Ratigan Conor M, Yocum Derek S, Fuller Sam M
From the South Bend Orthopaedics, South Bend, Ind.
Plast Reconstr Surg Glob Open. 2024 Sep 9;12(9):e6138. doi: 10.1097/GOX.0000000000006138. eCollection 2024 Sep.
Carpal tunnel release is among the most frequently conducted upper extremity procedures. While it typically provides patients with improved sensation, decreased pain, and improved function, a small percentage of cases require revision due to failed initial surgery. Consequently, adoption of endoscopic techniques for carpal tunnel revision procedures is beginning to be explored.
A retrospective analysis was conducted of postoperative clinical visits and patient-reported outcome measures for four patients who had undergone five endoscopic revision carpal tunnel release procedures (one patient had bilateral disease). All five cases had symptoms consistent with recurrent carpal tunnel syndrome.
One hundred percent (5 of 5) of cases resulted in patients reporting symptom improvement. Postoperative clinical visits and improved patient-reported outcome measures (QuickDash, PROMIS Upper Extremity, VAS Pain, PSEQ, PHQ, and Surgery Satisfaction) scores from baseline to 6 weeks demonstrated successful postoperative function and symptom resolution. Five of five cases resulted in patients resuming normal activities without restrictions within 1-5 weeks, with an average of 3.4 weeks.
Preliminary findings suggest the endoscopic revision procedure may be safe and effective for patients with recurrent carpal tunnel syndrome, extending the indications to include scars proximal to the wrist crease. Moreover, this minimally invasive procedure facilitates a transition back to normal activities and avoids incisions on weight-bearing surfaces of the palm. Adopting endoscopic revision may reduce the need for prolonged postoperative care and physical therapy. However, due to the limited sample size of five patients, further investigation with larger cohorts is warranted to confirm these observations.
腕管松解术是上肢最常开展的手术之一。虽然该手术通常能使患者感觉改善、疼痛减轻、功能增强，但仍有一小部分病例因初次手术失败而需要翻修。因此，人们开始探索将内镜技术应用于腕管翻修手术。
对4例接受了5次内镜下腕管翻修松解手术（1例患者为双侧病变）的患者的术后临床就诊情况及患者报告的结局指标进行回顾性分析。所有5例患者的症状均符合复发性腕管综合征。
100%（5/5）的病例患者报告症状改善。术后临床就诊情况以及患者报告结局指标（QuickDash、上肢患者报告结局测量信息系统、视觉模拟评分法疼痛评分、患者自我效能问卷、患者健康问卷和手术满意度）从基线到6周的评分显示术后功能恢复及症状缓解情况良好。5例患者均在1至5周内恢复正常活动且无限制，平均为3.4周。
初步研究结果表明，内镜翻修手术对于复发性腕管综合征患者可能是安全有效的，其适应证扩展至包括腕横纹近端的瘢痕。此外，这种微创手术有助于患者恢复正常活动，并避免在手掌的负重面上进行切口。采用内镜翻修术可能会减少术后长期护理和物理治疗的需求。然而，由于仅5例患者样本量有限，有必要通过更大样本量的队列研究来进一步证实这些观察结果。
