手术与类固醇注射治疗腕管综合征的随机对照试验

A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome

Background: Decompressive surgery and steroid injection are widely used forms of treatment for carpal tunnel syndrome (CTS) but there is no consensus on thei r effectiveness in comparison to each other. The authors evaluated the efficacy of surgery vs steroid injection in relieving symptoms in patients with CTS. Meth ods: The authors conducted a randomized, single blind, controlled trial. Fifty p atients with electrophysiologically confirmed idiopathic CTS were randomized and assigned to open carpal tunnel release (25 patients) or to a single injection o f steroid (25 patients). Patients were followed up at 6 and 20 weeks. The primar y outcome was symptom relief in terms of the Global Symptom Score (GSS), which r ates symptoms on a scale of 0 (no symptoms) to 50 (most severe). Nerve conductio n studies and grip strength measurements were used as secondary outcome assessme nts. Results: At 20 weeks after randomization, patients who underwent surgery ha d greater symptomatic improvement than those who were injected. The mean improve ment in GSS after 20 weeks was 24.2 (SD 11.0)- in the surgery group vs 8.7 (SD 13.0) in the injection group (p < 0.001); surgical decompression also resulted i n greater improvement in median nerve distal motor latencies and sensory nerve conduction velocity. Mean grip strength in the surgical group w as reduced by 1.7 kg (SD 5.1) compared with a gain of 2.4 kg (SD 5.5) in the inj ection group. Conclusion: Compared with steroid injection, open carpal tunnel re lease resulted in better symptomatic and neurophysiologic outcome but not grip s trength in patients with idiopathic carpal tunnel syndrome over a 20- week peri od.