Wellborn Patricia K, Jeffs Alexander D, Allen Andrew D, Zaidi Zohair S, Luther G Aman
Department of Orthopaedics, University of North Carolina, Chapel Hill, NC; Department of Orthopaedics, University of Colorado, Aurora, CO.
Department of Orthopaedics, University of North Carolina, Chapel Hill, NC.
J Hand Surg Am. 2024 Dec 16. doi: 10.1016/j.jhsa.2024.10.016.
The standard treatment for recurrent carpal tunnel syndrome (CTS) has been open revision. We hypothesize that endoscopic carpal tunnel release can be used successfully in the revision setting.
We identified patients between 2018-2023 who underwent revision carpal tunnel release (CTR). All patients underwent prior open or mini-open CTR (OCTR). All had electrodiagnostically proven CTS and CTS-6 scores >12. Those with suspected or documented nerve injury after primary CTR were excluded. Patient-reported outcomes, including visual analog scale pain scores and 5-point Likert-style rating of symptom improvement, were collected.
Thirty patients were identified: 22 with recurrent and 8 with persistent CTS. Average time from index surgery was 110 months in recurrent and 18 months in persistent CTS cases. Twenty-five patients had prior mini-open CTR, and five underwent traditional-open CTR. Intraoperative findings included incomplete release (n = 4), median nerve (MN) adhesions to skin (n = 1) or flexor retinaculum (n = 4), inadequate visualization of the MN (n = 5) and no documented findings (n = 17). Five of 30 patients (16%) were converted from endoscopic to open release procedures intraoperatively. All conversions occurred in patients with prior traditional-open CTR and incisions crossing the wrist flexion crease. At 6-month follow-up, average visual analog pain scores improved from 7 to 2 after revision endoscopic release and from 7 to 3 in cases in which conversion from endoscopic to open release was required. Of the patients, 92% in the revision endoscopic group and 60% in the conversion group had symptom improvement (5-point Likert score ≥3 at final follow-up).
Revision endoscopic carpal tunnel release can be performed successfully after primary mini-open CTR. A prior traditional OCTR with an incision crossing the wrist crease is more likely to require conversion to open release. A lower proportion of patients converted to OCTR have postoperative symptom improvement than those treated with revision endoscopic release.
Therapeutic IV.
复发性腕管综合征（CTS）的标准治疗方法一直是开放性翻修手术。我们假设内镜下腕管松解术可成功用于翻修手术。
我们确定了2018年至2023年间接受腕管松解术（CTR）翻修的患者。所有患者均曾接受过开放性或小切口开放性CTR（OCTR）。所有患者均经电诊断证实患有CTS且CTS-6评分>12。排除初次CTR后怀疑或记录有神经损伤的患者。收集患者报告的结果，包括视觉模拟量表疼痛评分和症状改善的5分制李克特式评分。
共确定30例患者：22例为复发性CTS，8例为持续性CTS。复发性CTS患者距初次手术的平均时间为110个月，持续性CTS患者为18个月。25例患者曾接受过小切口开放性CTR，5例接受过传统开放性CTR。术中发现包括松解不完全（n = 4）、正中神经（MN）与皮肤粘连（n = 1）或与屈肌支持带粘连（n = 4）、MN可视化不充分（n = 5）以及未记录到异常发现（n = 17）。30例患者中有5例（16%）在术中由内镜手术转为开放手术。所有转为开放手术的患者均为曾接受过传统开放性CTR且切口越过腕部屈曲横纹的患者。在6个月的随访中，翻修内镜松解术后平均视觉模拟疼痛评分从7分改善至2分，而需要从内镜手术转为开放手术的患者评分从7分改善至3分。在内镜翻修组中，92%的患者症状改善，在转为开放手术组中，60%的患者症状改善（末次随访时5分制李克特评分≥3）。
初次小切口开放性CTR后可成功进行翻修内镜下腕管松解术。先前接受过切口越过腕横纹的传统OCTR的患者更有可能需要转为开放手术。转为OCTR的患者术后症状改善的比例低于接受翻修内镜松解术治疗的患者。
治疗性IV级。
