术中低高频交替电刺激对肘管综合征手术疗效的影响

Effect of electrical stimulation with alternating between low and high frequencies on surgical effectiveness of cubital tunnel syndrome

目的观察术中低高频交替电刺激对肘管综合征手术疗效的影响。方法选取168例(181侧)肘管综合征保守治疗无效需行手术治疗的患者,随机分A~D 4组,每组42例。A组为对照组,B组为低频(3 Hz)电刺激组,C组为高频(15 Hz)电刺激组,D组为低高频交替(3 Hz/15 Hz)电刺激组。术后1 d、3个月、6个月随访观察患者Lovett肌力分级、顾玉东肘管综合征的功能评分、肘段尺神经运动传导速度(MCV)等指标,并与术前比较。两组间比较采用t检验,多组间比较采用方差分析。结果治疗前4组患者的各项评分差异无统计学意义(t=1.200,P>0.05);术后1 d各组分并指肌力分级比较差异无统计学意义(t=1.622,P>0.05);术后3个月及6个月时低高频交替电刺激组优于其他3组(t=7.200,P<0.05)。在术后1 d时顾玉东肘管综合征的功能评分4组的优良率(23.81%、28.57%、26.19%、28.57%)差异无统计学意义(t=0.946,P>0.05);在术后3个月时,低高频交替电刺激组的优良率(73.81%)显著高于低频电刺激组(61.90%)及高频电刺激组(50.00%),3组均高于对照组(42.86%)(t=7.285,P<0.05);低高频交替电刺激组患者MCV(62.88±11.87)均明显优于其他3组(48.57±9.39、53.68±9.69、51.20±10.57),差异有统计学意义(t=8.494、7.200、6.350,P<0.05),且在术后3个月就已经恢复正常,术后6个月改变较前变化不大,差异无统计学意义(t=1.100,P>0.05)。结论术中低高频交替电刺激较单一低频或高频电刺激具有一定优势,可有效改善肘管综合征患者手术松解预后。

Objective To observe the impact of electrical stimulation with the alternating application of low and high frequencies on surgical effectiveness of cubital tunnel syndrome.Methods To select 168 patients with failed conservative treatment of cubital tunnel syndrome,randomly divided into four groups of ABCD,each size of 42.Group A was not given any electrical stimulation.Group B was given low frequency(3 Hz)electrical stimulation.Group C received high frequency(15 Hz)electrical stimulation.Group D received alternating(3 Hz/15 Hz)electrical stimulation.After the release of nerve compression,all patients were given corresponding electrical stimulation and EMG monitoring.The follow-up on patients was carried out on the 1st day,3rd month and 6th month,to record the Lovett muscle grading,Gu′s cubital tunnel syndrome function score,MCV and other indicators.Comparative analysis was used between preoperative and postoperative statistics.T test was used for comparison between the two groups,and anova was used for comparison between multiple groups,P<0.05 considered to be statistically significant.Results The differences between the four groups before the operation is trivial(t=1.200,P>0.05);There is no significant difference in the Lovett muscle grading on the 1st day after the operation(t=1.622,P>0.05);Group D showed superior results to the other three groups(t=7.200,P<0.05)in the 3rd and 6th months after the operation.No significant difference was identified in the excellent rate(23.81%,28.57%,26.19%,28.57%)of the four groups of Gu′s cubital tunnel syndrome function score on 1st day after the operation(t=0.946,P>0.05);At 3rd month after the operation,the group D′s excellent rate(73.81%)was significantly higher than group B(61.90%)and group D(50.00%).Group A as the control group showed the lowest excellent rate(42.86%)(t=7.285,P<0.05).The MCV of patients in group D(62.88±11.87)was significantly better than the other three groups(48.57±9.39,53.68±9.69,51.20±10.57,t=8.494,7.200,6.350,P<0.05)and had returned to normal at 3rd month after the operation with little subsequent change afterwards until the 6th month(t=1.100,P>0.05).Conclusion Electrical stimulation alternating application of low and high frequencies has some advantages over a single low-frequency or high-frequency electrical stimulation,which can effectively improve the surgical release prognosis of patients with cubital tunnel syndrome.