Kahan Riley, Garoosi Kassra, Enthoven Luke F, Gehring Michael, Greyson Mark
University of Colorado Anschutz School of Medicine, Aurora, USA.
Hand (N Y). 2025 May 3:15589447251333817. doi: 10.1177/15589447251333817.
Carpal tunnel syndrome (CTS), affecting approximately 8% of the population, is treated with open (oCTR) or endoscopic (eCTR) carpal tunnel release. Previous literature compares outcomes within 1 to 2 years; this study evaluated >5-year reoperation rates and short-term complications using a large electronic health record database.
A retrospective analysis using data from the TriNetX Research Network (2007-2024) identified patients with unilateral CTS who underwent either oCTR or eCTR within 1 year of diagnosis, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Propensity score matching and multiple logistic regression calculated adjusted risk and odds ratios (ORs) with 95% confidence intervals (95% CIs) to assess reoperation rates at 2, between 2 and 5, >5 years after operation and 90-day postoperative complications (wound dehiscence, surgical site infection [SSI]).
Within 2 years of CTR, reoperation rate was higher for eCTR than that for oCTR (relative risk [RR] = 1.15, 95% CI = 1.09-1.22; OR = 1.36, 95% CI = 1.21-1.53). Beyond 5 years, the revision rate of the two approaches was similar (RR = 0.85, 95% CI = 0.74-1.01; OR = 0.76, 95% CI = 0.58-1.00). The number needed to treat to prevent one reoperation within 2 years was 67, and beyond 5 years, it was 473. Within 90 days of surgery, eCTR was associated with decreased wound dehiscence (RR = 0.67, 95% CI = 0.53-0.85; OR = 0.50, 95% CI = 0.36-0.71) and SSI (RR = 0.77, 95% CI = 0.65-0.91; OR = 0.63, 95% CI = 0.48-0.81).
This study demonstrates the clinical insignificance of the difference in early CTR revision rate between approaches and that eCTR necessitates a similar reoperation rate at long term, supporting eCTR to remain an appropriate intervention for CTR.
腕管综合征（CTS）影响着约8%的人群，可通过开放式（oCTR）或内镜下（eCTR）腕管松解术进行治疗。既往文献比较了1至2年内的治疗效果；本研究使用大型电子健康记录数据库评估了5年以上的再次手术率和短期并发症。
利用TriNetX研究网络（2007 - 2024年）的数据进行回顾性分析，通过当前手术操作术语（CPT）和国际疾病分类（ICD）编码确定在诊断后1年内接受oCTR或eCTR的单侧CTS患者。倾向评分匹配和多因素逻辑回归计算调整后的风险和比值比（OR）及95%置信区间（95%CI），以评估术后2年、2至5年、5年以上的再次手术率以及术后90天内的并发症（伤口裂开、手术部位感染[SSI]）。
在CTR术后2年内，eCTR的再次手术率高于oCTR（相对风险[RR]=1.15，95%CI = 1.09 - 1.22；OR = 1.36，95%CI = 1.21 - 1.53）。5年以后，两种手术方式的翻修率相似（RR = 0.85，95%CI = 0.74 - 1.01；OR = 0.76，95%CI = 0.58 - 1.00）。为预防2年内1次再次手术所需治疗的患者数为67，5年以后为473。在术后90天内，eCTR与伤口裂开减少（RR = 0.67，95%CI = 0.53 - 0.85；OR = 0.50，95%CI = 0.36 - 0.71）和SSI减少（RR = 0.77，95%CI = 0.65 - 0.91；OR = 0.63，95%CI = 0.48 - 0.81）相关。
本研究表明两种手术方式早期CTR翻修率的差异在临床上无显著意义，且eCTR长期的再次手术率相似，支持eCTR仍是CTR的一种合适干预方式。
