• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Journal of hand therapy: Official journal of the American Society of Hand Therapists >Clinical outcomes of carpal tunnel release in patients 65 and older.
【24h】

Clinical outcomes of carpal tunnel release in patients 65 and older.

机译：65岁及65岁以上患者的腕管释放临床结果。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

PURPOSE: The authors of this article present a study which examines the benefits of Carpal Tunnel Release surgery in patients 65 years of age or older. A common misconception among referring physicians holds that elderly patients have a poorer recovery after peripheral nerve injury and repair than younger patients, and that nerve conduction velocities naturally decrease with age. Therefore, their attitude and reluctance to send patients to hand surgeons suggest the belief that CTR surgery is less effective in the older population. Carpal Tunnel Syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. Some studies suggest that CTS may be more prevalent and more severe in the elderly. The authors conducted a prospective study of patients 65 years of age or older who were seeking surgical release for treatment of CTS. These patients were evaluated before and after surgery to determine the benefits of the procedure for the older population. Method: Seventy-five patients and a total of 105 hands were enrolled in the study. The average age of participants was 75 years of age. Patients were evaluated prior to surgery and again at six months after surgery. Thirty-one men and 35 women completed the 6-month follow up evaluation. Ninety-four percent of the patients were right handed. Fifty-nine percent of the patients had bilateral symptoms. The median duration of symptoms was 24 months (range 2-180 months). The evaluation consisted of a detailed history of hand dominance and symptoms including paresthesias, nocturnal symptoms, and subjective weakness. The physical examination included Tinel's sign, Phalen's sign, median nerve compression test, 2-pt discrimination, grip and pinch strength measurements and thenar wasting. CHTs performed quantitative sensory testing using a pressure-sensing device (Pressure Specified Sensory Device, Sensory Measurement Services, LLC, Baltimore, MD). This allowed for standardized grip and pinch strength measurements and static 2-pt discrimination testing. The Michigan Hand Outcomes Questionnaire (MHQ) was used to assess clinical outcomes. The MHQ evaluates overall hand function, activities of daily living (ADL's), work performance, pain, aesthetics and satisfaction with hand function. It is an internally consistent and validated measurement for patients following hand surgery. Prior to surgery, patients were asked to rate paresthesias, numbness, day pain, night pain and nocturnal weakness on a scale of 1-5 (none, mild, moderate, severe, very severe). Results: After surgery, patient symptoms of paresthesias, numbness, day pain, night pain and nocturnal weakness were significantly decreased in severity with a p value of less than .0001. Sixty-three percent of patients had complete relief of all symptoms. Tinel's sign and Phalen's sign were significantly decreased after surgery. Grip strength increased slightly while pinch strength increased significantly from pre and post surgical measures (p < .02). Even thenar wasting, noted in 44% of the patients prior to surgery, decreased to 29% after surgery (p < .01). The 6 scales of the MHQ (overall hand function, activities of daily living, work performance, aesthetics, satisfaction with hand function and pain) all showed significant improvement after surgery with a p value of less than .0001. Discussion: In recognition of the fact that CTS is common among the elderly, and that their symptoms are often more severe than in the general public, CTR should be considered a viable course of treatment for this population. This study demonstrates the benefits of surgical interventions in terms of improved physical findings and most importantly, improved clinical outcomes. Despite long duration of symptoms in this elderly population, pre-operative symptoms decreased significantly. Overall, 83% of the patients were either completely satisfied or very satisfied with their surgical outcome.
机译：目的：本文的作者提出了一项研究，研究了65岁或65岁以上患者的腕管松解术的益处。在转诊医师中，一个普遍的误解是，老年患者的周围神经损伤和修复后的康复能力较年轻患者低，并且神经传导速度自然会随着年龄的增长而降低。因此，他们的态度和不愿让患者去看手外科医师的想法表明，CTR手术对老年人群的疗效较差。腕管综合症（CTS）是腕部正中神经的压迫性神经病。一些研究表明，CTS在老年人中可能更为普遍和严重。作者对65岁以上寻求手术释放以治疗CTS的患者进行了前瞻性研究。对这些患者进行手术前后的评估，以确定该手术对老年人群的益处。方法：75例患者，共105手。参加者的平均年龄为75岁。在手术前和手术后六个月对患者进行评估。 31名男性和35名女性完成了为期6个月的随访评估。百分之九十四的患者是右撇子。 59％的患者有双侧症状。症状的中位持续时间为24个月（范围2-180个月）。评估包括详细的手部支配史和症状，包括感觉异常，夜间症状和主观虚弱。体格检查包括Tinel体征，Phalen体征，正中神经压迫测试，2点分辨力，握力和捏力强度测量值以及鼻塞消瘦。 CHT使用压力传感设备（压力指定的传感设备，Sensory Measurement Services，LLC，巴尔的摩，马里兰州）进行了定量的传感测试。这样就可以进行标准化的抓地力和捏力强度测量以及静态的2点分辨力测试。密歇根州的结果调查问卷（MHQ）用于评估临床结果。 MHQ评估总体手功能，日常生活活动（ADL），工作表现，疼痛，美观以及对手功能的满意度。对于手部手术后的患者，这是一种内部一致且经过验证的测量方法。手术前，要求患者以1-5级（无，轻度，中度，重度，非常重度）对感觉异常，麻木，日间疼痛，夜间疼痛和夜间无力进行评分。结果：手术后，患者的感觉异常，麻木，日间疼痛，夜间疼痛和夜间无力的症状严重程度明显减轻，p值小于.0001。 63％的患者可完全缓解所有症状。手术后Tinel征和Phalen征明显减少。术前和术后的握力略有增加，而捏力明显增加（p <.02）。甚至在手术前，有44％的患者出现了narnar消瘦，在手术后也减少到了29％（p <.01）。 MHQ的6个量表（总体手功能，日常生活活动，工作表现，美学，手功能满意度和疼痛程度）在手术后均显示出显着改善，p值小于.0001。讨论：认识到CTS在老年人中很常见，而且其症状通常比普通公众更为严重，因此CTR应该被视为对该人群的可行治疗方案。这项研究证明了手术干预对改善体格检查结果以及最重要的是改善临床结局的益处。尽管该老年人群中症状持续时间长，但术前症状明显减少。总体而言，83％的患者对手术结果完全满意或非常满意。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号