■支柱疼痛是公认的腕管松解(CTR)术后并发症。微创和替代手术技术理论上可以预防支柱疼痛,本综述的目的是比较标准开放式CTR和替代手术技术后支柱疼痛的发生率。
■MEDLINE,Embase,并彻底搜索了Scopus数据库。确定了将微创手术技术与标准开放式CTR进行比较的随机对照试验。数据,包括手术技术,手的数量,支柱疼痛的发生率,和随访间隔,被提取。赔率比(OR)表示为干预组相对于标准开放CTR的支柱疼痛发生率。
■纳入了12项研究。内镜间差异无统计学意义(OR=0.53,P=.20),屈肌支持带延长(OR=1.00,P=1.00),短切口(OR=0.41,P=.07)或照明刀技术(OR=0.18,P=.16)。微创CTR后支柱疼痛有统计学意义的降低(OR=0.41,95%置信区间0.20-0.86,I2=0%,P=.02)3至6个月的随访;然而,所有其他随访期间的分析均未达到统计学意义.
■尽管我们的研究结果表明,标准的开放性CTR可能与术后3至6个月的支柱疼痛持续时间增加有关,我们的结果表明,微创CTR技术不会影响支柱疼痛的初期发展或持续.
■我们的结果说明了支柱疼痛的自然史,大多数病例在6个月后解决,强调对症和保守治疗以及患者教育在支柱疼痛管理中的效用。
UNASSIGNED: Pillar pain is a recognized postoperative complication of carpal tunnel release (CTR). Minimally invasive and alternative surgical techniques can theoretically prevent pillar pain, and the aim of this
review was to compare the incidence of pillar pain after standard open CTR and alternative surgical techniques.
UNASSIGNED: MEDLINE, Embase, and Scopus databases were thoroughly searched. Randomized controlled trials comparing minimally invasive surgical techniques to standard open CTR were identified. Data, including surgical technique, number of hands, incidence of pillar pain, and follow-up intervals, were extracted. Odds ratios (OR) were expressed as pillar pain incidence in the intervention group relative to standard open CTR.
UNASSIGNED: There were 12 studies included. No statistically significant differences were noted among endoscopic (OR = 0.53, P = .20), flexor retinaculum lengthening (OR = 1.00, P = 1.00), short incision (OR = 0.41, P = .07) or illuminated knife techniques (OR = 0.18, P = .16). There was a statistically significant decrease in pillar pain after minimally invasive CTR (OR = 0.41, 95% confidence interval 0.20-0.86, I2 = 0%, P = .02) between 3- and 6-months follow-up; however, analyses at all other follow-up periods failed to reach statistical significance.
UNASSIGNED: Although our findings suggest that standard open CTR may be associated with an increased duration of pillar pain between 3 and 6 months postoperatively, our results suggest that minimally invasive CTR techniques do not affect either the initial development or persistence of pillar pain.
UNASSIGNED: Our results illustrate the natural history of pillar pain with the majority of cases resolving after 6 months, highlighting the utility of symptomatic and conservative treatments and patient education in the management of pillar pain.