内镜手术对比开放手术治疗腕管综合征的系统评价

Systematic evaluation on endoscopic operation versus open operation for treating carpal tunnel syndrome

目的系统评价内镜手术和开放手术治疗腕管综合征的效果。方法计算机检索MEDLINE、EMBASE、COCHRANCE CENTRAL、CNKI数据库、维普数据库、万方数据库,收集这些数据库1989年至2012年8月所有相关随机对照试验。对纳入的文献进行数据提取、偏倚风险评估、质量评价并进行Meta分析。结果共纳入随机对照试验21篇,包括手术1 863例,内镜组982例,开放手术组881例,内镜组和开放手术组在术后握力值、两点辨别觉、并发症发生率、满意度、术后症状缓解率、手术时间差异无统计学意义。内镜组返回工作时间、捏力值、术后疼痛率均优于开放手术组。结论内镜组在返回工作时间、捏力值、术后疼痛率方面要优于开放手术组,其他相关指标两种手术方法无明显差异。

Objective To systematically assess the efficacy of endoscopic operation and open operation for treating carpal tunnel syndrome .Methods The computer retrieval from MEDLINE ,EMBASE ,Cochrane August ,CNKI ,VIP ,Wanfang databases were conducted for collecting all related randomized controlled trials （RCT ） from February 1989 to February 2012 .The included litera-tures were performed the data extraction ,assessment of bias risk and the quality evaluation .Mata analysis was performed by the RevMan 5 .1 .6 software .Results 21 RCTs including 1 863 operations ,982 cases endoscopic carpal tunnel release （ECTR） and 881 cases of open carpal tunnel release（OCTR） ,met the inclusion criteria .Meta analysis showed that the differences in terms of postop-erative grip strength ,two points discrimination ,incidence of complications ,satisfaction rate ,postoperative symptom relief rate and operation time between the ECTR group and the OCTR group had no statistical significance .The ECTR group was better than the OCTR in the aspects of the time returnning to work ,pinch strength ,postoperative pain rate .Conclusion The ECTR group is supe-rior to the OCTR group in terms of the time returnning to work ,pinch strength ,postoperative pain rate .The other related indexes have no obvious differences between the two kinds of operation procedures .Due to the poor quality of some RCTs ,the above conclu-sion needs more high-quality ,large-sample clinical researches to confirm .