Panwar Ajay, Roy Ujjawal, Srivastava Achal Kumar, Surange Pankaj N, Gupta Praveen
Neurology, Rotary Ambala Cancer and General Hospital, Ambala Cantt, IND.
Neurology, Pulse Hospital, Ranchi, IND.
Cureus. 2024 Dec 13;16(12):e75681. doi: 10.7759/cureus.75681. eCollection 2024 Dec.
This study evaluates the efficacy of a sequential dual one-month interval hydrodissection (HD) protocol in mild-moderate as well as severe carpal tunnel syndrome (CTS) cases, with a comprehensive analysis of clinical and electrophysiological outcomes.
A retrospective analysis was conducted on 286 patients (379 wrists) treated between 2021 and 2024 at two centers in India. The enrolled patient population was divided into mild-moderate and severe CTS subgroups. The dual HD protocol comprised an initial HD with methylprednisolone acetate followed by another with 5% dextrose in water (D5W) one month later. Clinical and electrophysiological characteristics were assessed and compared at baseline and three months after initiating the treatment. Outcomes were measured in terms of Visual Analog Scale (VAS) scores, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and nerve conduction studies (NCS) parameters.
The number of patients categorized into mild-moderate and severe subgroups was 239 (321 wrists) and 47 (58 wrists), respectively. Significant improvements were noted among both subgroups. In the mild-moderate subgroup, mean VAS scores decreased from 2.03 to 0.12 (p<0.001). BCTQ functional and severity scores also showed a significant improvement (p<0.001). In the severe subgroup, mean VAS scores decreased from 7.43 to 2.12 (p<0.001), and BCTQ scores also decreased significantly (p<0.001). The key highlight of the study was significant electrophysiological improvement, with 71% of the severe CTS patients showing recordable sensory nerve action potentials (SNAPs) that were non-recordable at baseline.
The dual HD protocol was efficacious in improving clinical as well as electrophysiological outcomes in both mild-moderate and severe CTS patients. This study presents the dual HD strategy as a potentially effective minimally invasive alternative to surgery in severe cases where surgical intervention is the conventional treatment. Further randomized controlled trials with a longer follow-up period are warranted to validate these findings.
本研究评估了序贯双月间隔水分离（HD）方案在轻中度以及重度腕管综合征（CTS）病例中的疗效，并对临床和电生理结果进行了综合分析。
对2021年至2024年期间在印度两个中心接受治疗的286例患者（379只手腕）进行了回顾性分析。纳入的患者群体被分为轻中度和重度CTS亚组。双HD方案包括初始使用醋酸甲基强的松龙进行水分离，随后在一个月后使用5%葡萄糖溶液（D5W）进行另一次水分离。在基线和开始治疗三个月后评估并比较临床和电生理特征。结果通过视觉模拟量表（VAS）评分、波士顿腕管问卷（BCTQ）评分和神经传导研究（NCS）参数进行衡量。
分为轻中度和重度亚组的患者数量分别为239例（321只手腕）和47例（58只手腕）。两个亚组均有显著改善。在轻中度亚组中，平均VAS评分从2.03降至0.12（p<0.001）。BCTQ功能和严重程度评分也显示出显著改善（p<0.001）。在重度亚组中，平均VAS评分从7.43降至2.12（p<0.001），BCTQ评分也显著降低（p<0.001）。该研究的关键亮点是电生理有显著改善，71%的重度CTS患者在基线时无法记录到感觉神经动作电位（SNAPs），而治疗后可记录到。
双HD方案在改善轻中度和重度CTS患者的临床和电生理结果方面均有效。本研究提出双HD策略作为在手术干预为传统治疗方法的严重病例中一种潜在有效的微创替代手术方法。需要进行进一步的长期随访随机对照试验来验证这些发现。
