Hulsizer D L, Staebler M P, Weiss A P, Akelman E
Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital, Providence, USA.
J Hand Surg Am. 1998 Sep;23(5):865-9. doi: 10.1016/S0363-5023(98)80164-0.
This study compared the outcomes of revision open carpal tunnel release following previous open versus endoscopic release to determine whether revision surgery has different results based on the type of initial surgical treatment. Thirty revision carpal tunnel releases were performed in 13 wrists that had previous endoscopic release and in 17 wrists with prior open release. At a follow-up visit an average of 30 months after surgery, self-assessment questionnaires demonstrated improved or complete symptom relief in 77% of the postendoscopic release group versus 47% in the previous open release group. Combining both groups, 18% of workers' compensation patients improved after revision surgery compared with 84% of those with conventional insurance (p < .05). Patients having persistent or recurrent symptoms following a previous endoscopic carpal tunnel release have a greater chance of symptom improvement or resolution compared with patients who had previous open carpal tunnel surgery. Our results support the observation that a higher incidence of incomplete release of the carpal tunnel is found with endoscopic surgery than with open release.
本研究比较了既往开放式与内镜下腕管松解术后翻修开放式腕管松解术的结果，以确定翻修手术是否因初始手术治疗方式的不同而有不同结果。对13例既往接受内镜下松解术的手腕和17例既往接受开放式松解术的手腕进行了30次翻修腕管松解术。在术后平均30个月的随访中，自我评估问卷显示，内镜下松解术后组77%的患者症状改善或完全缓解，而既往开放式松解术组为47%。综合两组来看，工伤赔偿患者中有18%在翻修手术后症状改善，而传统保险患者中这一比例为84%（p<0.05）。与既往接受开放式腕管手术的患者相比，既往接受内镜下腕管松解术后仍有持续或复发症状的患者症状改善或缓解的机会更大。我们的结果支持以下观察结果：与开放式手术相比，内镜手术中腕管不完全松解的发生率更高。
