内镜下腕管松解术与常规腕管切开松解术治疗腕管综合征的Meta分析

Endoscopic vs. Open Carpal Tunnel Release: Meta-analysis

目的对内镜下腕管松解术（endoscopic carpal tunnel release,ECTR）和常规腕管切开松解术（open carpal tunnelrelease,OCTR）治疗腕管综合征的疗效进行系统评价。方法按照Cohrane系统评价的方法,计算机检索MEDLINE（1966年~2010年3月）、EMBASE（1966年~2010年3月）、Cochrane图书馆（2010年1月）及中国生物医学文献数据库（1979年~2009年12月）,并手工检索相关的中英文骨科杂志。收集所有相关的随机对照试验,并评价纳入研究的方法学质量,采用Cochrane协作网提供的软件Revman4.2.2进行Meta分析,以获得ECTR与OCTR治疗腕管综合征的疗效及其安全性是否有差异的相关证据。结果共纳入8个随机对照试验进行评价,Meta分析显示,ECTR组与OCTR组的术后并发症发生率、主观满意率、手术时间及术后手握力和捏力功能恢复差异无统计学意义（P〉0.05）;ECTR组术后疼痛发生率和恢复工作时间显著低于OCTR组（P〈0.05）。结论与OCTR相比,ECTR可降低腕管综合征的术后疼痛发生率,缩短恢复工作时间;2种手术方式术后并发症发生率、主观满意度、手术时间、术后握力与捏力无统计学差异。因研究质量及样本的局限性,2种手术方法与手术时间和手功能的关系有待于进一步研究。

Objective To compare the efficacy and safety of endoscopic carpal tunnel release with open surgery for carpal tunnel syndrome. Methods Based on Cochrane Systematic Review,we searched through the MEDLINE,EMBASE,Cochrane Library and CBM disc,and relevant Chinese and English orthopedic journals by hand,and then collected all the randomized control trials（RCTs） that related to carpal tunnel syndrome.The quality of trials was critically assessed.The Revman4.2.2 that provided by Cochrane Collaboration were used for data management and analysis on the evidence of the difference in the efficacy and safety of endoscopic versus open carpal tunnel（ECTR vs.OCTR） release. Results Totally 8 RCTs were included by total retrieve and riddling.The results of meta-analysis showed no significant differences in the rate of complications,subjective satisfaction,operation time,and hand grip and pinch between groups ECTR and OCTR（P0.05）.The rate of pain and recovery time in group ECTR were lower than that in group OCTR（P0.05）. Conclusions Compared with OCTR,ECTR can reduce the postoperative pain rate and recovery time.There is no significant statistical difference on the rate of complications,subjective satisfaction,operation time,and postoperative hand grip and pinch between the two approaches.However,owing to the study quality and limited sample size,the relationship between the surgical approaches with operation time,and hand grip and pinch needs further studies.