显微镜下微创松解联合术后口服坚骨胶囊治疗肘管综合征的效果研究

高星; 孟玉凤; 王伟; 李世英; 张桐桐

doi:10.16766/j.cnki.issn.1674-4152.003289

显微镜下微创松解联合术后口服坚骨胶囊治疗肘管综合征的效果研究

doi: 10.16766/j.cnki.issn.1674-4152.003289

高星^{1, 2, ,},
孟玉凤^{1, 2},
王伟^{1, 2},
李世英^{1, 2},
张桐桐^{1, 2}

1.
河北省沧州中西医结合医院手显微外二科，河北沧州 061001
2.
河北省中西医结合骨关节病研究重点实验室(筹)，河北沧州 061001

基金项目:

河北省中医药管理局2021年度中医药类科研计划项目 2021299

详细信息

通讯作者:
高星，E-mail：Gaoxing1109@yeah.net

中图分类号: R686
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出版历程
- 收稿日期: 2023-07-31

Study on the therapeutic effect of minimally invasive release under microscope combined with postoperative oral administration of Jiangu capsules on cubital tunnel syndrome

GAO Xing^{1, 2
, ,},
MENG Yufeng^{1, 2},
WANG Wei^{1, 2},
LI Shiying^{1, 2},
ZHANG Tongtong^{1, 2}

1.
2nd Hand & Microsurgery of Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou, Hebei 061001, China

摘要

摘要: 目的探讨口服坚骨胶囊在肘管综合征患者显微镜下微创松解术后中的应用效果，旨在对该疾病治疗研究提供借鉴。方法选择2022年1月—2023年4月河北省沧州中西医结合医院收治的肘管综合征患者94例，采用随机数字表法分为观察组(47例)和对照组(47例)。2组均行尺神经前置手术，对照组采用显微镜下微创松解术治疗，观察组联合术后口服坚骨胶囊治疗，2组均完成4周治疗，比较2组治疗有效率、尺神经传导速度、潜伏期、波幅、白细胞介素-1(IL-1)、神经生长因子(NGF)、运动、感觉功能及视觉模拟疼痛(VAS)评分。结果观察组有效率为95.74%(45/47), 高于对照组[82.98%(39/47), χ²=4.029，P=0.045]。干预4周后，观察组尺神经传导速度、波幅及NGF水平高于对照组(均P < 0.05)；潜伏期及IL-1水平低于对照组(均P < 0.05)。2组干预4周后运动和感觉功能改善，疼痛得到缓解；观察组拇食指握力[(3.73±0.56)kg vs. (2.85±0.45)kg]和示中指握力[(5.78±0.94)kg vs. (4.64±0.87)kg]高于对照组(均P < 0.05)；上肢功能障碍测定量表[(26.95±4.19)分vs. (36.39±5.51)分]及VAS评分[(1.03±0.43)分vs. (3.26±0.52)分]低于对照组(均P < 0.05)。结论显微镜下微创松解联合术后口服坚骨胶囊能提高肘管综合征的治疗有效率，有助于改善尺神经传导速度、IL-1及NGF水平，提高患者运动和感觉功能，减轻患者疼痛，值得推广应用。
- 显微镜下微创松解联合术 /
- 坚骨胶囊 /
- 肘管综合征 /
- 治疗效果 /
- 白细胞介素-1 /
- 神经生长因子
Abstract: Objective To investigate the application effect of oral Jiangu capsules in minimally invasive release of elbow tunnel syndrome patients under microscope, It aims to provide reference for research on the treatment of the disease. Methods A total of 94 patients with cubital tunnel syndrome from January 2022 to April 2023 were selected as study subjects, and randomly divided into two groups of 47 patients each. Both groups underwent anterior ulnar nerve surgery, while the control group underwent minimally invasive release surgery under a microscope. The observation group received postoperative oral treatment with Jiangu capsules. Both groups completed 4 weeks of treatment, and efficacy, ulnar nerve conduction velocity, latency, amplitude, interleukin-1 (IL-1), nerve growth factor (NGF), motor function, sensory function and visual analogue scale (VAS) scores were compared between the two groups. Results The efficacy rate of the observation group after 4 weeks of intervention was 95.74% (45/47), which was higher than that of the control group [82.98% (39/47), χ²=4.029, P=0.045]; after 4 weeks of intervention, ulnar nerve conduction velocity, amplitude and NGF levels were higher in the observation group than in the control group (all P < 0.05). The incubation period and IL-1 levels were lower than in the control group (all P < 0.05). After 4 weeks of intervention, motor and sensory functions were improved in both groups, and pain was relieved. The grip strength of the index finger [(3.73±0.56) kg vs. (2.85±0.45) kg] and middle finger [(5.78±0.94) kg vs. (4.64±0.87) kg] in the observation group was higher than in the control group (both P < 0.05). DASH [(26.95±4.19) points vs. (36.39±5.51) points] and VAS [(1.03±0.43) points vs. (3.26±0.52) points] scores were lower than in the control group (both P < 0.05). Conclusion Minimally invasive microscopic release combined with postoperative oral administration of Jiangu Capsule can improve the efficacy rate of patients with cubital tunnel syndrome, help improve ulnar nerve conduction velocity, IL-1 and NGF levels, improve motor and sensory functions, and alleviate pain in patients. It is worth promoting and using.
- Microscopic minimally invasive release combined surgery /
- Jiangu Capsules /
- Elbow tunnel syndrome /
- Therapeutic effect /
- Interleukin-1 /
- Nerve growth factor
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表 1 2组肘管综合征患者有效率比较

Table 1. Comparison of effective rate between 2 groups in patients with cubital tunnel syndrome

组别	例数	显效 [例(%)]	好转 [例(%)]	无效 [例(%)]	有效率 (%)
观察组	47	34(72.34)	11(23.40)	2(4.26)	95.74(45/47)
对照组	47	29(61.70)	10(21.28)	8(17.02)	82.98(39/47)
注：2组有效率比较，χ²=4.029，P=0.045。

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表 2 2组肘管综合征患者尺神经功能、IL-1及NGF比较(x±s)

Table 2. Comparison of ulnar nerve function, IL-1, and NGF between 2 groups in patients with cubital tunnel syndrome (x±s)

组别	例数	尺神经传导速度(ms)		潜伏期(ms)		波幅(mV)		IL-1(pg/mL)		NGF(ng/mL)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
观察组	47	26.98±4.31	40.36±5.73^a	9.74±0.83	6.29±0.61^a	4.89±0.93	7.85±1.15^a	16.37±3.15	5.11±0.96^a	122.41±8.56	145.29±12.15^a
对照组	47	27.01±4.33	34.25±5.15^a	9.76±0.85	7.94±0.74^a	4.91±0.95	5.92±1.04^a	16.41±3.17	11.69±1.69^a	123.26±8.59	132.64±10.19^a
t值		0.034	5.437	0.115	11.795	0.103	8.489	0.061	23.209	0.481	5.469
P值		0.973	＜0.001	0.908	＜0.001	0.918	＜0.001	0.951	＜0.001	0.632	＜0.001
注：与同组干预前比较，^aP < 0.05。

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表 3 2组肘管综合征患者手指握力和VAS评分比较(x±s)

Table 3. Comparison of finger grip strength and VAS score between 2 groups in patients with cubital tunnel syndrome (x±s)

组别	例数	拇食指握力(kg)		示中指握力(kg)		DASH(分)		VAS评分(分)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
观察组	47	1.98±0.31	3.73±0.56^a	3.32±0.78	5.78±0.94^a	58.37±6.32	26.95±4.19^a	5.12±0.86	1.03±0.43^a
对照组	47	2.00±0.32	2.85±0.45^a	3.34±0.81	4.64±0.87^a	58.41±6.35	36.39±5.51^a	5.15±0.87	3.26±0.52^a
t值		0.308	8.398	0.122	6.102	0.031	9.349	0.168	22.657
P值		0.759	＜0.001	0.903	＜0.001	0.976	＜0.001	0.867	＜0.001
注：与同组干预前比较，^aP < 0.05。

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参考文献(20)

[1]	宿晓雷, 余航, 李闯, 等. 中医疗法结合3D打印技术治疗中重度肘管综合征[J]. 中国中西医结合外科杂志, 2021, 27(3): 498-502. doi: 10.3969/j.issn.1007-6948.2021.03.024 SU X L, YU H, LI C. Treatment of moderate-severe cubital tunnel syndrome with integrated traditional Chinese and Western medicine therapy combined with 3D printing technology[J]. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, 2021, 27(3): 498-502. doi: 10.3969/j.issn.1007-6948.2021.03.024
[2]	户文耀, 李汶霖, 王洋, 等. WALANT麻醉联合小切口原位松解术治疗肘管综合征的疗效分析[J]. 中国骨与关节损伤杂志, 2021, 36(3): 294-296. HU W Y, LI W L, WANG Y, et al. Analysis of the efficacy of WALANT anesthesia combined with small incision in situ release surgery in the treatment of cubital tunnel syndrome[J]. Chinese Journal of Bone and Joint Injury, 2021, 36(3): 294-296.
[3]	DE RUITER G C W, DE JONGE J G H, VLAK M H M, et al. Letter to the editor regarding "Ulnar Neuropathy Caused by a Muscular Arcade of Struthers"[J]. World Neurosurg, 2021, 148: 228-229. doi: 10.1016/j.wneu.2021.01.073
[4]	李海滨, 王铭, 代娟, 等. 半开放手术松解治疗肘管综合征合并肘关节骨性关节炎35例[J]. 中国微创外科杂志, 2022, 28(11): 888-892. doi: 10.3969/j.issn.1009-6604.2022.11.009 LI H B, WANG M, DAI J, et al. Semi-open surgical release in the treatment of cubital tunnel syndrome combined with elbow osteoarthritis: report of 35 cases[J]. Chinese Journal of Minimally Invasive Surgery, 2022, 28(11): 888-892. doi: 10.3969/j.issn.1009-6604.2022.11.009
[5]	涂振兴, 王斌, 张顶顶, 等. 显微镜下神经松解治疗非创伤性Ⅱ型Guyon管综合征[J]. 实用骨科杂志, 2022, 28(2): 166-169. TU Z X, WANG B, ZHANG D D, et al. Neurolysis under a microscope for the treatment of non traumatic type Ⅱ Guyon' s tunnel syndrome[J]. Journal of Practical Orthopaedics, 2022, 28(2): 166-169.
[6]	RUSSO N, QAYYUM F, DIVANYAN T, et al. Protocol-based treatment of neurogenic thoracic outlet syndrome[J]. J Vasc Surg, 2021, 73(3): 40-41.
[7]	张宪男, 顾宇, 张梁, 等. 尺神经松解前置合并示指外展功能重建治疗重度肘管综合征20例[J]. 中国中医骨伤科杂志, 2022, 30(5): 73-76. ZHANG X N, GU Y, ZHANG L, et al. 20 cases on anterior ulnar nerve release combined with reconstruction of finger abduction on the treatment of severe cubital tunnel syndrome[J]. Chinese Journal of Traditional Medical Traumatology & Orthopedics, 2022, 30(5): 73-76.
[8]	焦悦, 刘维, 刘昱材, 等. 金乌骨通胶囊联合塞来昔布胶囊治疗强直性脊柱炎的临床研究[J]. 现代生物医学进展, 2022, 22(5): 852-856. JIAO Y, LIU W, LIU Y C, et al. Clinical study of Jinwugutong Capsule combined with celecoxib capsule in the treatment of ankylosing spondylitis[J]. Progress in Modern Biomedicine, 2022, 22(5): 852-856.
[9]	王立, 谢晴, 吕莉, 等. 旋前方肌肌支移位治疗重度肘管综合征[J]. 中华手外科杂志, 2022, 38(6): 483-486. doi: 10.3760/cma.j.cn311653-20211115-0033 WANG L, XIE Q, LYU L, et al. Motor branch of pronator quadratus transfer for treatment of severe cubital tunnel syndrome[J]. Chinese Journal of Hand Surgery, 2022, 38(6): 483-486. doi: 10.3760/cma.j.cn311653-20211115-0033
[10]	HOSSEINI-FARID M, SCHRIER V J M M, STARLINGER J, et al. Carpal tunnel syndrome treatment and the subsequent alterations in tendon and connective tissue dynamics[J]. Clin Biomech (Bristol, Avon), 2021, 88: 105440. DOI: 10.1016/j.clinbiomech.2021.105440.
[11]	李阳, 谢康, 袁毅, 等. 造影下克氏针撬拨复位弹性髓内钉固定治疗低龄儿童Judet Ⅳ型桡骨颈骨折效果观察[J]. 中华全科医学, 2021, 19(9): 1459-1462. doi: 10.16766/j.cnki.issn.1674-4152.002085 LI Y, XIE K, YUAN Y, et al. Treatment of JudetⅣtype radial neck fracture in young children with Kirschner wire percutaneous leverage reduction and elastic intramedullary nail fixation under elbow arthrography[J]. Chinese Journal of General Practice, 2021, 19(9): 1459-1462. doi: 10.16766/j.cnki.issn.1674-4152.002085
[12]	王瀚博, 刘瑞, 赵建民, 等. 肌骨超声结合神经电生理检查对肘管综合征术前的指导意义[J]. 内蒙古医科大学学报, 2021, 43(5): 485-488. WANG H B, LIU R, ZHAO J M, et al. The guiding significance of muscle bone ultrasound combined with neuroelectrophysiological examination for preoperative diagnosis of cubital tunnel syndrome[J]. Journal of Inner Mongolia Medical University, 2021, 43(5): 485-488.
[13]	代丽, 余航, 陈华, 等. 针灸结合黄芪桂枝五物汤对保守治疗肘管综合征患者IL-1、NGF和功能恢复的影响[J]. 长春中医药大学学报, 2022, 38(9): 1011-1014. DAI L, YU H, CHEN H, et al. Effects of acupuncture combined with Huangqi Guizhi Wuwu Decoction on IL-1, NGF and functional recovery in patients with the cubital tunnel syndrome treated conservatively[J]. Journal of Changchun University of Chinese Medicine, 2022, 38(9): 1011-1014.
[14]	ZIMMERMAN M, SCHRAMME M, BARTHÉLEMY A, et al. CT is a feasible imaging technique for detecting lesions in horses with elbow lameness: a study of 139 elbows in 99 horses[J]. Vet Radiol Ultrasound, 2022, 63(2): 164-175. doi: 10.1111/vru.13044
[15]	李晓明, 赵云超, 郭东辉, 等. 坚骨胶囊对胫骨高位截骨术后膝关节功能的近期疗效观察[J]. 中国中医骨伤科杂志, 2019, 27(12): 22-25. JLI X M, ZHAO Y C, GUO D H, et al. Observation on short-term efficacy of Jian Gu Capsule on knee function after high tibial osteotomy[J]. Chinese Journal of Traditional Medical Traumatology & Orthopedics, 2019, 27(12): 22-25.
[16]	张磊, 王海林, 刘旋, 等. 尺神经松解前置术治疗肘管综合征的临床疗效及预后的影响因素分析[J]. 局解手术学杂志, 2021, 30(6): 520-524. ZHANG L, WANG H L, LIU X, et al. Clinical efficacy of ulnar nerve release anterior transposition on cubital tunnel syndrome and its influencing factors for prognosis[J]. Journal of Regional Anatomy and Operative Surgery, 2021, 30(6): 520-524.
[17]	薛金雷, 肖海军, 陆义安, 等. 开放腕管松解术与关节镜下腕管松解术治疗腕管综合征的疗效比较[J]. 中国骨与关节损伤杂志, 2021, 36(7): 763-765. XUE J L, XIAO H J, LU Y A, et al. Comparison of therapeutic effects between open carpal tunnel release and arthroscopic carpal tunnel release in the treatment of carpal tunnel syndrome[J]. Chinese Journal of Bone and Joint Injury, 2021, 36(7): 763-765.
[18]	MANZI J E, CICCOTTI M C, TRAUGER N, et al. Increased elbow and olecranon injury history in professional pitchers with increased elbow flexion at ball release[J]. Am J Sports Med, 2022, 50(4): 1054-1060. doi: 10.1177/03635465211072223
[19]	王伟, 李世英, 郭晓平, 等. 坚骨胶囊对肘关节退变性骨关节炎伴尺神经卡压综合征患者术后康复的影响[J]. 中华中医药学刊, 2022, 40(9): 200-203. WANG W, LI S Y, GUO X P, et al. Effect of Jiangu Capsule on postoperative rehabilitation of degenerative osteoarthritis of elbow joint with uinar nerve entrapment syndrome[J]. Chinese Archives of Traditional Chinese Medicine, 2022, 40(9): 200-203.
[20]	武晔, 王晓磊, 郝泽普, 等. 坚骨胶囊佐治类风湿关节炎继发骨质疏松临床评价[J]. 中国药业, 2022, 31(20): 87-90. WU Y, WANG X L, HE Z P, et al. Clinical evaluation of Jiangu Capsules in the adjuvant treatment of osteoporosis secondary to rheumatoid arthritis[J]. China Pharmaceuticals, 2022, 31(20): 87-90.