Geoffrey K Seidel, Salma Al Jamal, Eric Weidert, Frederick Carington, Michael T Andary, Scott R Millis, Brian G Loder
{"title":"跗骨隧道手术术前临床症状和电诊断数据的预测结果建模。","authors":"Geoffrey K Seidel, Salma Al Jamal, Eric Weidert, Frederick Carington, Michael T Andary, Scott R Millis, Brian G Loder","doi":"10.1055/s-0041-1731747","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background</b> The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. <b>Methods</b> Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. <b>Results</b> Patient-reported improvement was 92% in the probable TTS group ( <i>n</i> = 41) and 77% of the non-TTS group ( <i>n</i> = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS ( <i>p</i> = 0.04), neuropathic symptoms ( <i>p</i> = 0.045), and absent Phalen's test ( <i>p</i> = 0.001). The <i>R</i> <sup>2</sup> was 0.21 which is a robust result for this outcome measurement process. <b>Conclusion</b> The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2021-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1731747","citationCount":"1","resultStr":"{\"title\":\"Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery.\",\"authors\":\"Geoffrey K Seidel, Salma Al Jamal, Eric Weidert, Frederick Carington, Michael T Andary, Scott R Millis, Brian G Loder\",\"doi\":\"10.1055/s-0041-1731747\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background</b> The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. <b>Methods</b> Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. <b>Results</b> Patient-reported improvement was 92% in the probable TTS group ( <i>n</i> = 41) and 77% of the non-TTS group ( <i>n</i> = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS ( <i>p</i> = 0.04), neuropathic symptoms ( <i>p</i> = 0.045), and absent Phalen's test ( <i>p</i> = 0.001). The <i>R</i> <sup>2</sup> was 0.21 which is a robust result for this outcome measurement process. <b>Conclusion</b> The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.</p>\",\"PeriodicalId\":15280,\"journal\":{\"name\":\"Journal of Brachial Plexus and Peripheral Nerve Injury\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2021-07-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1055/s-0041-1731747\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Brachial Plexus and Peripheral Nerve Injury\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1055/s-0041-1731747\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Brachial Plexus and Peripheral Nerve Injury","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0041-1731747","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery.
Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. Results Patient-reported improvement was 92% in the probable TTS group ( n = 41) and 77% of the non-TTS group ( n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS ( p = 0.04), neuropathic symptoms ( p = 0.045), and absent Phalen's test ( p = 0.001). The R2 was 0.21 which is a robust result for this outcome measurement process. Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.
期刊介绍:
JBPPNI is an open access, peer-reviewed online journal that will encompass all aspects of basic and clinical research findings, in the area of brachial plexus and peripheral nerve injury. Injury in this context refers to congenital, inflammatory, traumatic, degenerative and neoplastic processes, including neurofibromatosis. Papers on diagnostic and imaging aspects of the peripheral nervous system are welcomed as well. The peripheral nervous system is unique in its complexity and scope of influence. There are areas of interest in the anatomy, physiology, metabolism, phylogeny, and limb growth tropism of peripheral nerves.