Zaidi Zohair S, Mauffrey Océane, Jeffs Alexander D, Allen Andrew D, Wellborn Patricia K, Obudzinski Sarah E, Luther G Aman
The University of North Carolina, Department of Orthopaedics, 130 Mason Farm Road, Chapel Hill, NC.
The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC.
J Hand Surg Glob Online. 2024 Dec 4;7(2):135-138. doi: 10.1016/j.jhsg.2024.10.008. eCollection 2025 Mar.
Open carpal tunnel release (OCTR) after distal radius fractures is well described; however, the use of endoscopic carpal tunnel release (ECTR) in the setting of prior distal radius fixation is less clear. We report clinical outcomes and intraoperative findings of patients with carpal tunnel syndrome following prior ipsilateral distal radius fixation who underwent subsequent ECTR.
A retrospective cohort of patients who had undergone prior ipsilateral distal radius fixation and ECTR for ipsilateral carpal tunnel syndrome (CTS) from 2018-2023 was collected at a single institution. All patients had electrodiagnostic evidence of CTS and scored positive on the CTS-6 Questionnaire. All patients underwent ECTR within 1 year of their initial distal radius fixation. Patients with carpal tunnel release at the time of initial distal radius surgery were excluded. Postoperative outcomes included 5-point Likert scale questionnaires regarding overall satisfaction and improvement in symptoms. Intraoperative findings were noted for all patients. Complications including nerve injury, conversion to OCTR, and need for revision surgery were documented. Patients were followed for 1 year after surgery.
Twenty-two patients with electrodiagnostic evidence confirmed CTS were identified following prior distal radius fixation. Average time from initial distal radius surgery to carpal tunnel release was 3.2 months. Scarring of the median nerve (MN) to the flexor retinaculum was noted in seven patients and hemosiderin deposition along the MN was noted in four patients. Likert scale questionairre demonstrated 95% symptom improvement and 95% patient satisfaction. There were no injuries to the palmar cutaneous branch, recurrent motor branch, third common digital nerve, or MN. No patients required conversion to OCTR or revision within the 1-year follow-up.
Endoscopic carpal tunnel release provides reliable outcomes for patients with CTS after prior distal radius fixation with low complication rates and high patient satisfaction.
Prognostic IIIa.
桡骨远端骨折后行开放性腕管松解术（OCTR）已有详尽描述；然而，在先前已进行桡骨远端固定的情况下使用内镜下腕管松解术（ECTR）的情况尚不清楚。我们报告了先前同侧桡骨远端固定后出现腕管综合征的患者接受后续ECTR后的临床结果和术中发现。
在一家机构收集了2018年至2023年期间因同侧腕管综合征（CTS）接受过先前同侧桡骨远端固定和ECTR的患者的回顾性队列。所有患者均有CTS的电诊断证据，且在CTS-6问卷上得分呈阳性。所有患者在初次桡骨远端固定后1年内接受了ECTR。初次桡骨远端手术时行腕管松解的患者被排除。术后结果包括关于总体满意度和症状改善的5级李克特量表问卷。记录所有患者的术中发现。记录包括神经损伤、转为OCTR以及翻修手术需求等并发症。患者术后随访1年。
在先前桡骨远端固定后，确定了22例有CTS电诊断证据的患者。从初次桡骨远端手术到腕管松解的平均时间为3.2个月。7例患者出现正中神经（MN）与屈肌支持带粘连，4例患者沿MN有含铁血黄素沉积。李克特量表问卷显示症状改善率为95%，患者满意度为95%。掌皮支、返支运动神经、第三指总神经或MN均未受损。在1年随访期内，没有患者需要转为OCTR或进行翻修。
对于先前桡骨远端固定后出现CTS的患者，内镜下腕管松解术能提供可靠的结果，并发症发生率低，患者满意度高。
预后性IIIa级。
