Bessette L, Keller R B, Lew R A, Simmons B P, Fossel A H, Mooney N, Katz J N
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Rheumatol. 1997 Apr;24(4):726-34.
To evaluate symptom patterns on a hand diagram as predictors of surgical outcome in carpal tunnel syndrome (CTS).
202 patients with CTS enrolled in a prospective, community based cohort study in Maine completed a hand symptom diagram before surgery and at 6 month followup. They were asked to mark on the hand diagram the location of 3 symptoms: pain, numbness/tingling (NT), and "other" symptoms. The diagram was first divided into 6 regions following a standardized procedure. For the 6 regions, symptom patterns were identified separately for each of the 3 symptoms. Outcomes 6 months after surgery were expressed as the percentage of change on the Symptom Severity Scale and Function Status Scale of the Carpal Tunnel Syndrome Assessment Questionnaire, and the satisfaction with the results of the surgery.
Several distinct symptom patterns were associated with the 3 principal outcomes in univariate and multivariate analysis. In linear regression models controlling for the baseline severity of symptoms and function, as well as other predictors, the hand symptom pattern variables accounted for 30, 14, and 24%, respectively, of the total explained variance in satisfaction, symptom severity, and functional status. Patients receiving Workers' Compensation (37% of the cohort) had more wrist pain and NT of the arm, and less pain involving the arm and upper palm. This group also had worse outcomes and were less satisfied with surgery. Drawing expansion was associated with a low score on the SF-36 mental health subscale. However, psychological impairment was not associated with a worse outcome.
Symptom patterns identified preoperatively with a hand symptom diagram help to predict the outcome of carpal tunnel release.
评估手部示意图上的症状模式作为腕管综合征（CTS）手术结果的预测指标。
202例CTS患者参与了缅因州一项基于社区的前瞻性队列研究，在手术前及术后6个月随访时完成了一份手部症状示意图。他们被要求在手部示意图上标记出三种症状的位置：疼痛、麻木/刺痛（NT）和“其他”症状。按照标准化程序，该示意图首先被划分为6个区域。对于这6个区域，分别针对三种症状中的每一种确定症状模式。手术后6个月的结果用腕管综合征评估问卷的症状严重程度量表和功能状态量表上的变化百分比以及对手术结果的满意度来表示。
在单变量和多变量分析中，几种不同的症状模式与三个主要结果相关。在控制症状和功能的基线严重程度以及其他预测因素的线性回归模型中，手部症状模式变量分别占满意度、症状严重程度和功能状态总解释方差的30%、14%和24%。接受工伤赔偿的患者（占队列的37%）手腕疼痛和手臂NT更多，而涉及手臂和手掌上部的疼痛更少。该组患者的手术结果也更差，对手术的满意度更低。绘图扩展与SF - 36心理健康子量表得分低相关。然而，心理障碍与较差的手术结果无关。
术前通过手部症状示意图确定的症状模式有助于预测腕管松解术的结果。
