正中神经松解术联合倍他米松治疗糖尿病合并腕管综合征的研究

Study on neurolysis of median nerve combined with betamethasone in the treatment of diabetes complicated with carpal tunnel syndrome

目的评价正中神经松解术联合倍他米松治疗糖尿病合并腕管综合征的疗效。方法选取2019年1月至2020年3月宁波市第一医院骨科收治的糖尿病合并腕管综合征患者68例,使用随机数字表法分为两组:研究组(n=34)采用正中神经松解术联合倍他米松局部浸润,对照组(n=34)采用单纯的正中神经松解术。分别在入院时(T_(1))、术后第1天(T_(2))、术后1周(T_(3))、术后2周(T_(4))、术后6个月(T_(5)),采用视觉模拟评分法(VAS)评估记录患者疼痛程度;采用Kelly评定法以麻木症状缓解程度来评价疗效;监测术前1 h血糖及术后24 h血糖,分别记录患者术前及术后6 h、12 h、18 h、24 h血糖。结果两组患者围术期血糖差异无统计学意义(P>0.05)。T_(1)、T_(5)时点,两组患者VAS评分差异无统计学意义(P>0.05),T_(2)、T_(3)、T_(4)时点,研究组VAS评分显著低于对照组(P<0.05);研究组患者Kelly分级优良率为91.2%,显著高于对照组的76.5%(P<0.05)。结论正中神经松解术联合正中神经外膜下注射倍他米松,可以迅速且显著地减轻糖尿病合并腕管综合征患者的刺痛症状,改善远期神经功能康复。

Objective To evaluate the efficacy of neurolysis of median nerve combined with betamethasone in the treatment of diabetes complicated with carpal tunnel syndrome.Methods From January 2019 to March 2020,a total of 68 patients with diabetes and carpal tunnel syndrome admitted to the Department of Orthopedics of Ningbo First Hospital were divided into two groups by random number table:the patients in the study group(n=34)were treated with neurolysis of median nerve combined with local infiltration of betamethasone,while patients in the control group(n=34)were treated with neurolysis of median nerve alone.Respectively on admission(T_(1)),postoperative day 1(T_(2)),postoperative week 1(T_(3)),postoperative week 2(T_(4)),postoperative month 6(T_(5)),the visual analog scale(VAS)was adopted to evaluate and record the pain degree of the patients;Kelly's evaluation was used to evaluate the efficacy by the degree of numbness relief.The blood glucose of 1 h before the operation and the blood glucose of 24 h after the operation were monitored,and the blood glucose of the patients was recorded at 6 h,12 h,18 h,and 24 h before and after the operation,respectively.Results There was no significant difference in perioperative blood glucose between the two groups of patients(P>0.05).At T_(1) and T_(5),there was no significant difference in VAS score between the two groups of patients(P>0.05).At T_(2),T_(3) and T_(4),the VAS score of the study group was significantly lower than that of the control group(P<0.05).The excellent and good rate of Kelly grading in the study group was 91.2%,which was significantly higher than that(76.5%)in the control group(P<0.05).Conclusion Neurolysis of median nerve combined with betamethasone injection under the median epineurium will quickly and significantly reduce the tingling symptoms of patients with diabetes and carpal tunnel syndrome,and improve long-term neurological rehabilitation.