Kishan Arman, Kubsad Sanjay, Haft Mark, Fox Henry M, Tuffaha Sami H, LaPorte Dawn M, Nguyen Duc M
Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA.
J Hand Surg Glob Online. 2024 Jun 12;6(4):577-582. doi: 10.1016/j.jhsg.2024.04.015. eCollection 2024 Jul.
Patients with type 2 diabetes mellitus (T2DM) often face higher postoperative complication rates. Limited data exist regarding outcomes in T2DM patients undergoing carpal tunnel release (CTR). This study compares complication rates between endoscopic CTR (ECTR) and open CTR (OCTR) in patients with T2DM.
The TriNetX database was used to perform a retrospective cohort study of 67,225 patients with T2DM who underwent ECTR (n = 17,792) or OCTR (n = 49,433). Demographic data, medical comorbidities, and complication rates were analyzed. A 1:1 propensity score match was performed to calculate risk ratios and 95% confidence intervals of postoperative median nerve injury, 6-week wound dehiscence, and 6-week wound infection.
After matching, a significantly greater number of ECTR patients had liver disease ( = <.001) and a body mass index > 40 ( = .001) compared to the OCTR group. These patients also had a lower incidence of fluid and electrolyte disorders ( = .003). Patients with T2DM who underwent ECTR had a significantly lower relative risk of 6-week wound infection, 6-week wound dehiscence, and median nerve injury (all < .001) compared to patients who underwent OCTR.
In our analysis of T2DM patients undergoing CTR, ECTR yielded significantly lower rates of wound infection, wound dehiscence, and nerve injury within 6-weeks post-surgery, reducing the risk by 43%, 52%, and 58%, respectively. These findings suggest that ECTR may result in a lower complication rate in this patient population.
TYPE OF STUDY/LEVEL OF EVIDENCE: III.
2型糖尿病（T2DM）患者术后并发症发生率通常较高。关于接受腕管松解术（CTR）的T2DM患者的预后数据有限。本研究比较了T2DM患者接受内镜下CTR（ECTR）和开放式CTR（OCTR）后的并发症发生率。
使用TriNetX数据库对67225例接受ECTR（n = 17792）或OCTR（n = 49433）的T2DM患者进行回顾性队列研究。分析人口统计学数据、合并症和并发症发生率。进行1:1倾向评分匹配，以计算术后正中神经损伤、6周伤口裂开和6周伤口感染的风险比及95%置信区间。
匹配后，与OCTR组相比，ECTR患者中患有肝病（P = <.001）和体重指数>40（P = .001）的人数明显更多。这些患者的液体和电解质紊乱发生率也较低（P = .003）。与接受OCTR的患者相比，接受ECTR的T2DM患者6周伤口感染、6周伤口裂开和正中神经损伤的相对风险显著更低（均P < .001）。
在我们对接受CTR的T2DM患者的分析中，ECTR在术后6周内产生的伤口感染、伤口裂开和神经损伤发生率显著更低，风险分别降低了43%、52%和58%。这些发现表明，ECTR可能使该患者群体的并发症发生率更低。
研究类型/证据水平：III级
