Hansen Logan M, Jiang Eric X, Hodson Noah M, Livingston Nicholas, Kazanjian Ani, Wu Mitchell, Day Charles S
Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI, USA.
School of Medicine, Wayne State University, Detroit, MI, USA.
Hand (N Y). 2024 Feb 29:15589447241233764. doi: 10.1177/15589447241233764.
The purpose of this study is to compare outcomes of carpal tunnel release (CTR) in patients with and without double crush syndrome (DCS), defined as concurrent carpal tunnel syndrome (CTS) and cervical radiculopathy at C5-T1 on preoperative nerve conduction studies.
Patients with preoperative nerve conduction studies who underwent unilateral, isolated CTR were retrospectively identified. All patients completed preoperative and 3-month postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI), and Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires, and responded to the anchor question: "Since your treatment, how would you rate your overall function?" (much worse, worse, slightly worse, no change, slightly improved, improved, much improved). Preoperative, postoperative, and changes in scores for UE, PI, and QuickDASH were compared, as were the anchor question responses and rates of achieving the minimal clinically important difference (MCID).
Sixty-three patients with DCS and 115 patients with CTS only were included. At 3- to 4-month follow-up, absolute and change in UE, PI, and QuickDASH scores were not statistically different between patients with DCS and CTS. Rates of anchor question response and MCID achievement were comparable for patients with CTS only and DCS on each questionnaire. The MCID achievement ranged from 48.4% to 68.8% in the unmatched cohort and 48.4% to 60% in the matched group.
At 3 to 4 months, patients with DCS experience similar patient-reported symptomatic and functional improvement, and achieve MCID of outcome measures at comparable rates to patients with CTS only. For patients with nerve compression at the carpal tunnel and cervical spine, CTR is a reasonable first step prior to proceeding with cervical spine decompression.
本研究旨在比较患有和未患有双重压迫综合征（DCS）的患者进行腕管松解术（CTR）的结果，双重压迫综合征定义为术前神经传导研究显示同时存在腕管综合征（CTS）和C5 - T1节段的颈神经根病。
回顾性确定接受单侧、孤立性CTR且术前进行了神经传导研究的患者。所有患者均完成术前和术后3个月的患者报告结局测量信息系统（PROMIS）上肢（UE）和疼痛干扰（PI）以及手臂、肩部和手部功能障碍（QuickDASH）问卷，并回答锚定问题：“自治疗以来，您如何评价您的整体功能？”（差得多、更差、稍差、无变化、稍有改善、改善、改善很多）。比较术前、术后UE、PI和QuickDASH评分的变化，以及锚定问题的回答和达到最小临床重要差异（MCID）的比率。
纳入63例患有DCS的患者和115例仅患有CTS的患者。在3至4个月的随访中，患有DCS和CTS的患者在UE、PI和QuickDASH评分的绝对值及变化方面无统计学差异。仅患有CTS的患者和患有DCS的患者在每份问卷上的锚定问题回答率和达到MCID的比率相当。在未匹配队列中，达到MCID的比率为48.4%至68.8%，在匹配组中为48.4%至60%。
在3至4个月时，患有DCS的患者在患者报告的症状和功能改善方面与仅患有CTS的患者相似，并且在结局指标达到MCID的比率相当。对于腕管和颈椎存在神经压迫的患者，CTR是在进行颈椎减压之前合理的第一步。
