Calzado-Alvarez Irene, Camacho-Sanchez Maria R, Carpintero-Lluch Rocio, Muñoz-Luna Francisco, Lopez-Medina Clementina, Minarro Jose Carlos, Izquierdo-Fernandez Alberto
From the Orthopaedics and Traumatology Department, Reina Sofia University Hospital.
Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Cordoba.
Plast Reconstr Surg. 2025 Mar 1;155(3):514-521. doi: 10.1097/PRS.0000000000011677. Epub 2024 Aug 14.
Conventional surgery performed to treat carpal tunnel syndrome (CTS) is associated with complications such as pillar pain or loss of strength. This study aimed to compare the incidence of pillar pain between 2 techniques at the 3-week and 6-month follow-up and to determine differences in the recovery of grip strength (GS), pinch strength (PS), and Boston Carpal Tunnel Questionnaire scores.
This randomized clinical trial included 109 patients, 55 of whom underwent ligament Z-plasty and 54, conventional surgery (longitudinal section of the transverse carpal ligament without posterior closure). GS, PS, pillar pain, and Boston Carpal Tunnel Questionnaire scores were assessed preoperatively and 3 weeks and 6 months after surgery.
The incidence of pillar pain 3 weeks after surgery was lower in patients undergoing Z-plasty than in those undergoing conventional surgery (25.5% versus 44.4%; P = 0.04). Moreover, the absolute change in PS 3 weeks after surgery ( P = 0.01) and GS 6 months after surgery ( P = 0.05) and the absolute and relative changes in PS after 6 months ( P = 0.008 and P = 0.01, respectively) were significantly higher in the Z-plasty group than in the conventional surgery group.
Z-plasty is a valid surgical procedure for treating CTS. It is associated with a lower incidence of pillar pain and better recovery of postoperative strength compared with the conventional surgical technique, with both techniques showing similar results in CTS recovery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
用于治疗腕管综合征（CTS）的传统手术会引发诸如支柱疼痛或力量丧失等并发症。本研究旨在比较两种手术技术在术后3周和6个月随访时支柱疼痛的发生率，并确定握力（GS）、捏力（PS）恢复情况以及波士顿腕管综合征问卷评分的差异。
这项随机临床试验纳入了109例患者，其中55例行韧带Z成形术，54例行传统手术（横行腕横韧带纵行切开且不进行后壁缝合）。在术前以及术后3周和6个月评估GS、PS、支柱疼痛情况以及波士顿腕管综合征问卷评分。
接受Z成形术的患者术后3周支柱疼痛的发生率低于接受传统手术的患者（25.5% 对44.4%；P = 0.04）。此外，Z成形术组术后3周PS的绝对变化（P = 0.01）以及术后6个月GS的绝对变化（P = 0.05），还有术后6个月PS的绝对和相对变化（分别为P = 0.008和P = 0.01）均显著高于传统手术组。
Z成形术是一种治疗CTS的有效手术方法。与传统手术技术相比，其支柱疼痛发生率更低，术后力量恢复更好，两种技术在CTS恢复方面的结果相似。
临床问题/证据水平：治疗性，II级。
