腕管综合征的开放手术：是否有必要松解前臂筋膜？一项随机临床试验研究。
Open surgery for carpal tunnel syndrome: is it necessary to release the antebrachial fascia? A randomized clinical trial study.
作者信息
Razavipour Mehran, Taheri Sadegh, Abdollahi Amirsaleh, Yahaghi Yazdan
机构信息
Department of Orthopedics, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Orthopedics, Mazandaran University of Medical Sciences, Sari, Iran.
出版信息
Front Surg. 2024 Nov 27;11:1300972. doi: 10.3389/fsurg.2024.1300972. eCollection 2024.
BACKGROUND
Open surgery for carpal tunnel syndrome (CTS) has historically involved release of the antebrachial fascia. The benefit of antebrachial fascia release in CTS surgery is still controversial. So, this study was designed to evaluate this hypothesis.
METHODS
The study was designed as a two-arm randomized clinical trial study. Patients diagnosed with bilateral carpal tunnel syndrome were enrolled in the study, while those under 18 years of age and those with a history of carpal tunnel release, trauma to the spine, shoulder, or elbow, rheumatologic disease, inflammatory arthropathy, and CTS onset during pregnancy were excluded. The hands of the eligible patients were randomly assigned to two surgical groups. In the first group, the antebrachial fascia was opened to the proximal part, while in the second group, the fascia was opened from the central part of the deep layer to the distal volar part of the wrist. Pain severity, grip and pinch strength, symptom severity, and functional status were evaluated by the visual analog scale, the SAEHAN® hydraulic handgrip and pinch dynamometer, and the Boston Carpal Tunnel Questionnaire (BCTQ), respectively, at the baseline and 1, 3, and 6 months after surgery.
RESULTS
Finally, 230 patients (220 women and 10 men, 460 hands) completed the study. The mean age of the patients was 50.4 ± 8.4 years. In both open surgery groups with and without antebrachial fascia release, the grip and pinch strength, BCTQ scores, and pain severity significantly improved at the end of the study ( < 0.01), but there was no statistically significant difference between the two groups ( > 0.05). Patient satisfaction improved in both groups; again, no significant difference was observed between the two groups ( > 0.05).
CONCLUSION
Both open CTS surgery with and without antebrachial fascia release show the same clinical and functional outcomes. Therefore, avoiding the release of the antebrachial fascia preserves proprioception and prevents iatrogenic injury to the median nerve and its branches. Conversely, a blunt release of the antebrachial fascia does not adversely affect the outcome.
CLINICAL TRIAL REGISTRATION
https://irct.behdasht.gov.ir/search/result?query=@irct_id:IRCT2012103111341N1, Identifier: IRCTID: IRCT2012103111341N1.
背景
腕管综合征（CTS）的开放手术历来包括前臂筋膜松解。前臂筋膜松解在CTS手术中的益处仍存在争议。因此，本研究旨在评估这一假设。
方法
本研究设计为双臂随机临床试验研究。纳入诊断为双侧腕管综合征的患者，排除18岁以下、有腕管松解史、脊柱、肩部或肘部外伤史、风湿性疾病、炎性关节病以及孕期发生CTS的患者。符合条件的患者的手被随机分配到两个手术组。第一组，将前臂筋膜向近端打开；第二组，将筋膜从深层中央部分向腕部掌侧远端打开。分别在基线以及术后1、3和6个月，通过视觉模拟量表、SAEHAN®液压握力和捏力计以及波士顿腕管问卷（BCTQ）评估疼痛严重程度、握力和捏力、症状严重程度以及功能状态。
结果
最终，230例患者（220例女性和10例男性，共460只手）完成了研究。患者的平均年龄为50.4±8.4岁。在有和无前臂筋膜松解的两个开放手术组中，研究结束时握力和捏力、BCTQ评分以及疼痛严重程度均显著改善（<0.01），但两组之间无统计学显著差异（>0.05）。两组患者满意度均有所提高；同样，两组之间未观察到显著差异（>0.05）。
结论
有和无前臂筋膜松解的开放性CTS手术均显示出相同的临床和功能结果。因此，避免前臂筋膜松解可保留本体感觉并防止对正中神经及其分支造成医源性损伤。相反，钝性松解前臂筋膜对结果没有不利影响。
临床试验注册
https://irct.behdasht.gov.ir/search/result?query=@irct_id:IRCT2012103111341N1，标识符：IRCTID: IRCT201
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