HAND & WRIST
Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(6):21 PLoS One. 2015 Dec 16;10(12):e014368327 randomized and quasi-randomized trials that investigated safety outcomes in patients undergoing either endoscopic or open carpal tunnel release for carpal tunnel syndrome were included in this meta-analysis. The study was conducted to determine whether earlier concerns regarding the safety of endoscopic release in comparison to an open approach were still applicable presently. The study found that previous drawbacks of an endoscopic release such as high reoccurrence and reoperation rates have been gradually lessened to where they are now comparable with rates in an open approach. Total and major complications are also comparable between groups, whereas minor occurrences were significantly less frequent following endoscopic release. Return to activity was significantly earlier following endoscopic release compared to open release.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Introduction
3/4
Accessing Data
2/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Open surgery was traditionally used for carpal tunnel ligament (TCL) release, though more recently, the use of endoscopic release has gained popularity. While the reduced invasiveness of endoscopic carpal tunnel release (ECTR) offers theoretical advantages related to morbidity, early studies suggested that complication rate was in fact increased following ECTR compared to open carpal tunnel release (OCTR), which was largely attributed by authors to the reduced operative field through which surgeons were working. More recent randomized controlled trials have found similar complications rates between the two approaches though there is still considerable debate regarding the comparative efficacy and safety between the two.
主な研究課題は何ですか？
How safe is endoscopic carpal tunnel release as compared to open carpal tunnel release for treatment of carpal tunnel syndrome?
重要な知見は？
- The pooled results from 15 studies found no significant difference between carpal tunnel release approaches for data on recurrence (ECTR=24/878; OCTR=19/806; OR=1.02 [95%CI 0.55, 1.90]).
- Pooled incidence of reoperation from 11 studies demonstrated no significant difference between ETCR (20/869) and OTCR (8/727) (OR=1.36 [95%CI 0.61, 3.00]).
- From 25 studies, the incidence of major complications was both infrequent and similar between ECTR (12/1366) and OCTR (12/1199) (OR=1.00 [95%CI 0.44, 2.27]).
- From 24 studies, the incidence of minor complications was significantly lower following ECTR (63/1275) versus OCTR (120/1167) (OR=0.50; [95%CI 0.31, 0.82]). Sub-analysis of specific types of minor complications demonstrated a significantly higher rate of transient neuropraxia following ECTR compared to OCTR (OR=0.242 [95%CI 1.22, 4.80]), and a significantly lower rate of wound healing or scar problems with ECTR compared to OCTR (OR=0.24 [95%CI 0.15, 0.40]).
- In terms of total complications, results were comparable between the two groups (24 studies; ECRT=119/OCRT=159; OR=0.82; 95% CI 0.52, 1.51), however heterogeneity was high among studies.
- Patients who underwent ECTR returned to work significantly sooner than those OCTR (6 studies; MD=-9.56; 95% CI -12.51, -6.60), however there was high heterogeneity among studies.
- Outcomes were consistent in a post hoc sensitivity analysis that excluded studies with a high risk of bias for allocation concealment.
最も覚えておくべきことは？
In patients with carpal tunnel syndrome undergoing surgical release with either an open or endoscopic approach, no significant differences in pooled incidences of reoccurrence or reoperation were observed. Total and major complications were also comparable between open and endoscopic release, whereas minor complications occurred less frequently following endoscopic release. Nevertheless, within minor complications, an endoscopic release was associated with a significantly higher risk of transient neuropraxia, whereas open release was associated with a high risk of wound healing and scarring problems. A significantly earlier return to work was also noted following endoscopic release compared to open release.
それが私の患者ケアにどのように影響するか？
This analysis suggests that previous drawback of endoscopic carpal tunnel release being unsafe in comparison to open release in carpal tunnel syndrome may no longer be a concern. Rates of reoperation, reoccurrence, and complications were comparable between techniques and endoscopic release patients additionally exhibited a significantly faster return to activity. Studies with smaller populations tended to favour OCTR; however, these were generally studies published in the earlier years, and effect sizes could potentially be explained by a learning curve. As concerns of low study quality are expressed throughout this report, a further analysis with inclusion being limited to only high-quality trials is warranted.
免責事項
このページに記載されている内容は、情報提供のみを目的としたものであり、専門的な医療アドバイス、診断、治療の代わりとなるものではありません。治療が必要な場合は、必ず医師の診断を仰ぐか、最寄りの救急外来を受診してください。このページに記載されている内容に関して個人が表明した意見、信念、見解は、OrthoEvidenceの意見、信念、見解を反映するものではありません。
0の4 月間無料記事のロック解除
