Rajapandian Ramkumar, Moti Wala Sajida, Aledani Esraa M, Samuel Essa A, Ahmad Khoula, Manongi Naelijwa J, Rauf Butt Samia
Trauma and Orthopedics, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2024 Jul 20;16(7):e64991. doi: 10.7759/cureus.64991. eCollection 2024 Jul.
Carpal tunnel syndrome (CTS) is a condition that causes discomfort due to the compression of the median nerve in the wrist. Carpal tunnel release (CTR) is a surgical procedure that can help alleviate the symptoms of CTS. Two methods are commonly used for CTR: endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). The choice of method can impact surgical outcomes and potential complications. This review aims to compare the outcomes of both methods for individuals diagnosed with CTS. This systematic review analyzes the outcomes and potential complications of ECTR and OCTR for CTS. The study encompassed a comprehensive analysis of randomized controlled trials (RCTs) and meta-analyses comparing both methods. We searched for studies released between January 2012 and October 2023 on PubMed, Science Direct, and Google Scholar. The researchers assessed the quality of studies using the Cochrane risk of bias tool and the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool. The study's scope included a range of outcomes and complications, such as symptom relief, functional recovery, grip strength, return to work, patient satisfaction, scar sensitivity, pillar pain, wound complications, nerve-related issues, morphological changes, and recurrence. The review analyzed 11 studies, including seven RCTs and four meta-analyses. These studies evaluated 4367 ECTR and 4107 cases of OCTR. The patients' ages ranged from 46 to 58, and the follow-up periods ranged from three to 24 months. The findings reveal that ECTR has comparable or better outcomes than OCTR, particularly in postoperative discomfort, functional recovery, grip strength, resumption of work, and patient satisfaction. Additionally, ECTR has lower levels of scar sensitivity, pillar pain, and wound-related complications than OCTR. However, ECTR carries a higher risk of reversible nerve injury. There were no substantial differences between the two techniques regarding other potential complications. Both ECTR and OCTR are safe and effective interventions for CTS. ECTR has benefits like faster recovery and improved cosmetic outcomes but requires higher technical proficiency and carries the risk of nerve injury. The choice of technique should consider patient preference, cost-effectiveness, and surgeon expertise.
腕管综合征（CTS）是一种由于手腕部正中神经受压而导致不适的病症。腕管松解术（CTR）是一种有助于缓解腕管综合征症状的外科手术。腕管松解术通常采用两种方法：内镜下腕管松解术（ECTR）和开放式腕管松解术（OCTR）。方法的选择会影响手术效果和潜在并发症。本综述旨在比较这两种方法对诊断为腕管综合征患者的治疗效果。本系统综述分析了内镜下腕管松解术和开放式腕管松解术治疗腕管综合征的效果及潜在并发症。该研究全面分析了比较这两种方法的随机对照试验（RCT）和荟萃分析。我们在PubMed、Science Direct和谷歌学术上搜索了2012年1月至2023年10月期间发表的研究。研究人员使用Cochrane偏倚风险工具和AMSTAR 2（一种评估系统综述的测量工具）工具评估研究质量。该研究的范围包括一系列结果和并发症，如症状缓解、功能恢复、握力、重返工作岗位、患者满意度、瘢痕敏感性、支柱疼痛、伤口并发症、神经相关问题、形态变化和复发情况。该综述分析了11项研究，包括7项随机对照试验和4项荟萃分析。这些研究评估了4367例内镜下腕管松解术和4107例开放式腕管松解术病例。患者年龄在46岁至58岁之间，随访期为3至24个月。研究结果显示，内镜下腕管松解术的效果与开放式腕管松解术相当或更好，尤其是在术后不适、功能恢复、握力、恢复工作和患者满意度方面。此外，内镜下腕管松解术的瘢痕敏感性、支柱疼痛和伤口相关并发症水平低于开放式腕管松解术。然而，内镜下腕管松解术存在可逆性神经损伤的风险较高。在其他潜在并发症方面，这两种技术之间没有实质性差异。内镜下腕管松解术和开放式腕管松解术都是治疗腕管综合征的安全有效的干预措施。内镜下腕管松解术具有恢复更快和美容效果更好等优点，但需要更高的技术水平，并且存在神经损伤的风险。技术的选择应考虑患者的偏好、成本效益和外科医生的专业知识。
