背景:内镜下腕管松解术(ECTR)与开放式腕管松解术(OCTR)是否具有更好的结果仍然是一个有争议的话题。因此,我们试图进行一项综述和荟萃分析,以比较ECTR和OCTR(1)术后功能能力,(2)手术结果,(3)回到工作岗位的时间。
方法:PubMed,Scopus,根据PRISMA和JoannaBriggsInstitute的总括审查指南,对2000年至2022年之间进行的ECTR和OCTR的所有meta分析进行了Cochrane数据库搜索.主要结果如下:(1)功能能力-症状严重程度,术后握力,术后捏合强度,两点歧视,和疼痛;(2)手术结果-手术时间,总并发症,神经损伤,和瘢痕相关的并发症;和(3)恢复工作的时间。使用多重系统评价评估质量。进行了汇总分析,以比较组间的几种临床结果指标,取决于使用ReviewManager版本5.2.11的数据的可用性。
结果:共纳入9项meta分析,5个是高质量的,4个是中等质量的。对于功能能力,ECTR与3个月(0.70,95%置信区间[CI]=0.00,1.40,P=0.05)和6个月(0.77,95%CI=0.14,1.40,P=0.02,I2=84%)后较好的夹捏强度相关。为了重返工作岗位,与ECTR相比,OCTR与更长的工作时间相关(-10.89,95%CI=-15.14,-6.64,P<0.00001,I2=83%)。OCTR和ECTR在手功能上无显著差异,症状严重程度,握力,疼痛,操作时间,和总并发症。
结论:在对ECTR与OCTR的综述和荟萃分析中,ECTR与较高的夹紧强度有关,和更短的时间返回工作。主要并发症的差异,比如神经损伤,由于统计学上的不一致和偏倚,不清楚。
BACKGROUND: Whether endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) has superior outcomes remains a controversial topic. Therefore, we sought to perform an umbrella
review and meta-analysis to compare ECTR and OCTR with regards to (1) postoperative functional ability, (2) operative outcomes, and (3) time to return to work.
METHODS: A PubMed, Scopus, and Cochrane database search was conducted for all meta-analyses comparing ECTR and OCTR performed between 2000 and 2022 in accordance to PRISMA and Joanna Briggs Institute guidance for umbrella reviews. The primary outcomes were as follows: (1) functional ability-symptoms severity, postoperative grip strength, postoperative pinch strength, 2-point discrimination, and pain; (2) operative outcomes-operation time, total complications, nerve injury, and scar-related complication; and (3) time to return to work. Quality was assessed using the Assessment of Multiple Systematic Reviews. Pooled analysis was performed to compare several clinical outcome measures between groups, depending on the availability of data using
Review Manager Version 5.2.11.
RESULTS: A total of 9 meta-analyses were included, 5 were of high quality and 4 were moderate quality. For functional ability, ECTR was associated with better pinch strength after 3 months (0.70, 95% confidence interval [CI] = 0.00, 1.40, P = 0.05) and 6 months (0.77, 95% CI = 0.14, 1.40, P = 0.02, I2 = 84%). For return to work, OCTR was associated with longer return to work compared with ECTR (-10.89, 95% CI = -15.14, -6.64, P < 0.00001, I2= 83%). There were no significant differences between OCTR and ECTR in the hand function, symptom severity, grip strength, pain, operation time, and total complications.
CONCLUSIONS: In an umbrella
review and meta-analysis of ECTR versus OCTR, ECTR was associated with a higher pinch strength, and a shorter time to return to work. Differences in major complications, such as nerve injury, were unclear due to statistical inconsistency and bias.