经皮电刺激促进桡神经损伤后神经再生的临床研究

Transcutaneous electrical nerve stimulation after radial nerve injury in the upper arm： a randomized conlrolled dinical study

目的探讨经皮电刺激对上臂桡神经完全损伤后神经再生的促进作用，并对电刺激的参数、波形进行优化组合，以寻求最佳治疗方案。方法对28例上臂段桡神经完全损伤患者，随机分为电刺激组和对照组，每组14例，在行桡神经缝合术后，各组同时服用神经营养药物治疗，电刺激组在术后4～6周石膏拆除后加用电刺激治疗。第1个月使用方波治疗，脉冲频率为2Hz；第2个月使用变幅脉冲波治疗，脉冲频率为15Hz；第3个月起继续使用变幅脉冲波治疗，脉冲频率为15Hz，同时每次附加肌肉训练波，脉冲频率为60Hz；之后均使用变幅脉冲波＋肌肉训练波，并适度增加肌肉训练波的治疗时间。术后随访内容：伸腕、伸指肌力，神经电生理检测。结果电刺激组的临床伸腕、伸指肌力与肌电图结果均优于对照组，两组差异有统计学意义（P〈0．05）。电刺激组的肌力恢复时间与肌电图恢复时间也明显短于对照组，两组差异有统计学意义（P〈0．05）。结论经皮电刺激治疗对促进上臂段桡神经损伤后神经再生的效果明显，在对电刺激仪的工作参数、电流波形进行优化组合后，可获得良好的疗效。

Objective To assess the clinical effect of transcutaneous electrical nerve stimulation on nerve regeneration after complete radial nerve injury in the upper ann, and investigate the parameters and waveforms of the electrical stimulation that can be a best treatment regimen. Methods A total of 28 cases of radial nerve complete injury in the upper arm were involve in the study. After nerve repair these patients were randomly distributed into two groups. Patients were given TENS and medication （electrical stimulation group） or medication only （control group）. Electrical stimulation was given to patients in this group 4 to 6 weeks after plaster removal. The regimen for the first month was square wave at 2 Hz, for the second month pulsate wave at 15 Hz, and for the third month pulsate wave at 15 Hz plus muscle stimulation at 60 Hz. Postoperative evaluation included muscle strength of wrist extensors and finger extensors, and compound muscle action potentials. Rcsults Significant therapeutic benefits were achieved in muscle strength and compound muscle action potentials in the electrical stimulation group （ P 〈 0.05 ）. Shorter recovery time determined by muscle strength and electromyogrsm activity was observed in the electrical stimulation group （P 〈 0.05 ）. Conclusion Transcutaneous electrical stimulation has obvious effect on promoting nerve regeneration after radial nerve injury in the upper arm. A better therapeutic benefit can be achieved by optimizing the regimen of parameters and waveforms.