坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征的临床研究

Clinical study of Jiangu Capsule combined with arthroscopy and ulnar nerve release in the treatment of elbow osteoarthritis with ulnar nerve entrapment syndrome

目的探讨坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征的临床疗效。方法选择河北省沧州中西医结合医院2018年1月至2021年5月收治的80例肘关节骨关节炎伴尺神经卡压综合征患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。对照组给予关节镜和尺神经松解术治疗;在此基础上,观察组口服坚骨胶囊治疗。连续治疗6个月后采用顾玉东建议的肘管综合征功能评定标准进行疗效评定。治疗前后对两组患者进行Mayo肘关节功能评分(Mayo elbow performance score,MEPS)、视觉模拟量表(visual analogue scale,VAS)评分,测量肘关节活动度,进行肌电图检查。并统计两组患者副反应情况。结果观察组肘管综合征功能评定优良率为75.00%(30/40),与对照组的52.50%(21/40)相比显著升高(P<0.05)。两组治疗后MEPS评分均较治疗前显著升高(P<0.05),疼痛VAS评分均较治疗前显著降低(P<0.05);且治疗后,观察组MEPS评分显著高于对照组(P<0.05),疼痛VAS评分显著低于对照组(P<0.05)。两组治疗后肘关节旋前度数、旋后度数以及屈伸度数均较治疗前显著增加(P<0.05),且均以观察组改善更显著(P<0.05)。两组治疗后尺神经神经传导速度(nerve conduction velocity,NCV)、小指展肌复合肌肉动作电位(compound muscle action potential,CMAP)均较治疗前显著增加(P<0.05),小指展肌运动诱发电位潜伏期(motor evoked potential latent period,MEPLP)均较治疗前显著缩短(P<0.05);治疗后,观察组尺神经的NCV、小指展肌的CMAP显著高于对照组(P<0.05),小指展肌的MEPLP显著短于对照组(P<0.05)。所有对象均无明显副反应发生。结论坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征能安全有效地改善患者的手、肘功能,提高关节活动度,减轻疼痛程度。

Background As a degenerative joint disease,the incidence of elbow osteoarthritis increased significantly with the severe aging of the population in China.Ulnar nerve compression syndrome(CuTS)induced by elbow osteoarthritis could affect patients'quality of life,exceptionally moderate and severe CuTS.At present,there is still no recognized optimal treatment plan for treating this kind of patient,so it is of great value to actively explore safe and effective treatment measures to improve the quality of life of these patients.Objective To explore the clinical efficacy of Jiangu Capsule combined with arthroscopy and ulnar nerve release in the treatment of elbow osteoarthritis with ulnar nerve entrapment syndrome(CuTS).Methods From January 2018 to May 2021,80 patients with elbow osteoarthritis and CuTS admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were selected as research objects and randomly divided into observation and control groups with 40 cases in each group.The control group was treated with arthroscopy and ulnar nerve release,and the observation group was treated with Jiangu Capsule.After six months of treatment,the efficacy was evaluated by using the CuTS functional evaluation standard recommended by Gu Yudong.Before and after treatment,Mayo elbow joint function score(MEPS)and pain visual analogue scale(VAS)were used to measure elbow joint motion and electromyography.The side effects of the two groups were counted.Results The excellent and good rate of CuTS function evaluation in the observation group was 75.00%(30/40),which was significantly higher than that in the control group(52.50%,21/40)(P<0.05).After treatment,MEPS scores of both groups were substantially higher than those before treatment(P<0.05),while VAS scores were significantly lower than those before treatment(P<0.05).After treatment,the MEPS score of the observation group was significantly higher than that of the control group(P<0.05),and the VAS score of pain was significantly lower than that of the control group(P<0.05).After treatment,the degree of elbow flexion,supination,flexion,and extension in both groups increased significantly(P<0.05),and the improvement in the observation group was more significant(P<0.05).After treatment,NCV of the ulnar nerve and CAMP of abductor digiti quinti increased significantly(P<0.05),while MEPLP of abductor digiti quinti shortened significantly(P<0.05).After treatment,the nerve conduction velocity(NCV)of the ulnar nerve and the compound muscle action potential(CMAP)of abductor digiti quinti in the observation group were significantly higher than those in the control group(P<0.05).In contrast,the latency of motor potential(MEPLP)of abductor digitorum minor was substantially shorter than that in the control group(P<0.05).No noticeable side effects occurred in all subjects.Conclusion Jiangu Capsule combined with arthroscopy and ulnar nerve release can safely and effectively improve the functions of hands and elbows,increase the range of motion of joints and reduce the degree of pain.