手术和非手术介入治疗腕管综合征的疗效比较—Meta分析
摘要
目的:探讨比较手术治疗与非手术治疗腕管综合征(CTS)的短期和长期疗效。方法:检索Pubmed、Cochrane、Medline、Embase等数据库。以患者自我评估的功能和症状变化及电生理学检查数据为评估研究结果。Meta分析在RevMan中进行。结果:手术和非手术治疗的临床疗效差异有统计学意义(P<0.05);治疗后1个月,非手术治疗患者手功能恢复情况好于手术治疗(P<0.05);治疗后3个月,手术治疗患者手部症状改善情况优于非手术治疗(P<0.05);治疗后6个月,手术治疗患者手部功能改善情况优于非手术治疗(P<0.05),手术治疗组远端感觉潜伏期改善程度更好(P<0.05)。结论:接受手术或非手术治疗的CTS患者在治疗后短期手功能与症状改善方面各有优势,长期随访手术治疗较非手术治疗疗效更好,但仍需要长期大量研究。
引文
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[2]Raizman NM,Blazar PE.AAOS Appropriate Use Criteria:Management of Carpal Tunnel Syndrome[J].J Am Acad Orthop Surg2018,26:e131-e133.
[3]Graham B,Peljovich AE,Afra R,et al.The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on:Management of Carpal Tunnel Syndrome[J].J BONE JOINT SURG AM,2016,98:1750-1754.
[4]Fernández-de-Las Pe?as C,Ortega-Santiago R,de la Llave-Rincón AIet al.Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome:A Randomized Parallel-Group Trial[J].J Pain,2015,16:1087-1094.
[5]Shi Q,Mac Dermid JC.Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome?A systematic review[J]J Orthop Surg Res,2011,6:17.
[6]Jerosch-Herold C,Leite JC,Song F.A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning Disability and Health(ICF)as a reference tool[J].BMC Musculoskelet Disord,2006,7:96.
[7]Leite JC,Jerosch-Herold C,Song F.A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire[J].BMC Musculoskelet Disord,2006,7:78.
[8]Demirci S,Kutluhan S,Koyuncuoglu HR,et al.Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome[J].Rheumatol Int,2002,22:33-37.
[9]Celik G,Ilik MK.Effects of Two Different Treatment Techniques on the Recovery Parameters of Moderate Carpal Tunnel Syndrome:ASix-Month Follow-up Study[J].J Clin Neurophysiol,2016,33:166-170.
[10]Hui AC,Wong S,Leung CH,et al.A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome[J].Neurology,2005,64:2074-2078.
[11]Fernández-de-Las Pe?as C,Ortega-Santiago R,de la Llave-Rincón AI,et al.Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome:A Randomized Parallel-Group Trial[J].J Pain,2015,16:1087-1094.
[12]Gerritsen AA,de Vet HC,Scholten RJ,et al.Splinting vs surgery in the treatment of carpal tunnel syndrome:a randomized controlled trial[J].JAMA,2002,288:1245-1251.
[13]Jarvik JG,Comstock BA,Kliot M,et al.Surgery versus non-surgical therapy for carpal tunnel syndrome:a randomised parallel-group trial[J].Lancet,2009,374:1074-1081.
[14]Ucan H,Yagci I,Yilmaz L,et al.Comparison of splinting,splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome[J].Rheumatol Int,2006,27:45-51.
[15]Atkins D,Eccles M,Flottorp S,et al.Systems for grading the quality of evidence and the strength of recommendations I:critical appraisal of existing approaches The GRADE Working Group[J].BMC Health Serv Res,2004,4:38.
[16]Ly-Pen D,Andréu JL,de Blas G,et al.Surgical decompression versus local steroid injection in carpal tunnel syndrome:a one-year,prospective,randomized,open,controlled clinical trial[J].Arthritis Rheum,2005,52:612-619.