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Résultats fonctionnels après la decompression du canal carpien

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Paul Stirling
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This prospective single-centre study describes the functional outcomes, satisfaction and health-related quality of life after open revision carpal tunnel decompression for recurrent carpal tunnel syndrome. The QuickDASH, patient satisfaction and EuroQol-5 dimensions questionnaires were collected preoperatively and postoperatively over a 5-year period (2013–2018). The median time to revision was 13.3 years (range 3.9–35.4 years; interquartile range 7.2–15.9 years). Outcomes were available for 14 hands in 13 patients at a mean of 20 months after revision surgery. The mean preoperative and postoperative QuickDASH scores were 55 and 29, respectively, and the mean improvement in QuickDASH was 26. The mean improvement in EuroQol-5 dimensions score was 0.1, and 13 of the 14 patients were satisfied. The net promoter score was 85. This study confirms that patients undergoing revision open carpal tunnel decompression for recurrent carpal tunnel syndrome experience a significant improvement in function and health-related quality of life. Level of evidence: IV
Jane E Mceachan
added 2 research items
This study describes functional outcomes, patient satisfaction, and health-related quality of life (HRQoL) following open revision carpal tunnel decompression (CTD) for recurrent carpal tunnel syndrome (CTS). Postoperative results were available for 16 hands in 15 patients (100% at mean follow-up at 19.9 months). This was a prospective study at a single-centre serving a population of 360,000. QuickDASH, patient satisfaction, and EQ-5D-5L questionnaires were collected pre and postoperatively for patients undergoing revision CTD over a five-year period (2013–2018). The incidence of revision CTD was 0.9 per 100,000 patients per year. Fifteen patients reported recurrent and 1 patient-reported persistent symptoms. Median time to revision was 12.5 years (interquartile range 6.7–15.7 years). Mean preoperative and postoperative quickDASH was 57.7 and 36.1, respectively. The overall mean improvement in QuickDASH was 28.1. The mean improvement in EQ-5D-5L was 0.17. Thirteen patients (81.8%) were satisfied. The Net Promoter Score was 87.5. This study confirms the widely-held view that patients with late-presenting CTS can expect to enjoy a similar improvement in function and HRQoL as patients undergoing primary CTD. Recurrent CTS presents following a long symptom-free period after primary CTD, and hand function regresses to a similar level of disability. These results can be used to counsel patients who are considering revision surgery.
This study investigated the impact of self-reported hand-arm vibration (HAV) exposure on patient-reported functional outcomes (PROMs), Health-related quality of life (HRQoL), and patient satisfaction following carpal tunnel decompression (CTD). This was a single-centre prospective study investigating postoperative PROMs in 609 patients undergoing elective CTD. QuickDASH, patient satisfaction, and EQ-5D-5L questionnaires were collected pre- and postoperatively over a three-year period. Outcomes were available for 475 patients (78% at mean 14.4 months follow-up). One hundred and twenty-eight patients (28%) reported previous HAV-exposure. Median postoperative QuickDASH was significantly (27.3 vs 15.9; P = 0.005) worse in the group exposed to HAV. Although both groups reported a postoperative improvement in QuickDASH this was significantly lower in the group exposed to HAV (−12.8 vs −19.4; P = 0.002). Multivariable linear regression revealed significantly worse preoperative, postoperative and change in QuickDASH when adjusting for covariates in patients with HAV-exposure. The most predictive variable for impact on QuickDASH was weekly vibration exposure. There was no significant difference in satisfaction between the two groups (51.2% vs 55.6%; P = 0.4), though postoperative EQ-5D-5L was significantly worse in the group exposed to HAV (0.70 vs 0.78; P = 0.007). CTD in patients with previous HAV-exposure results in improved postoperative PROMs, though the improvement was significantly lower when compared to patients without HAV-exposure. Although there was no significant difference in satisfaction rate, HRQoL was significantly lower following CTD in patients with previous HAV-exposure. Patients with previous HAV-exposure should be made aware of these results prior to CTD.