Histopathological, Clinical, and Electrophysiological Features Influencing Postoperative Outcomes in Carpal Tunnel Syndrome
Histopathological, Clinical, and Electrophysiological Features Influencing Postoperative Outcomes in Carpal Tunnel Syndrome
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DOI：
10.1002/jor.21356
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发表时间：
2011-08-01
影响因子：
2.8
通讯作者：
Gasparini, Giorgio
中科院分区：
文献类型：
--
作者：
Galasso, Olimpio;Mariconda, Massimo;Gasparini, Giorgio
关于腕管综合征（CTS）手术预后预测因素的数据很少，而且常常相互矛盾。本前瞻性比较研究的目的是评估CTS患者屈肌腱滑膜的神经生理学表现和组织学特征，评估这些表现与患者术前状态或手术结果之间的可能关联。我们评估了30例连续诊断为特发性CTS并转介手术的患者。术前和术后6个月收集人口学数据、主观和客观数据以及对扩展评估集的反应。所有患者在手术前进行诊断性神经生理检查，并对术中切除的腱鞘标本进行组织学分析。10具新鲜冷冻的尸体作为对照。在6个月的随访中，研究中使用的大多数疾病特异性（波士顿问卷和Hi-Ob量表）和健康通用（SF-36问卷）评估工具均有显著改善。与对照组相比，CTS患者屈肌腱腱鞘血管发生改变。较大的滑膜血管化是术前SF-36物理综合评分的负预测因子。双侧症状表现和低神经传导速度是CTS术后患者生活质量的负向预测因子。在与患者讨论CTS手术的预期和期望结果时，必须考虑这些发现。屈肌腱滑膜血管化的增加与患者的功能状态有关。(C) 2011骨科研究学会。Wiley期刊公司出版。[J]中华骨科杂志，2011,29 (4):391 - 391
Data on the outcome predictors of surgical result of carpal tunnel syndrome (CTS) is sparse and often conflicting. The purpose of this prospective comparative study was to evaluate the neurophysiologic findings and histological characteristics of the flexor tenosynovium in patients with CTS, assessing possible associations between these findings and preoperative patient status or surgical outcome. We evaluated 30 consecutive patients with a diagnosis of idiopathic CTS who were referred for surgery. Demographic data, subjective and objective data, and responses on an expanded assessment set, were collected before and 6 months after surgery. All patients underwent diagnostic neurophysiological testing prior to surgery, and histological analysis of tenosynovium specimens that were removed during surgery. Ten fresh-frozen cadavers served as controls. There was significant improvement in most of the disease specific (Boston questionnaire and Hi-Ob scale) and health generic (SF-36 questionnaire) evaluation tools used in the study at the 6-month follow-up. Vascular changes were noted in the tenosynovium of the flexor tendon of patients with CTS when compared with controls. Greater synovial vascularization was negative predictor of the SF-36's physical summary score before surgery. Bilateral presentation of symptoms and low nerve conduction velocity were negative predictors of the quality of life of patients after surgery for CTS. These findings have to be considered when discussing with patients as for the expected and desired outcomes of CTS surgery. The increased vascularization of flexor tenosynovium is associated with patients' functional status. (C) 2011 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29: 1298-1304, 2011