Lee Julianna, Buttrick Eliza, Shah Apurva S
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Soc North Am. 2024 Apr 30;7:100027. doi: 10.1016/j.jposna.2024.100027. eCollection 2024 May.
Given limited information about acute carpal tunnel syndrome (CTS) in children, the purpose of this study is to describe the presentation and treatment results of CTS after traumatic wrist or forearm injury in a pediatric population.
In this retrospective single-center cohort study, all children with post-traumatic CTS were identified. Demographic and clinical presentation, treatment, and outcomes data were collected from the electronic medical record. Descriptive statistics were calculated for variables of interest, and Χ and independent sample t-tests were used for subgroup comparisons.
18 patients (16 male, average age 12.8 ± 3.6 years) with post-traumatic CTS were identified. 13 presented acutely (<3 days) versus 4 subacutely (1-6 weeks) and one delayed presentation (>6 weeks) after injury. Of associated traumas, 83% (15/18) involved distal radius fractures, of which 40% (6/15) had an associated ulna fracture. The most common symptoms were numbness (78%), paresthesias (33%), and increasing pain (28%). Three patients had clinical concerns for concomitant compartment syndrome. 6 patients were initially monitored (2 acute, 3 subacute, 1 delayed). Ultimately, 16/18 underwent operative release (13/13 acute, 2/4 subacute, 1/1 delayed). At follow-up, 81% of the surgically treated patients had complete symptomatic relief. There was no statistically significant difference in treatment outcomes between acute versus subacute or delayed presentation (OR: 6.67, p = .214). Of patients with acute CTS, delayed surgery resulted in prolonged recovery (28.0 vs. 2.4 weeks, p < .001).
Post-traumatic CTS more often presents acutely than as a delayed complication of distal radius fractures in children. The type of injury and clinical presentation can vary, but patients most often present with median neuropathy symptoms like numbness. Acute CTS should be treated urgently with carpal tunnel release. While patients with delayed presentation can trial observation, the patient will likely warrant surgery for complete symptom relief. Operative treatment for both acute and subacute cases generally results in positive outcomes.
(1)Post-traumatic CTS may present acutely as a complication of distal radius fractures in children with symptoms of numbness, paresthesias, and increasing pain.(2)Acute CTS should be treated with urgent carpal tunnel release to avoid prolonged recovery.(3)Children with delayed presentation of CTS can be safely monitored, but the patient often needs surgery to experience complete symptom relief.(4)Operative treatment for post-traumatic CTS in children generally results in positive outcomes.
IV Case Series.
鉴于儿童急性腕管综合征（CTS）的相关信息有限，本研究旨在描述儿科人群中腕部或前臂创伤后CTS的表现及治疗结果。
在这项回顾性单中心队列研究中，确定了所有创伤后CTS患儿。从电子病历中收集人口统计学和临床表现、治疗及结局数据。对感兴趣的变量进行描述性统计，并使用χ²检验和独立样本t检验进行亚组比较。
确定了18例创伤后CTS患儿（16例男性，平均年龄12.8±3.6岁）。13例为急性发病（<3天），4例为亚急性发病（1 - 6周），1例为延迟发病（>6周）。在相关创伤中，83%（15/18）涉及桡骨远端骨折，其中40%（6/15）合并尺骨骨折。最常见的症状是麻木（78%）、感觉异常（33%）和疼痛加剧（28%）。3例患者临床上怀疑合并骨筋膜室综合征。6例患者最初接受观察（2例急性、3例亚急性、1例延迟）。最终，16/18例患者接受了手术松解（13/13例急性、2/4例亚急性、1/1例延迟）。随访时，81%接受手术治疗的患者症状完全缓解。急性与亚急性或延迟发病患者的治疗结局无统计学显著差异（OR：6.67，p = 0.214）。急性CTS患者延迟手术导致恢复时间延长（28.0对2.4周，p < 0.001）。
创伤后CTS在儿童中更多表现为急性发病，而非桡骨远端骨折的延迟并发症。损伤类型和临床表现可能各异，但患者最常出现如麻木等正中神经病变症状。急性CTS应紧急行腕管松解术治疗。虽然延迟发病患者可先观察，但可能仍需手术以完全缓解症状。急性和亚急性病例的手术治疗通常能取得良好效果。
（1）创伤后CTS可能作为儿童桡骨远端骨折的并发症急性出现，伴有麻木、感觉异常和疼痛加剧症状。（2）急性CTS应紧急行腕管松解术治疗以避免恢复时间延长。（3）CTS延迟发病的儿童可安全观察，但通常需要手术才能完全缓解症状。（4）儿童创伤后CTS的手术治疗通常能取得良好效果。
IV病例系列。
