超声引导下腕管释放与开放和小开放腕管释放：随机对照试验的系统回顾和荟萃分析

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.04.001

Seper Ekhtiari MD, MSc , Mark Phillips PhD , Dalraj Dhillon BSc , Ali Shahabinezhad MD , Conner McMains MD , Bill Dzwierzynski MD , Mohit Bhandari MD, PhD

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引用次数: 0

摘要

目的腕管释放术（CTR）可采用几种技术，包括传统的开放式CTR、微型开放式CTR、内镜下CTR （ECTR）和超声引导下的CTR （cr - us）。超声引导下的腕管松解术可以通过一个小的非掌心切口进行，同时保持关键解剖结构的可视化，并可能在早期恢复和切口相关并发症方面带来好处。本研究的目的是基于随机对照试验（RCTs）的证据，将CTR- us与传统的开放式或迷你开放式CTR进行比较。方法检索Embase和MEDLINE电子数据库，检索时间为建库至2022年11月。将CTR- us与传统开放式或迷你开放式CTR进行比较的随机对照试验符合纳入条件。从题目和摘要对研究的合格性进行评估，然后进行全文审查。主要关注的结果是恢复正常活动或恢复工作，患者报告的功能评分和并发症。结果3项随机对照试验符合纳入条件，共221例患者被随机化。meta分析显示，与开放式CTR患者相比，接受CTR- us治疗的患者在3个月时的功能评分明显更高(标准化平均差：- 0.91,95%可信区间（CI）： - 1.38至- 0.44,P <；0.01)和更快地恢复正常活动（平均差异：- 20.8天，95% CI: - 21.77至- 19.73）。两组并发症发生率无显著差异（优势比：0.80,95% CI: 0.04 ~ 15.10, P = 0.07）。在任何研究中，没有领域被认为具有高偏倚风险。结论基于现有证据，CTR- us是一种安全有效的治疗腕管综合征的手术选择，其风险与开放式CTR相似。数据显示，接受cr - us治疗的患者功能预后得到改善，恢复工作或正常活动的速度更快。未来需要更大样本量的随机对照试验来证实这些益处，并证明cr - us的长期效果。研究类型/证据水平：治疗性II。

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Carpal Tunnel Release with Ultrasound Guidance Versus Open and Mini-Open Carpal Tunnel Release: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Purpose

Carpal tunnel release (CTR) can be performed using several techniques, including traditional open CTR, mini-open CTR, endoscopic CTR (ECTR), and CTR with ultrasound guidance (CTR-US). Carpal tunnel release with ultrasound guidance allows the procedure to be performed through a small, nonpalmar incision while maintaining visualization of critical anatomy and may confer benefits in terms of early recovery and incision-related complications. The objective of this study was to compare CTR-US with traditional open or mini-open CTR based on evidence from randomized controlled trials (RCTs).

Methods

The electronic databases Embase and MEDLINE were searched from inception to November 2022. Randomized controlled trials comparing CTR-US with traditional open or mini-open CTR were eligible for inclusion. Studies were assessed for eligibility from title and abstract followed by a full-text review. The main outcomes of interest were return to normal activity or return to work, patient-reported functional scores, and complications.

Results

Three RCTs were eligible for inclusion with a total of 221 patients randomized. Meta-analysis demonstrated that compared with open CTR patients, patients treated with CTR-US had significantly higher functional scores at 3 months (standardized mean difference: −0.91, 95% confidence interval (CI): −1.38 to −0.44, P < .01) and faster return to normal activities (mean difference: −20.8 days, 95% CI: −21.77 to −19.73). There was no significant difference in complication rates between the two groups (odds ratio: 0.80, 95% CI: 0.04–15.10, P = .07). No domains were deemed to be at high risk of bias in any study.

Conclusions

Based on the available evidence, CTR-US is a safe and effective surgical option for treating carpal tunnel syndrome with a similar risk profile to open CTR. Data suggest that patients who receive CTR-US have improved functional outcomes and faster return to work or normal activities. Future RCTs with larger sample sizes are needed to corroborate these benefits and demonstrate long-term outcomes of CTR-US.