Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
From the Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
Ann Plast Surg. 2024 Jun 1;92(6):677-687. doi: 10.1097/SAP.0000000000004005.
Whether endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) has superior outcomes remains a controversial topic. Therefore, we sought to perform an umbrella review and meta-analysis to compare ECTR and OCTR with regards to (1) postoperative functional ability, (2) operative outcomes, and (3) time to return to work.
A PubMed, Scopus, and Cochrane database search was conducted for all meta-analyses comparing ECTR and OCTR performed between 2000 and 2022 in accordance to PRISMA and Joanna Briggs Institute guidance for umbrella reviews. The primary outcomes were as follows: (1) functional ability-symptoms severity, postoperative grip strength, postoperative pinch strength, 2-point discrimination, and pain; (2) operative outcomes-operation time, total complications, nerve injury, and scar-related complication; and (3) time to return to work. Quality was assessed using the Assessment of Multiple Systematic Reviews. Pooled analysis was performed to compare several clinical outcome measures between groups, depending on the availability of data using Review Manager Version 5.2.11.
A total of 9 meta-analyses were included, 5 were of high quality and 4 were moderate quality. For functional ability, ECTR was associated with better pinch strength after 3 months (0.70, 95% confidence interval [CI] = 0.00, 1.40, P = 0.05) and 6 months (0.77, 95% CI = 0.14, 1.40, P = 0.02, I2 = 84%). For return to work, OCTR was associated with longer return to work compared with ECTR (-10.89, 95% CI = -15.14, -6.64, P < 0.00001, I2= 83%). There were no significant differences between OCTR and ECTR in the hand function, symptom severity, grip strength, pain, operation time, and total complications.
In an umbrella review and meta-analysis of ECTR versus OCTR, ECTR was associated with a higher pinch strength, and a shorter time to return to work. Differences in major complications, such as nerve injury, were unclear due to statistical inconsistency and bias.
内镜腕管松解术（ECTR）与开放式腕管松解术（OCTR）相比，哪种术式的术后效果更好，目前仍存在争议。因此，我们进行了一项伞式综述和荟萃分析，以比较 ECTR 和 OCTR 在以下方面的疗效：（1）术后功能能力，（2）手术结果，和（3）恢复工作的时间。
根据 PRISMA 和 Joanna Briggs 研究所关于伞式综述的指南，对 2000 年至 2022 年间进行的比较 ECTR 和 OCTR 的所有荟萃分析进行了 PubMed、Scopus 和 Cochrane 数据库检索。主要结局如下：（1）功能能力-症状严重程度、术后握力、术后捏力、2 点辨别觉和疼痛；（2）手术结果-手术时间、总并发症、神经损伤和与瘢痕相关的并发症；和（3）恢复工作的时间。使用评估多个系统评价（AMSTAR）工具对质量进行评估。根据数据的可用性，使用 Review Manager Version 5.2.11 对几个临床结局指标进行了荟萃分析。
共纳入 9 项荟萃分析，其中 5 项为高质量，4 项为中质量。在功能能力方面，ECTR 在术后 3 个月（0.70，95%置信区间 [CI] = 0.00，1.40，P = 0.05）和 6 个月（0.77，95% CI = 0.14，1.40，P = 0.02，I2 = 84%）时握力更好。对于恢复工作时间，与 ECTR 相比，OCTR 恢复工作时间更长（-10.89，95% CI = -15.14，-6.64，P < 0.00001，I2= 83%）。OCTR 和 ECTR 在手部功能、症状严重程度、握力、疼痛、手术时间和总并发症方面无显著差异。
在 ECTR 与 OCTR 的伞式综述和荟萃分析中，ECTR 与更高的捏力和更短的恢复工作时间相关。由于统计不一致和偏倚，神经损伤等主要并发症的差异尚不清楚。
