Opioid Versus Nonopioid Analgesia After Carpal Tunnel Release: A Randomized,Prospective Study

Background: The purpose of this investigation was to compare pain control and patient satisfaction for conventional postoperative opioid analgesia and nonopioid multimodal analgesia after elective open or endoscopic carpal tunnel release (CTR). Methods: As part of a randomized, prospective study, patients undergoing primary, elective CTR were randomized to receive either postoperative opioids or nonopioid medications as part of a multimodal pain control strategy. Patients currently taking opioids were excluded. Patients completed a postoperative pain journal and completed the shortened version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), Boston Carpal Tunnel Questionnaire, Numeric Pain Rating Scale (NPRS), and satisfaction ratings at their 2-week visit. Results: A total of 68 patients were included. Preoperatively, there were no statistically significant differences between the 2 groups with respect to pain scores, coping skills, or carpal tunnel symptoms. At 2 weeks postoperatively, patients in the nonopioid group had lower average NPRS and QuickDASH scores. Patients who took opioids consumed an average of 5 pills. No patient randomized to the nonopioid group required any opioids. Patients in the nonopioid group demonstrated lower early postoperative NPRS scores. Patient satisfaction with their pain control regimen and outcome was not significantly different between the 2 groups at any time point. Conclusions: Nonopioid medications as part of a perioperative pain control strategy demonstrate improved pain scores compared with opioid medications with similar patient satisfaction and functional outcomes. Considering the risks associated with the use of opioid analgesics, we recommend against prescribing opioids after CTR, particularly in patients not currently taking narcotic medications.     

Outcomes of Mini-Open Carpal Tunnel Release in Patients With Unrecordable Preoperative Nerve Conduction Potentials at a Minimum of 5 Years

Background: The aim of this study is to assess the outcomes of carpal tunnel release (CTR) in a cohort of patients with preoperatively unrecordable median nerve sensory and motor potentials in comparison with historical controls at minimum 5-year follow-up. Methods: We retrospectively identified 1297 patients who underwent CTR at a tertiary care referral center from July 2008 to June 2013. After exclusion criteria and review of available preoperative nerve conduction studies, 24 patients who underwent CTR with preoperative unrecordable sensory and motor nerve potentials were identified. Fifteen living, mentally capable patients were contacted by telephone for follow-up. Our primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Secondary outcome measures included Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain on a 0 to 10 Likert scale, and satisfaction on a 0 to 10 Likert scale. Results: Our response rate was 80% (12 out of 15) of eligible patients. Mean follow-up was 6.9 years in our study (range, 5.4-9.5 years). The mean BCTQ symptom score was 1.4, and the mean BCTQ functional score was 1.8. Mean DASH score was 15.2. On average, patient-reported pain was 0.3 and satisfaction was 8.3. No difference was found in outcomes of CTR in patients with end-stage carpal tunnel syndrome compared with historical means. Conclusions: Patients with end-stage carpal tunnel syndrome do not have worse long-term patient-reported outcomes after CTR compared with the general population. Unrecordable nerve potentials are not a contraindication for CTR.     

RESULTS OF OPEN CARPAL TUNNEL RELEASE: A COMPREHENSIVE,RETROSPECTIVE STUDY OF 188 HANDS

Background : Many recent reports of the results of decompression of the median nerve in the carpal tunnel have concentrated on only one aspect of recovery (numbness, grip etc.), and there are no reports of a comprehensive study of outcome. The aim of the present study was to review comprehensively the results of the direct visualization method of decompression of the carpal tunnel and to compare them with the published results of endoscopic release. Methods : Patients' perceptions of the severity of pain, numbness and paraesthesiae due to carpal tunnel syndrome (CTS), before and after open carpal tunnel release (CTR) in 188 hands were reviewed retrospectively at a minimum time of follow-up of 18 months. Motor and sensory testing, provocation testing and measurement of scar tenderness in 135 hands were performed at a clinical review. Results : Subjective results showed that 70% experienced a reduction in the severity of pain after CTR, 78% of hands experienced a reduction in the severity of paraesthesiae and 77% experienced a reduction in the severity of numbness. A total of 49% had improvements in all three symptoms after CTR. At the clinical review, sensory testing revealed that 59% of hands had normal or slightly diminished light touch, 35% had normal static two-point discrimination and 61% had normal dynamic two-point discrimination. Results for Tinel's test, Phalen's test and pressure provocation testing were positive in 10% of hands. There was no scar tenderness in 38%, no persisting thenar atrophy in 90%. Normal grip strength was found in 93% and 91% had normal pinch strength. Conclusions : It was concluded that open carpal tunnel release remains a safe and reliable treatment for carpal tunnel syndrome. The very low incidence of serious complications from the open technique of CTR, when compared with endoscopic CTR as published by different authors in the literature, and the comparable clinical results, appears to make the open technique a safer and preferable option. However, a properly controlled trial of both techniques is necessary to compare them.     

Single-portal endoscopic carpal tunnel release compared with open release : a prospective,randomized trial

BACKGROUND: Carpal tunnel syndrome is a common condition causing hand pain and numbness. Endoscopic carpal tunnel release has been demonstrated to reduce recovery time, although previous studies have raised concerns about an increased rate of complications. The purpose of this prospective, randomized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release. METHODS: A prospective, randomized, multicenter center study was performed on 192 hands in 147 patients. The open method was performed in ninety-five hands in seventy-two patients, and the endoscopic method was performed in ninety-seven hands in seventy-five patients. All of the patients had clinical signs or symptoms and electrodiagnostic findings consistent with carpal tunnel syndrome and had not responded to, or had refused, nonoperative management. Follow-up evaluations with use of validated outcome instruments and quantitative measurements of grip strength, pinch strength, and hand dexterity were performed at two, four, eight, twelve, twenty-six, and fifty-two weeks after the surgery. Complications were identified. The cost of the procedures and the time until return to work were recorded and compared between the groups. RESULTS: During the first three months after surgery, the patients treated with the endoscopic method had better Carpal Tunnel Syndrome Symptom Severity Scores, better Carpal Tunnel Syndrome Functional Status Scores, and better subjective satisfaction scores. During the first three months after surgery, they also had significantly (p < 0.05) greater grip strength, pinch strength, and hand dexterity. The open technique resulted in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work (median, thirty-eight days compared with eighteen days after the endoscopic release). No technical problems with respect to nerve, tendon, or artery injuries were noted in either group. There was no significant difference in the rate of complications or the cost of surgery between the two groups. CONCLUSION: Good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used. Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome.     

The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome

There is conflicting evidence regarding the effectiveness of carpal tunnel release in older patients. This is a prospective study which evaluates the impact of age and gender upon symptoms, self-reported disability and surgical outcome in a series of 97 patients with carpal tunnel syndrome. Symptom severity, hand function and patient satisfaction were assessed using the Boston Carpal Tunnel Questionnaire and the Patient Evaluation Measure. A statistical correlation of age and gender with symptoms, hand function and surgical outcome was performed with questionnaires administered before open carpal tunnel decompression and 6 months after surgery. Women reported greater pre-operative symptoms and disability than men, but there was no gender-related difference in surgical outcome or patient satisfaction. There was no difference in surgical outcome between patients 60 and 70 years of age and younger patients. The majority of patients over the age of 70 reported an improvement in symptoms and function, but they were less satisfied with their treatment than younger patients. Some patients had problems with persistent numbness and loss of dexterity following surgery. The outcome of carpal tunnel release in terms of improvement in the symptom and functional scores is sufficient to justify surgery in the elderly, but surgical outcomes are less predictable than in younger patients and we recommend that this is explained to them when obtaining consent for surgery.     

Patient satisfaction after open carpal tunnel release correlates with depression

PURPOSE: To test the null hypothesis that depression does not correlate with patient satisfaction after open release of electrodiagnostically confirmed carpal tunnel syndrome when controlling for other demographic, disease-related, and psychosocial factors. METHODS: Eighty-two survey respondents who had recovered (minimum 2 years after surgery) from a limited incision open carpal tunnel release completed measures of satisfaction, perceived disability, depression, pain catastrophizing, and pain anxiety. Univariate and multivariate analyses sought predictors of satisfaction and perceived disability from among demographic, disease related, and psychological factors. RESULTS: The average satisfaction score was 8 points (range, 0-10) and the average Disabilities of the Arm, Shoulder, and Hand score was 13 points (range, 0-76). Predictors of greater dissatisfaction included greater depression and the categorical electrophysiologic test rating. Predictors of perceived disability included depression, pain catastrophizing, and static numbness. Depression was the dominant predictor of both satisfaction and perceived disability. CONCLUSIONS: Dissatisfaction and perceived disability after limited open carpal tunnel release for electrodiagnostically confirmed idiopathic carpal tunnel syndrome is predicted primarily by depression and ineffective coping skills and to a lesser degree by clinical or electrophysiologic evidence of advanced nerve damage. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.     

Endoscopic carpal tunnel release in the elderly.

The present study is aimed to clarify the postoperative outcome of endoscopic carpal tunnel release in elderly patients with carpal tunnel syndrome. Endoscopic carpal tunnel release was performed on 37 hands of 27 patients (2 men, 25 women) who were aged 70 years or older and clinically and electrophysiologically diagnosed with carpal tunnel syndrome. Mean age at the time of surgery was 74.5 years (range: 70-85 years). Mean postoperative follow-up was 35.5 months (range: 12-114 months). Pain was present preoperatively in 20 hands, but quickly resolved postoperatively in all cases. Numbness completely disappeared in 13 of 37 hands (35.1%), but some degree of numbness remained in the remaining cases. Preoperative severity of thenar muscle atrophy was none in 4 hands, mild in 7 hands, moderate in 12 hands and severe in 14 hands. Postoperative severity of thenar muscle atrophy at final follow-up was none in 13 hands, mild in 16 hands, moderate in 2 hands and severe in 6 hands, confirming that thenar muscle atrophy improves even in elderly patients. However, moderate or severe thenar muscle atrophy remained in 8 hands (21.6%). Endoscopic carpal tunnel release should be considered in the elderly, even though clinical symptoms may not improve substantially in advanced cases.     

Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire in carpal tunnel surgery

PURPOSE: Symptom resolution and functional improvement are the 2 primary reasons for patients to seek treatment for carpal tunnel syndrome (CTS). This study aimed to measure the responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand (DASH) when evaluating outcomes after carpal tunnel surgery. METHODS: Fifty patients prospectively completed the MHQ and the DASH before and 6 months after open carpal tunnel release. Data were analyzed using paired t tests and responsiveness to clinical change was calculated by using standardized response means (SRMs). RESULTS: All domains of the MHQ significantly improved after carpal tunnel release: the pain scale had a large SRM of 0.9 and the function scale showed medium responsiveness of 0.6. The combined function/symptom scale of the DASH significantly improved after surgery; the SRM revealed a medium effect of 0.7. CONCLUSIONS: The MHQ and the DASH are both responsive in measuring outcomes of carpal tunnel surgery. The MHQ has subscales that can measure symptom and function improvement independently. The MHQ and the DASH can be used for outcomes research related to carpal tunnel surgery with the advantage of also being useful for assessing and comparing outcomes for various other hand disorders.     

Double incision open technique for carpal tunnel release: An alternative to endoscopic release

I prospectively evaluated the results of 30 consecutive patients with bilateral carpal tunnel release using two techniques. The first release was performed with a standard incision while the opposite hand underwent release by a double incision open technique. Postoperatively, subjective complaints of pain, grip strength, pinch strength, and pillar tenderness were evaluated at 1, 2, 4, 6, and 10 weeks. All patients expressed complete relief of preoperative numbness in both hands. The improvement in pinch and grip strength and lack of pillar tenderness in the hands that underwent the double incision open technique closely matched the reported results of endoscopic carpal tunnel release. There were no complications with either technique.     

Carpal tunnel syndrome with severe sensory deficit: endoscopic release in 18 cases

Carpal tunnel syndrome (CTS) with severe sensory deficit was treated with endoscopic carpal tunnel release in 18 hands of 16 consecutive patients (median age 72 (28-92) years). In all hands, preoperative 2-point discrimination (2-PD) exceeded 15 mm in the radial and ulnar sides of the pulps of at least 2 of the 3 radial digits. All patients underwent an independent evaluation and answered a questionnaire concerning 11 activities of daily living (ADL) preoperatively and 6 months postoperatively. Complete resolution or improvement in daytime numbness and tingling was reported in 12 of 17 hands, of night symptoms in 12 of 16 hands, and of pain in 10 of 11 hands. The median ADL score improved from 3.1 to 1.4 (on a 1- to 5-point scale). 13 of the 16 patients were satisfied with the outcome. Two-PD had normalized in 14 hands and improved in 2. The results indicate that endoscopic carpal tunnel release is effective in improving symptoms and function in patients with CTS and severe sensory deficit, and that the prognosis for sensory recovery is good.     

Carpal tunnel syndrome with severe sensory deficit: Endoscopic release in 18 cases

Carpal tunnel syndrome (CTS) with severe sensory deficit was treated with endoscopic carpal tunnel release in 18 hands of 16 consecutive patients (median age 72 (28-92) years). In all hands, preoperative 2-point discrimination (2-PD) exceeded 15 mm in the radial and ulnar sides of the pulps of at least 2 of the 3 radial digits. All patients underwent an independent evaluation and answered a questionnaire concerning 11 activities of daily living (ADL) preoperatively and 6 months postoperatively. Complete resolution or improvement in daytime numbness and tingling was reported in 12 of 17 hands, of night symptoms in 12 of 16 hands, and of pain in 10 of 11 hands. The median ADL score improved from 3.1 to 1.4 (on a 1- to 5-point scale). 13 of the 16 patients were satisfied with the outcome. Two-PD had normalized in 14 hands and improved in 2. The results indicate that endoscopic carpal tunnel release is effective in improving symptoms and function in patients with CTS and severe sensory deficit, and that the prognosis for sensory recovery is good.     

Carpal tunnel syndrome with severe sensory deficit: Endoscopic release in 18 cases

Carpal tunnel syndrome (CTS) with severe sensory deficit was treated with endoscopic carpal tunnel release in 18 hands of 16 consecutive patients (median age 72 (28-92) years). In all hands, preoperative 2-point discrimination (2-PD) exceeded 15 mm in the radial and ulnar sides of the pulps of at least 2 of the 3 radial digits. All patients underwent an independent evaluation and answered a questionnaire concerning 11 activities of daily living (ADL) preoperatively and 6 months postoperatively. Complete resolution or improvement in daytime numbness and tingling was reported in 12 of 17 hands, of night symptoms in 12 of 16 hands, and of pain in 10 of 11 hands. The median ADL score improved from 3.1 to 1.4 (on a 1- to 5-point scale). 13 of the 16 patients were satisfied with the outcome. Two-PD had normalized in 14 hands and improved in 2. The results indicate that endoscopic carpal tunnel release is effective in improving symptoms and function in patients with CTS and severe sensory deficit, and that the prognosis for sensory recovery is good.     

Carpal tunnel syndrome: associated abnormalities in ulnar nerve function and the effect of carpal tunnel release on these abnormalities

Twenty of 59 hands (34%) of patients with carpal tunnel syndrome had abnormalities in sensibility testing of both median and ulnar nerves by either two-point discrimination, Semmes-Weinstein monofilament testing, or both. Before surgery, 53% of patients complained of paresthesias and/or numbness in ulnar nerve distribution. Eighty percent of the hands had abnormal Semmes-Weinstein monofilament testing of the ulnar nerve. Thirty-five percent had abnormal two-point discrimination. Forty-one percent had abnormal electromyographic testing of the ulnar nerve. All hands had median nerve decompression alone. Guyon's canal was not released. After surgery, 89% of patients had improvement in paresthesias and/or numbness of the ulnar nerve. Ninety-four percent had improvement in Semmes-Weinstein monofilament testing. Eighty-six percent had improvement in two-point discrimination. Patients with a residual abnormality in ulnar nerve sensibility also had continued abnormality in median nerve sensibility. A significant percentage of patients with carpal tunnel syndrome also have signs and symptoms of ulnar nerve compression. Most improved with carpal tunnel release alone.     

A Controlled Trial Evaluating the Safety and Effectiveness of Ultrasound-Guided Looped Thread Carpal Tunnel Release

Background: Open carpal tunnel release typically requires several weeks of recovery. A less invasive, ultrasound-guided percutaneous technique of releasing the transverse carpal ligament using a thread (thread carpal tunnel release [TCTR]) has been described. To date, its clinical effectiveness and safety have been evaluated exclusively by the group that developed the technique, using a single outcome measure without a control comparison. The objective of this study was to independently evaluate the safety and effectiveness of TCTR using multiple outcome measures and a control comparison. Methods: A convenience sample of 20 participants with refractory moderate or severe carpal tunnel syndrome underwent TCTR of their most symptomatic hand. Outcome measures included pre-TCTR and 1-, 3-, and 6-month post-TCTR Boston questionnaire; pre-, 3-, and 6-month post-TCTR monofilament sensibility, strength, ultrasound, and electrodiagnostic testing; weekly post-TCTR phone interviews for 1 month; and satisfaction surveys at 3 and 6 months post-TCTR. Results: No complications were reported. During the month post-TCTR, significant prompt improvements in hand pain and dysfunction occurred. The following significant improvements were demonstrated in the treated versus control hand: Boston Questionnaire scores, median nerve distal motor latency, transcarpal tunnel motor and sensory conduction velocities and sensory nerve action potential amplitudes. No significant differences in sensibility, pinch or grip strength, median nerve cross-sectional area (CSA) at the carpal tunnel inlet, or wrist: forearm median nerve CSA ratio were documented between TCTR and control sides. Satisfaction with the TCTR procedure was high (85%-90%). Conclusions: This study supports previous reports that the TCTR procedure is safe and effective.     

Pre-operative factors and treatment outcome following carpal tunnel release

The outcome of carpal tunnel release was evaluated retrospectively in 60 hands of 53 patients followed for six to 33 months (median ten months). Outcome was considered good in 27% (pain, weakness, and numbness were essentially resolved); fair in 42% (most of the symptoms improved); and poor in 32% (symptoms persisted or worsened). Patients whose pre-operative work activity was considered physically strenuous were associated with a slightly but significantly poorer outcome (60% good or fair) compared to those in light work or with no employment (89% good or fair). Proportionately fewer patients returned to their original work when they previously engaged in strenuous activity, ranging from 27% for those using air guns to 80% in light work. It appears that the highest chance of a poor outcome from carpal tunnel release occurs in patients who have either associated symptoms of thoracic outlet syndrome or physically strenuous work activities.     

Critical analysis of outcome measures used in the assessment of carpal tunnel syndrome

Clinicians and researchers are confounded by the various outcome measures used for the assessment of carpal tunnel syndrome (CTS). In this study, we critically analysed the conceptual framework, validity, reliability, responsiveness and appropriateness of some of the commonly used CTS outcome measures. Initially, we conducted an extensive literature search to identify all of the outcome measures used in the assessment of CTS patients, which revealed six different carpal tunnel outcome measures [Boston Carpal Tunnel Questionnaire (BCTQ), Michigan Hand Outcome Questionnaire (MHQ), Disability of Arm, Shoulder and Hand (DASH), Patient Evaluation Measure (PEM), clinical rating scale (Historical-Objective (Hi-Ob) scale) and Upper Extremity Functional Scale (UEFS)]. We analysed the construction framework, development process, validation process, reliability, internal consistency (IC), responsiveness and limitations of each of these outcome measures. Our analysis reveals that BCTQ, MHQ and PEM have comprehensive frameworks, good validity, reliability and responsiveness both in the hands of the developers, as well as independent researchers. The UEFS and Hi-Ob scale need validation and reliability testing by independent researchers. Region-specific measures like DASH have good frameworks and, hence, a potential role in the assessment of CTS but they require more validation in exclusive carpal tunnel patients.     

Is symptomatology useful in distinguishing between carpal tunnel syndrome and cervical spondylosis?

Hand paraesthesia is a common symptom found in patients either with carpal tunnel syndrome or cervical spondylosis. To differentiate between the two conditions, it is important to identify additional diagnostic symptoms. Ninety-two patients with operated carpal tunnel syndrome and 138 patients with spinal surgery for cervical spondylosis were reviewed. After exclusion of cases co-morbid with both cervical spondylosis and carpal tunnel syndrome or other neurological disorders, 44 patients with carpal tunnel syndrome and 41 patients with cervical spondylosis were compared. There were significant differences in the symptomatology between the two groups. In carpal tunnel syndrome, 84% had nocturnal paraesthesia, 82% hand paraesthesia were aggravated by hand activity, and hand pain occurred in 64%. The incidences were only 10%, 7% and 10%, respectively in cervical spondylosis. Neck pain was present in 76% of cervical spondylosis but only in 14% of carpal tunnel syndrome, and lower limb symptoms were present in 44% of cervical spondylosis and only 9% in carpal tunnel syndrome.     

Use of botulinum toxin in complex regional pain syndrome in the hand

This is the first report of the use of botulinum toxin injected into the hand to treat complex regional pain syndrome (CRPS). Botulinum toxin has been shown to improve pain in Raynaud's syndrome, carpal tunnel syndrome, and CRPS of the lower limb. Botulinum toxin has also been shown to act on pain neurotransmitters directly. A 40-year-old man was referred to us with bilateral CRPS after falling onto his hands. Fifty units of Botox® were injected into the carpal tunnel and 50 units around the digital neurovascular bundles of the left non-dominant hand. Hand assessments were performed before injection, and weekly for 6 weeks post-injection. The dominant hand acted as a control. A steady improvement of power grip strength in the left hand was shown. Power in his left hand was greater than the right, despite him being right handed. Total active movement did not change significantly. He felt the injection was beneficial. Botulinum toxin may have improved the signs and symptoms of CRPS in the hand due to its combined effect on the vascular and nervous systems. Botulinum toxin may block the self-perpetuation cycle of pain and sympathetic stimulation by blocking neurotransmitters and warrants further studies on CRPS.     

Prospective randomized comparison of single-incision and two-incision carpal tunnel release outcomes

Background

This study analyzes both the subjective and objective symptom and functional outcomes of patients who underwent either traditional single-incision or two-incision carpal tunnel release (CTR).

Methods

From 2008 to 2009, patients with isolated carpal tunnel syndrome were randomized to undergo either single-incision or two-incision CTR by a single surgeon at a university medical center. Pre-operatively, participants completed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ), as well as grip and pinch strength and Semmes–Weinstein monofilament sensation testing. At 2 weeks, 6 weeks and at least 6 months post-operatively, these measurements were repeated along with assessment of scar tenderness and pillar pain. Data were analyzed using SPSS version 20 software to perform non-parametric tests and Pearson's correlations. Significance was set at p?=?0.05.

Results

There was no statistically significant difference between the single- and two-incision CTR groups with respect to pre- and post-operative DASH scores, BWCTQ scores, grip strength, pinch strength, scar tenderness, or pillar pain. The only statistically significant difference was improved sensation by Semmes–Weinstein in the single-incision group in the second finger at 6 weeks post-operatively and in the third finger at 6 months post-operatively.

Conclusions

The preservation of the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences may account for reports of less scar tenderness and pillar pain among recipients of two-incision CTR compared to single-incision CTR in the early post-operative period. However, there is similar post-operative recovery and improvement in grip and pinch strength and sensation after 6+ months post-operatively.     

腕管综合征术后柱状痛的临床研究

目的 探讨腕管综合征常规手术后柱状痛的原因.方法 2006年12月至2008年10月,对27例(30侧)腕管综合征的患者,采用常规腕管切开正中神经松解术进行治疗,术后随访测量柱状痛的面积及发生柱状痛患腕的功能.结果 术后随访10～30个月,11侧出现手术切口周围柱状感觉麻木区,8侧出现切口周围单侧或双侧柱状痛.结论 在出现柱状痛或柱状感觉麻木的患者中,柱状痛的面积和切口长度呈正相关;有无柱状痛不是评价腕管切开减压术(OCTR)疗效的标准;切口的类型与柱状痛的发生无相关.