先前桡骨远端固定后的内窥镜腕管释放：临床结果和术中发现

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.10.008

Zohair S. Zaidi MD , Océane Mauffrey , Alexander D. Jeffs MD , Andrew D. Allen MD , Patricia K. Wellborn MD , Sarah E. Obudzinski MD , G. Aman Luther MD

{"title":"先前桡骨远端固定后的内窥镜腕管释放：临床结果和术中发现","authors":"Zohair S. Zaidi MD , Océane Mauffrey , Alexander D. Jeffs MD , Andrew D. Allen MD , Patricia K. Wellborn MD , Sarah E. Obudzinski MD , G. Aman Luther MD","doi":"10.1016/j.jhsg.2024.10.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Open carpal tunnel release (OCTR) after distal radius fractures is well described; however, the use of endoscopic carpal tunnel release (ECTR) in the setting of prior distal radius fixation is less clear. We report clinical outcomes and intraoperative findings of patients with carpal tunnel syndrome following prior ipsilateral distal radius fixation who underwent subsequent ECTR.</div></div><div><h3>Methods</h3><div>A retrospective cohort of patients who had undergone prior ipsilateral distal radius fixation and ECTR for ipsilateral carpal tunnel syndrome (CTS) from 2018–2023 was collected at a single institution. All patients had electrodiagnostic evidence of CTS and scored positive on the CTS-6 Questionnaire. All patients underwent ECTR within 1 year of their initial distal radius fixation. Patients with carpal tunnel release at the time of initial distal radius surgery were excluded. Postoperative outcomes included 5-point Likert scale questionnaires regarding overall satisfaction and improvement in symptoms. Intraoperative findings were noted for all patients. Complications including nerve injury, conversion to OCTR, and need for revision surgery were documented. Patients were followed for 1 year after surgery.</div></div><div><h3>Results</h3><div>Twenty-two patients with electrodiagnostic evidence confirmed CTS were identified following prior distal radius fixation. Average time from initial distal radius surgery to carpal tunnel release was 3.2 months. Scarring of the median nerve (MN) to the flexor retinaculum was noted in seven patients and hemosiderin deposition along the MN was noted in four patients. Likert scale questionairre demonstrated 95% symptom improvement and 95% patient satisfaction. There were no injuries to the palmar cutaneous branch, recurrent motor branch, third common digital nerve, or MN. No patients required conversion to OCTR or revision within the 1-year follow-up.</div></div><div><h3>Conclusions</h3><div>Endoscopic carpal tunnel release provides reliable outcomes for patients with CTS after prior distal radius fixation with low complication rates and high patient satisfaction.</div></div><div><h3>Level of Evidence</h3><div>Prognostic IIIa.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 135-138"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Endoscopic Carpal Tunnel Release after Prior Distal Radius Fixation: Clinical Outcomes and Intraoperative Findings\",\"authors\":\"Zohair S. Zaidi MD , Océane Mauffrey , Alexander D. Jeffs MD , Andrew D. Allen MD , Patricia K. Wellborn MD , Sarah E. Obudzinski MD , G. Aman Luther MD\",\"doi\":\"10.1016/j.jhsg.2024.10.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Open carpal tunnel release (OCTR) after distal radius fractures is well described; however, the use of endoscopic carpal tunnel release (ECTR) in the setting of prior distal radius fixation is less clear. We report clinical outcomes and intraoperative findings of patients with carpal tunnel syndrome following prior ipsilateral distal radius fixation who underwent subsequent ECTR.</div></div><div><h3>Methods</h3><div>A retrospective cohort of patients who had undergone prior ipsilateral distal radius fixation and ECTR for ipsilateral carpal tunnel syndrome (CTS) from 2018–2023 was collected at a single institution. All patients had electrodiagnostic evidence of CTS and scored positive on the CTS-6 Questionnaire. All patients underwent ECTR within 1 year of their initial distal radius fixation. Patients with carpal tunnel release at the time of initial distal radius surgery were excluded. Postoperative outcomes included 5-point Likert scale questionnaires regarding overall satisfaction and improvement in symptoms. Intraoperative findings were noted for all patients. Complications including nerve injury, conversion to OCTR, and need for revision surgery were documented. Patients were followed for 1 year after surgery.</div></div><div><h3>Results</h3><div>Twenty-two patients with electrodiagnostic evidence confirmed CTS were identified following prior distal radius fixation. Average time from initial distal radius surgery to carpal tunnel release was 3.2 months. Scarring of the median nerve (MN) to the flexor retinaculum was noted in seven patients and hemosiderin deposition along the MN was noted in four patients. Likert scale questionairre demonstrated 95% symptom improvement and 95% patient satisfaction. There were no injuries to the palmar cutaneous branch, recurrent motor branch, third common digital nerve, or MN. No patients required conversion to OCTR or revision within the 1-year follow-up.</div></div><div><h3>Conclusions</h3><div>Endoscopic carpal tunnel release provides reliable outcomes for patients with CTS after prior distal radius fixation with low complication rates and high patient satisfaction.</div></div><div><h3>Level of Evidence</h3><div>Prognostic IIIa.</div></div>\",\"PeriodicalId\":36920,\"journal\":{\"name\":\"Journal of Hand Surgery Global Online\",\"volume\":\"7 2\",\"pages\":\"Pages 135-138\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery Global Online\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589514124002172\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery Global Online","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589514124002172","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

目的桡骨远端骨折后开放腕管松解术（OCTR）的疗效良好；然而，内窥镜腕管松解术（ECTR）在桡骨远端固定中的应用尚不清楚。我们报道先前同侧桡骨远端固定后腕管综合征患者行ECTR的临床结果和术中发现。方法回顾性分析2018-2023年在同一医院接受过同侧桡骨远端固定和ECTR治疗同侧腕管综合征（CTS）的患者。所有患者均有CTS的电诊断证据，CTS-6问卷均为阳性。所有患者在首次桡骨远端固定后1年内均行ECTR。在首次桡骨远端手术时出现腕管释放的患者被排除在外。术后结果包括关于总体满意度和症状改善的5分李克特量表问卷。所有患者均记录术中发现。并发症包括神经损伤、转OCTR和需要翻修手术。术后随访1年。结果22例经电诊断证实为CTS的患者均行桡骨远端固定手术。从初始桡骨远端手术到腕管释放的平均时间为3.2个月。7例患者注意到正中神经（MN）到屈肌视网膜带的瘢痕形成，4例患者注意到沿MN的含铁血黄素沉积。李克特量表问卷显示95%的症状改善和95%的患者满意度。掌皮支、运动复发支、第三指总神经或MN均无损伤。在1年随访期间，没有患者需要转换为OCTR或翻修。结论内镜下腕管松解术治疗CTS桡骨远端固定术后疗效可靠，并发症发生率低，患者满意度高。证据水平预后：

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Endoscopic Carpal Tunnel Release after Prior Distal Radius Fixation: Clinical Outcomes and Intraoperative Findings

Purpose

Open carpal tunnel release (OCTR) after distal radius fractures is well described; however, the use of endoscopic carpal tunnel release (ECTR) in the setting of prior distal radius fixation is less clear. We report clinical outcomes and intraoperative findings of patients with carpal tunnel syndrome following prior ipsilateral distal radius fixation who underwent subsequent ECTR.

Methods

A retrospective cohort of patients who had undergone prior ipsilateral distal radius fixation and ECTR for ipsilateral carpal tunnel syndrome (CTS) from 2018–2023 was collected at a single institution. All patients had electrodiagnostic evidence of CTS and scored positive on the CTS-6 Questionnaire. All patients underwent ECTR within 1 year of their initial distal radius fixation. Patients with carpal tunnel release at the time of initial distal radius surgery were excluded. Postoperative outcomes included 5-point Likert scale questionnaires regarding overall satisfaction and improvement in symptoms. Intraoperative findings were noted for all patients. Complications including nerve injury, conversion to OCTR, and need for revision surgery were documented. Patients were followed for 1 year after surgery.

Results

Twenty-two patients with electrodiagnostic evidence confirmed CTS were identified following prior distal radius fixation. Average time from initial distal radius surgery to carpal tunnel release was 3.2 months. Scarring of the median nerve (MN) to the flexor retinaculum was noted in seven patients and hemosiderin deposition along the MN was noted in four patients. Likert scale questionairre demonstrated 95% symptom improvement and 95% patient satisfaction. There were no injuries to the palmar cutaneous branch, recurrent motor branch, third common digital nerve, or MN. No patients required conversion to OCTR or revision within the 1-year follow-up.

Conclusions

Endoscopic carpal tunnel release provides reliable outcomes for patients with CTS after prior distal radius fixation with low complication rates and high patient satisfaction.