小切口尺神经松解前置术联合黄芪桂枝五物汤对术后尺神经功能恢复及血清神经生长因子表达的影响

Effect of Anterior Operation of Small Incision Ulnar Nerve Lysis Combined with Huangqi Guizhi Wuwu Decoction(黄芪桂枝五物汤)on Postoperative Ulnar Nerve Function Recovery and Serum NGF Expression

目的探究小切口尺神经松解前置术联合黄芪桂枝五物汤对术后尺神经功能恢复及血清神经生长因子(nerve growth factor,NGF)表达的影响。方法选取2019年4月—2021年3月经该院骨科确诊为肘管综合征并拟行尺神原位松解术的104例为研究对象,根据随机数表法将其分为研究组及对照组,每组52例。两组均行小切口尺神经松解前置术,术后研究组联合使用黄芪桂枝五物汤治疗。检测并记录术前及术后4周血清NGF水平、患肢手握力、拇示指及中示指捏力、尺动脉肌电功能,上肢功能测定量表(disabilities of the arm,shoulder and hand,DASH)评分及术后总有效率。结果术后4周研究组尺神经传导速度、波幅指数及血清NGF水平均显著高于治疗前及对照组,潜伏期指数明显低于治疗前及对照组(P<0.05);术后4周研究组患手握力、拇示指捏力、中示捏力均显著高于术前及对照组,DASH评分明显低于术前及对照组(P<0.05);研究组总有效率98.08%(51/52)显著高于对照组84.62%(44/52)(P<0.05)。结论联合使用黄芪桂枝五物汤有助于尺神经松解前置术后尺神经功能恢复,可提高神经传导速度,有效改善手肌力和感觉功能,较单纯手术治疗效果更佳。

Objective To explore the effect of small incision anterior surgery of ulnar nerve lysis combined with Huangqi Guizhi Wuwu Decoction(黄芪桂枝五物汤)on postoperative ulnar nerve function recovery and serum nerve growth factor(NGF)expression.Methods From April 2019 to March 2021,104 patients who were diagnosed as cubital tunnel syndrome by the orthopedics department of the hospital and planned to undergo in situ ulnar lysis were selected as the research objects.According to the random number table method,they were divided into the study group and the control group,52 cases per group.Both groups underwent endoscopic in situ lysis of the ulnar nerve,and the study group was combined with Huangqi Guizhi Wuwu Decoction.The serum NGF level before and 4 weeks after the operation,the hand grip strength of the affected limb,the pinch force of the thumb and middle index fingers,the ulnar artery myoelectric function,the upper limb function measurement scale(DASH)score and the total effective rate after the operation were detected and recorded.Results The ulnar nerve conduction velocity,amplitude index and serum NGF level in the study group were significantly higher than those before treatment and those of the control group 4 weeks after operation,and the latency index was significantly lower than that before treatment and that of the control group(P<0.05).4 weeks after operation,the study group suffered from hand grip strength,the thumb finger pinch strength and middle pinch strength were significantly higher than those before operation and those of the control group,and the DASH score was significantly lower than that before operation and that of the control group(P<0.05).The total effective rate of the study group was 98.08%(51/52),significantly higher than that[84.62%(44/52)]of the control group(P<0.05).Conclusion The combined use of Huangqi Guizhi Wuwu Decoction can help to restore the ulnar nerve function after preoperative ulnar nerve release,increase the nerve conduction speed,effectively improve the hand muscle strength and sensory function,and has a better effect than the simple surgical treatment.