一种新型的腕管上韧带内镜松解术:手术技术、临床疗效和安全性(48例连续病例系列研究)

13 August 2021


Kok Kheng Teh, Jayaletchumi Gunasagaran, Ch’ng Hwei, Choo Tunku Sara Ahmad

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摘要

Purpose

Endoscopic carpal tunnel release has been shown to have a shorter recovery period than open surgery. This study was aimed at assessing the efficacy and possible clinical complications of a novel supraretinacular endoscopic carpal tunnel release technique.

Methods

A total of 50 cases involving 46 patients were evaluated in this prospective study, in which all surgeries were performed by a single surgeon between 2016 and 2018. The patients were evaluated preoperatively; at 3, 7, and 14 days after surgery; and at 1, 3, and 6 months after surgery. The effectiveness of the surgery was evaluated using pinch and grip strengths, modified table test, visual analog scale pain score, the Disabilities of the Arm, Shoulder and Hand, the Boston Carpal Tunnel Questionnaire symptom severity scale, and the Boston Carpal Tunnel Questionnaire functional status scale. The Friedman test and Wilcoxon signed-rank test were used for a statistical analysis.

Results

At 6 months after the surgery, all measured parameters showed improvements. The pinch strength score improved from 2.29 kg before the surgery to 2.96 kg 6 months after the surgery (P = .003), the grip strength score improved from 12.10 kg to 13.98 kg (P = .028), the modified table test score increased from 6.55 kg to 8.76 kg (P < .001), the visual analog scale score decreased from 6.31 to 0.52 (P < .001), the Disabilities of the Arm, Shoulder and Hand score reduced from 41.66 to 14.10 (P < .001), and the Boston Carpal Tunnel Questionnaire symptom severity scale and the Boston Carpal Tunnel Questionnaire functional status scale scores reduced from 2.68 to 1.51 (P < .001) and from 2.56 to 1.44 (P < .001), respectively. There were no serious injuries or complications reported in this series.

Conclusions

This new supraretinacular endoscopic carpal tunnel release technique was shown to be efficacious in this series.


参考资料

  1. Trumble, T. E., Diao, E., Abrams, R. A., & Gilbert-Anderson, M. M. (2002). Single-portal endoscopic carpal tunnel release compared with open release: A prospective, randomized trial. The Journal of Bone and Joint Surgery, 84(7), 1107–1115. https://doi.org/10.2106/00004623-200207000-00003
  2. Li, Y., Luo, W., Wu, G., Cui, S., Zhang, Z., & Gu, X. (2020). Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders, 21(1), 1–16. https://doi.org/10.1186/s12891-020-03306-1
  3. Agee, J. M., McCarroll, H. R., Jr., Tortosa, R. D., Berry, D. A., Szabo, R. M., & Peimer, C. A. (1992). Endoscopic release of the carpal tunnel: A randomized prospective multicenter study. The Journal of Hand Surgery, 17(6), 987–995. https://doi.org/10.1016/S0363-5023(09)91044-9
  4. Chow, J. C., & Hantes, M. E. (2002). Endoscopic carpal tunnel release: Thirteen years’ experience with the Chow technique. The Journal of Hand Surgery, 27(6), 1011–1018. https://doi.org/10.1053/jhsu.2002.35884
  5. Ip, W. Y., Sweed, T. A., Fung, K. K., Tipoe, G. L., & Pun, T. S. (2012). A new technique of single portal endoscopic carpal tunnel release. Techniques in Hand & Upper Extremity Surgery, 16(1), 27–29. https://doi.org/10.1097/BTH.0b013e318230db42
  6. Ecker, J., Perera, N., & Ebert, J. (2015). Supraretinacular endoscopic carpal tunnel release: Surgical technique with prospective case series. Journal of Hand Surgery (European Volume), 40(2), 193–198. https://doi.org/10.1177/1753193414524688
  7. Teh, K. K., Shanmugam, R., Ngim, J. H., & Ahmad, T. S. (2019). A novel supraretinacular endoscopic carpal tunnel release: Instrumentation and technique (cadaveric study). Journal of Hand Surgery Global Online, 1(4), 222–225.
  8. Roh, Y. H., Koh, Y. D., Kim, J. O., Lee, K. H., Gong, H. S., & Baek, G. H. (2018). Preoperative pain sensitization is associated with postoperative pillar pain after open carpal tunnel release. Clinical Orthopaedics and Related Research, 476(4), 734–740. https://doi.org/10.1007/s11999.0000000000000096
  9. Mirza, M. A., King, E. T., Jr., & Tanveer, S. (1995). Palmar uniportal extrabursal endoscopic carpal tunnel release. Arthroscopy, 11(1), 82–90. https://doi.org/10.1016/0749-8063(95)90093-4
  10. Atroshi, I., Larsson, G. U., Ornstein, E., Hofer, M., Johnsson, R., & Ranstam, J. (2006). Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: Randomised controlled trial. BMJ, 332(7556), 1473. https://doi.org/10.1136/bmj.38863.632789.1F
  11. Filippi, R., Reisch, R., El-Shki, D., & Grunert, P. (2002). Uniportal endoscopic surgery of carpal tunnel syndrome: Technique and clinical results. Minimally Invasive Neurosurgery, 45(2), 78–83. https://doi.org/10.1055/s-2002-32490
  12. Chen, A. C., Wu, M. H., Chang, C. H., Cheng, C. Y., & Hsu, K. Y. (2011). Single portal endoscopic carpal tunnel release: Modification of Menon’s technique and data from 65 cases. International Orthopaedics, 35(1), 61–65. https://doi.org/10.1007/s00264-010-1022-8
  13. Luchetti, R., & Amadio, P. (2002). Carpal tunnel syndrome (pp. 13–20). Springer.
  14. Benson, L. S., Bare, A. A., Nagle, D. J., Harder, V. S., Williams, C. S., & Visotsky, J. L. (2006). Complications of endoscopic and open carpal tunnel release. Arthroscopy, 22(9), 919–924. https://doi.org/10.1016/j.arthro.2006.05.008

引用

Teh, K. K., Gunasagaran, J., Choo, C. H., & Ahmad, T. S. (2021). A Novel Supraretinacular Endoscopic Carpal Tunnel Release: Surgical Technique, Clinical Efficacy and Safety (A Series of 48 Consecutive Cases). Journal of hand surgery global online3(6), 329–334. https://doi.org/10.1016/j.jhsg.2021.06.011

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