Katz J N, Keller R B, Simmons B P, Rogers W D, Bessette L, Fossel A H, Mooney N A
Department of Orthopedic Surgery, and Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Hand Surg Am. 1998 Jul;23(4):697-710. doi: 10.1016/S0363-5023(98)80058-0.
A prospective, community-based, observational study of the outcome of surgical and nonoperative management was conducted. The study included 429 patients with carpal tunnel syndrome recruited in physicians' offices throughout Maine. Patients were assessed at baseline and at 6, 18, and 30 months following presentation using validated scales that measured symptom severity, functional status, and satisfaction. Seventy-seven percent of eligible survivors from the original cohort were monitored for 30 months. Surgically treated patients demonstrated improvements of 1.2 to 1.6 points on the 5-point Symptom Severity and Functional Status scales (23% to 45% improvement in scores), which persisted over the 30-month follow-up period. The nonoperatively managed patients showed little change in clinical status at 6, 18, and 30 months. While workers' compensation recipients had worse outcomes than nonrecipients, 36 of 68 (53%) workers' compensation recipients were completely or very satisfied with the results of the procedure 30 months after surgery. There were no significant differences in outcome between patients treated with endoscopic versus open carpal tunnel release. Among worker's compensation recipients, 12 of 68 (18%) surgical patients and 4 of 32 (13%) nonoperatively treated patients remained out of work because of carpal tunnel syndrome at 30 months. Thus, carpal tunnel surgery offered excellent symptom relief and functional improvement in this prospective community-based sample, irrespective of the surgical approach, even in workers' compensation recipients. Work absence remained high in both surgically and nonoperatively managed workers' compensation recipients.
开展了一项基于社区的前瞻性观察性研究，以评估手术治疗和非手术治疗的效果。该研究纳入了缅因州各地医生办公室招募的429例腕管综合征患者。在基线以及就诊后6个月、18个月和30个月时，使用经过验证的量表对患者进行评估，这些量表用于测量症状严重程度、功能状态和满意度。对原队列中77%符合条件的幸存者进行了30个月的监测。接受手术治疗的患者在5分制症状严重程度和功能状态量表上的得分提高了1.2至1.6分（得分提高了23%至45%），且在30个月的随访期内一直保持。非手术治疗的患者在6个月、18个月和30个月时临床状态变化不大。虽然领取工伤赔偿的患者比未领取者的预后更差，但68例领取工伤赔偿的患者中有36例（53%）在手术后30个月对手术结果完全或非常满意。在内镜下与开放性腕管松解术治疗的患者之间，治疗效果没有显著差异。在领取工伤赔偿的患者中，68例手术患者中有12例（18%）、32例非手术治疗患者中有4例（13%）在30个月时因腕管综合征仍未工作。因此，在这个基于社区的前瞻性样本中，无论采用何种手术方式，即使是领取工伤赔偿的患者，腕管手术也能显著缓解症状并改善功能。手术治疗和非手术治疗的领取工伤赔偿的患者缺勤率仍然很高。
