HAND & WRIST
Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(10):19 Clin Orthop Relat Res. 2013 May;471(5):1548-54. doi: 10.1007/s11999-012-2666-z. Epub 2012 Oct 2652 patients with bilateral carpal tunnel syndrome were randomized to have endoscopic release performed on one hand and mini-incision on the other. The trial aimed to compare the subjective patient based outcomes between the two procedures. Despite similar Boston Carpal Tunnel Questionnaire (BCTQ) and DASH scores between the two groups after 3 months, 34 preferred endoscopic technique compared to 13 preferring the mini-incision, mostly due to scars and pillar pain.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
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。
3/4
Randomização
2/4
Medidas de resultado
4/4
Inclusão/Exclusão
4/4
Descrição do tratamento
3/4
Estatística
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？
Since non-operative treatments for carpal tunnel syndrome often fail, the condition can be treated either by endoscopic or open (standard or mini-incision) carpal tunnel releases. Endoscopic technique is often favoured, due to lower pain, faster return to work, and fewer infections and hypertrophic scars. However, it also comes with a risk of median nerve injury. Mini-incision is sometimes chosen by surgeons for its simplicity, cost, and lower complication rates. Regardless, patient preference is an important factor; therefore, the study aimed to compare subjective patient-based outcomes and preferences between the two techniques.
主な研究課題は何ですか？
Did subjective outcomes and patient preferences after 3 months differ between endoscopic release, performed on one hand, and mini-incision release, performed on the other, in patients with bilateral carpal tunnel syndrome?
重要な知見は？
- At 3 months, the mean BCTQ-S scores improved similarly in both groups; in the endoscopic group from 3.3 (95% CI 3.1 to 3.5) to 1.5 (95% CI 1.4 to 1.6) and in the mini-incision group from 3.3 (95% CI 3.1 to 3.5) to 1.4 (95% CI 1.4 to 1.6) (p>0.05).
- At 3 months, the mean BCTQ-F score similarly improved from 2.8 (95% CI 2.6 to 3.1) to 1.5 (95% CI 1.4 to 1.6) in the endoscopic group and from 3.0 (95% CI 2.6 to 3.0) to 1.7 (95% CI 1.3 to 1.5) in the mini-incision group (p>0.05).
- At 3 months, mean DASH score in the endoscopic group improved from 48.3 (95% CI 43.7 to 52.9) to 11.3 (95% CI 8.6 to 13.9) and in the mini-incision group from 47.8 (95% CI 43.1 to 52.4) to 10.8 (95%CI 8.1 to 13.6) with no differences between two groups (p>0.05)
- No instances of deep wound infections, median nerve injury, and revisions were seen.
- 34 patients preferred endoscopic technique, 13 preferred mini-incision technique, and the rest had no preference. Preference was not affected by occupation, hand dominance, or electrophysiologic test findings (all p>0.05)
- Endoscopic technique was preferred over mini-incision most primarily due to scar and pillar pain, but the proportion of patients was not significant (p = 0.114). However, a significant number of patients disliked endoscopic method because of transient worsening of symptoms (p=0.004)
最も覚えておくべきことは？
Endoscopic carpal tunnel release and mini-incision carpal tunnel release provided similar subjective outcomes 3 months after surgery. 34 patients preferred endoscopic technique over mini incision mostly due to the scar and pillar pain this is compared to 13 preferring the mini incision technique.
それが私の患者ケアにどのように影響するか？
Since subjective outcomes seem to not differ between endoscopic and mini-incision techniques, the procedure choice remains in the surgeon’s hand, taking the patient's preference into consideration. Studies with larger sample sizes may be considered, to confirm functional benefit and incidence of complications.
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