症负担以及同侧同期手术等多种其他因素对1年结局无显著影响。除1例感染患者和1例疑似小指肌腱损伤患者外，有2例患者进行了翻修手术。
在真实世界条件下接受CTR-US治疗的患者报告称，症状和功能有显著且具有临床意义的改善，且在1年时得以维持。结果在广泛的患者人口统计学特征中具有一致性，并且不受同期双侧手术的影响。
研究类型/证据水平：治疗性IV级。
