Lakhlani Devi, Shahoumian Troy A, Curtin Catherine
Stanford Medicine, Stanford, CA, USA.
Veterans Health Administration, Washington, DC, USA.
Int Orthop. 2025 Apr;49(4):805-812. doi: 10.1007/s00264-024-06395-y. Epub 2025 Jan 4.
Subclinical peroneal neuropathy without overt foot drop has been linked to increased fall risk in adults, yet remains under reported due to subtle symptoms and lack of awareness. Patients with carpal tunnel syndrome (CTS) often experience other nerve entrapments, prompting this study to evaluate CTS (a proxy for peroneal nerve entrapment) as a significant predictor of time to first fall.
Data from the Merative MarketScan Research Databases (2007-2021) were used to identify adult patients using ICD-9/10 codes. Patients were stratified by CTS diagnosis and fall occurrences, with relevant comorbidities recorded. A survival analysis employing the Cox proportional hazards model assessed relationships between CTS, comorbidities, and future fall risk, accounting for changes in health status over time. Age was the time scale with CTS as a time-varying predictor. This approach isolated CTS-associated risk, while considering the natural increase in fall risk with age.
Among 63,187,681 subjects (mean age = 52.82 years ± 7.61), 1,411,695 had a diagnosis of CTS. Of those with CTS, 45,479 patients had a future fall. Univariate analysis showed significant associations between CTS and higher rates of arthritis and diabetes, while heart disease was less prevalent. CTS increased fall risk by 25% (HR 1.25, p < .005). Heart disease was associated with a 10% increase in fall risk (HR 1.10, p < .005), while arthritis and diabetes increased fall risk by 2% (both HR 1.02, p < .005). Kaplan-Meier curve illustrated a steeper decline in survival probability for the CTS group, indicating they experienced falls at younger ages and at a higher rate than those without CTS (χ² = 4386.4, p < .001).
Prior diagnosis of CTS is associated with an increased fall risk. Providers should screen CTS patients for fall risk and implement appropriate monitoring strategies. Further investigation on the role of peroneal nerve entrapment in this increased fall risk is warranted. This study identifies a treatable cause of falls, with potential to enhance patient safety and reduce fall-related morbidity.
无明显足下垂的亚临床腓总神经病变与成年人跌倒风险增加有关，但由于症状不明显和认识不足，其报告率仍然较低。腕管综合征（CTS）患者常伴有其他神经卡压，促使本研究评估CTS（作为腓总神经卡压的替代指标）是否是首次跌倒时间的重要预测因素。
使用来自默克多市场扫描研究数据库（2007 - 2021年）的数据，通过ICD - 9/10编码识别成年患者。患者按CTS诊断和跌倒发生情况分层，并记录相关合并症。采用Cox比例风险模型进行生存分析，评估CTS、合并症与未来跌倒风险之间的关系，同时考虑健康状况随时间的变化。以年龄为时间尺度，CTS作为随时间变化的预测因素。这种方法在考虑跌倒风险随年龄自然增加的同时，分离出与CTS相关的风险。
在63187681名受试者（平均年龄 = 52.82岁±7.61岁）中，1411695人被诊断为CTS。在这些CTS患者中，45479人未来发生了跌倒。单因素分析显示，CTS与较高的关节炎和糖尿病发生率之间存在显著关联，而心脏病的发生率较低。CTS使跌倒风险增加25%（风险比1.25，p <.005）。心脏病使跌倒风险增加10%（风险比1.10，p <.005），而关节炎和糖尿病使跌倒风险增加2%（风险比均为1.02，p <.005）。Kaplan - Meier曲线显示CTS组的生存概率下降更为陡峭，表明他们比无CTS者在更年轻的年龄发生跌倒，且跌倒发生率更高（χ² = 4386.4，p <.001）。
既往CTS诊断与跌倒风险增加有关。医疗服务提供者应筛查CTS患者的跌倒风险，并实施适当的监测策略。有必要进一步研究腓总神经卡压在这种跌倒风险增加中所起的作用。本研究确定了一个可治疗的跌倒原因，有可能提高患者安全性并降低与跌倒相关的发病率。
