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Handchir Mikrochir Plast Chir 2020; 52(01): 11-17
DOI: 10.1055/a-1076-0814
Originalarbeit

An analysis of patient’s and disease related factors predictive of the outcomes of surgery for carpal tunnel syndrome

Welche patienten- und krankheitsbezogenen Faktoren haben für das Ergebnis nach Karpaltunneloperation Relevanz?
Andrzej Zyluk
1   Pomeranian Medical University in Szczecin, Department of General and Hand Surgery
,
Paulina Zyluk-Gadowska
1   Pomeranian Medical University in Szczecin, Department of General and Hand Surgery
,
Lukasz Kolodziej
2   Pomeranian Medical University in Szczecin, Department of Orthopedics and Traumatology
,
Zbigniew Szlosser
1   Pomeranian Medical University in Szczecin, Department of General and Hand Surgery
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Abstract

Purpose Outcomes of surgery for carpal tunnel syndrome may differ in relation to certain factors like age, duration of symptoms, clinical and electrophysiological severity. The objective of this study was an investigation into the hypothesis that several factors are predictive of results of surgical treatment of the condition.

Methods The pre- and postoperative records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years were analysed. Outcomes recorded in the sensory and functional severity scores of the Levine questionnaire were dichotomized into achieving or not-achieving a minimally clinically important difference. The effect of selected variables: sex, age, duration of symptoms, clinical and electrophysiological severity of and presence of comorbidities on outcomes of surgery at 6 months was investigated.

Results Univariate and multivariate analysis of covariates based on sex, age, duration of the disease and its clinical severity showed female gender and worse baseline symptom severity scores to be significant predictors for an improvement following carpal tunnel syndrome surgery. It showed also younger age, shorter duration of symptoms and higher baseline symptom severity scores to be predictive of a greater improvement of total grip strength, and younger age to be predictive of a greater pain cessation following surgery.

Conclusion Of all considered patient’s and disease related factors, the baseline clinical severity expressed in the Levine symptom severity scores had appeared to be the strongest predictor of better outcomes of surgery for carpal tunnel syndrome.

Zusammenfassung

Ziel Das Ergebnis nach Operation eines Karpaltunnelsyndroms (KTS) mag abhängig vom Alter des Patienten, der Dauer der Beschwerden sowie dem klinischen und elektrophysiologischen Schweregrad unterschiedlich ausfallen. Die vorliegende Studie untersucht die Hypothese, dass mehrere Faktoren eine Vorhersage des zu erwartenden Ergebnisses nach KTS-Operation erlauben.

Patienten und Methoden Die Krankenakten von 1.117 Patienten (999 Frauen = 81 % und 208 Männern = 19 % mit einem Durchschnittsalter von 63 Jahren) wurden ausgewertet. Untersuchte Faktoren waren Geschlecht, Alter, Dauer der Beschwerden, klinischer und elektrophysiologischer Schweregrad und das Vorhandensein von Begleiterkrankungen. Als Kriterium, ob ein Faktor als vorhersagerelevant eingestuft wurde oder nicht, diente das Erreichen bzw. Nicht-Erreichen eines minimal klinisch bedeutenden Unterschiedes im sensiblen und funktionellen Livine questionair 6 Monate postoperativ.

Ergebnisse Weibliches Geschlecht und schlechte Ausgangsdaten konnten als aussagekräftige Vorhersageparameter puncto Verbesserung nach KTS-Operation identifiziert werden. Jüngeres Alter, kürzere Beschwerdedauer und schlechtere Ausgangsdaten lassen eine stärkere Zunahme der Griffkraft erwarten; jüngeres Alter auch eine stärkere Schmerzreduktion.

Schlussfolgerung Von allen untersuchten patienten- und krankheitsbezogenen Parametern scheint der klinische Schweregrad, ermittelt durch den Levine symptom severity score, der aussagekräftigste Vorhersageparameter bzgl. einer Verbesserung nach KTS-Operation.

Schlüsselwörter

Karpaltunnelsyndrom - Pathologie - Vorhersageparameter für das Ergebnis

Key words

Carpal tunnel syndrome - outcomes of surgery - prediction of outcomes


Publication History

Received: 20 April 2019

Accepted: 09 November 2019

Article published online:
05 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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