Objective： To compare differences of acupotomy loosing combined with medication treatment, electroacupuncture combined with medication treatment and simple medication treatment in effects on rheumatoid arthritis pati...Objective： To compare differences of acupotomy loosing combined with medication treatment, electroacupuncture combined with medication treatment and simple medication treatment in effects on rheumatoid arthritis patients with elbow joint stiffness and investigate the anti-inflammatory mechanism of the acupotomy loosing.Methods： A total of 60 cases of rheumatoid arthritis（RA） patients with elbow joint stiffness were randomly assigned into the group receiving acupotomy loosing（group A）, group with electroacupuncture（group B） and the one undergoing medication treatment（group C） with 20 cases for each group. Based on the medication treatment, all patients underwent continuous oral administration with Methotrexate（MTX）, Leflunomide（LEF） and Bitongding capsules for 3 weeks. And no other treatments were given to group C. In addition to medications treatment, the electroacupuncture was performed in group B. The acupoints of Tianzhu（天柱 BL 10）,DAzhui（大椎 GV 14）; Fengchi（风池 GB 20）,Quchi（曲池 LI 11）,Quze（曲泽 PC 3）,Chize（尺泽 LU 5）, Shousanli（手三里 LI 10）, Xiaohai（小海 SI 8）, Shaohai（少海 HT 3）, Tianjing（天井 TE 10）,Qinglengyuan（清冷渊 TE 11） and Hegu（合谷 LI 4） in the affected side were selected. A pair of electrodes were connected to LI 11 and LI 10, and another pair of electrodes were connected to PC 3 and LU 5, and the continuous wave with frequency of 2 Hz was designed, the needle retention for 30 min was performed, and the acupuncture was performed for 6 times per week with 3 weeks for one course,and there was one course totally. Besides the medication treatment, group A underwent the acupotomy loosing therapy. The tender point in lateral elbow joint, etc. were taken as the treatment point, and 6-8 treatment points being taken for each time, and longitudinal dredging and transverse exfoliation were conducted for 2-3 times with the acupotomy. The treatment was given for one time per week with three weeks for one course, and there was one course totally. The changes of maximum angle of active extension position, maximum angle of active flexion position and range of motion were observed, and levels of IL-6, IL-10 and TNF-a in affected synovial fluid of elbow joint were tested before the treatment and 2 weeks after the treatment in the groups.Results： ① Compared with those before treatment, the maximum angle of active extension position were smaller, the maximum angle of active flexion position were larger and the range of motion were wider of the affected elbow joints of the patients in the 3 groups on the 2 weeks after the treatment.There were statistical significances for the differences（All P 0.05）. Two weeks after the treatment,as compared with those in group C, the affected elbow joint for patients in the group B and group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were statistical significances for the differences（All P 0.05）. Comparing with those in the group B, the affected elbow joint for patients in the group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were the statistical significances for the differences（All P 0.05）. ② Compared with those before treatment, the levels of TNF-a and IL-6 were lower and the level of IL-10 was higher of the 3 groups on the 2 weeks after the treatment. There were the statistical significances for the differences（All P 0.05）. For 2 weeks after the treatment, compared with those in the group C, group B and group A were lower in levels of TNF-α and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）. As compared with those in the group B, group A was lower in levels of TNF-a and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）.Conclusions： The combination of acupotomy loosing can improve the maximum angle of active extension position, maximum angle of active flexion position and range of motion in affected elbow joint for RA patients with elbow joint stiffness, whose efficacy was superior to single basic treatment and electroacupuncture combined with basic treatment. Meanwhile, the levels of proinflammatory cytokines,such as TNF-α and IL-6 can be decreased, and the level of anti-inflammatory cytokines, such as IL-10 can be increased, playing a role in regulating the imbalance between proinflammatory cytokines and anti-inflammatory cytokines in RA patients, which may be one of mechanisms regarding treating RA and improving the range of motion for stiff joints.展开更多
Background：Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome.However,deep approaches may result in iatrogenic elbow stiffness.This long-term study was to evaluate the range of motion ...Background：Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome.However,deep approaches may result in iatrogenic elbow stiffness.This long-term study was to evaluate the range of motion （ROM） of the elbow and functional outcomes after anterior subcutaneous transposition.Methods：A total of 115 patients （78 male and 37 female;mean age：46.6 years） who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively;mean follow-up was 13.5 years.Elbow ROM was measured as flexion arc,flexion,and extension preoperatively and at the final follow-up,and compared via a mixed analysis of variance adjusting for age.Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria.An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors.Results：Preoperative McGowan grades were Grade 1 in 14 patients （12.2%）,Grade 2A in 28 （24.3%）,Grade 2B in 53 （46.1%）,and Grade 3 in 20 （17.4%） patients.Postoperatively,66 patients （57.4%） had excellent results,26 （22.6%） had good results,16 （13.9%） had fair results,and 7 （6.1%） had poor results at the final follow-up,as per the Wilson-Krout criteria.There were no complications.Pre-and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without （P 〈 0.05）.Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM （P 〉 0.05）,after adjusting for age.Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes （P 〈 0.05）,after adjusting for covariates.Conclusions：Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.展开更多
基金Supported by 2014 Wuhan clinical medical research project:WZ14C01~~
文摘Objective： To compare differences of acupotomy loosing combined with medication treatment, electroacupuncture combined with medication treatment and simple medication treatment in effects on rheumatoid arthritis patients with elbow joint stiffness and investigate the anti-inflammatory mechanism of the acupotomy loosing.Methods： A total of 60 cases of rheumatoid arthritis（RA） patients with elbow joint stiffness were randomly assigned into the group receiving acupotomy loosing（group A）, group with electroacupuncture（group B） and the one undergoing medication treatment（group C） with 20 cases for each group. Based on the medication treatment, all patients underwent continuous oral administration with Methotrexate（MTX）, Leflunomide（LEF） and Bitongding capsules for 3 weeks. And no other treatments were given to group C. In addition to medications treatment, the electroacupuncture was performed in group B. The acupoints of Tianzhu（天柱 BL 10）,DAzhui（大椎 GV 14）; Fengchi（风池 GB 20）,Quchi（曲池 LI 11）,Quze（曲泽 PC 3）,Chize（尺泽 LU 5）, Shousanli（手三里 LI 10）, Xiaohai（小海 SI 8）, Shaohai（少海 HT 3）, Tianjing（天井 TE 10）,Qinglengyuan（清冷渊 TE 11） and Hegu（合谷 LI 4） in the affected side were selected. A pair of electrodes were connected to LI 11 and LI 10, and another pair of electrodes were connected to PC 3 and LU 5, and the continuous wave with frequency of 2 Hz was designed, the needle retention for 30 min was performed, and the acupuncture was performed for 6 times per week with 3 weeks for one course,and there was one course totally. Besides the medication treatment, group A underwent the acupotomy loosing therapy. The tender point in lateral elbow joint, etc. were taken as the treatment point, and 6-8 treatment points being taken for each time, and longitudinal dredging and transverse exfoliation were conducted for 2-3 times with the acupotomy. The treatment was given for one time per week with three weeks for one course, and there was one course totally. The changes of maximum angle of active extension position, maximum angle of active flexion position and range of motion were observed, and levels of IL-6, IL-10 and TNF-a in affected synovial fluid of elbow joint were tested before the treatment and 2 weeks after the treatment in the groups.Results： ① Compared with those before treatment, the maximum angle of active extension position were smaller, the maximum angle of active flexion position were larger and the range of motion were wider of the affected elbow joints of the patients in the 3 groups on the 2 weeks after the treatment.There were statistical significances for the differences（All P 0.05）. Two weeks after the treatment,as compared with those in group C, the affected elbow joint for patients in the group B and group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were statistical significances for the differences（All P 0.05）. Comparing with those in the group B, the affected elbow joint for patients in the group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were the statistical significances for the differences（All P 0.05）. ② Compared with those before treatment, the levels of TNF-a and IL-6 were lower and the level of IL-10 was higher of the 3 groups on the 2 weeks after the treatment. There were the statistical significances for the differences（All P 0.05）. For 2 weeks after the treatment, compared with those in the group C, group B and group A were lower in levels of TNF-α and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）. As compared with those in the group B, group A was lower in levels of TNF-a and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）.Conclusions： The combination of acupotomy loosing can improve the maximum angle of active extension position, maximum angle of active flexion position and range of motion in affected elbow joint for RA patients with elbow joint stiffness, whose efficacy was superior to single basic treatment and electroacupuncture combined with basic treatment. Meanwhile, the levels of proinflammatory cytokines,such as TNF-α and IL-6 can be decreased, and the level of anti-inflammatory cytokines, such as IL-10 can be increased, playing a role in regulating the imbalance between proinflammatory cytokines and anti-inflammatory cytokines in RA patients, which may be one of mechanisms regarding treating RA and improving the range of motion for stiff joints.
文摘Background：Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome.However,deep approaches may result in iatrogenic elbow stiffness.This long-term study was to evaluate the range of motion （ROM） of the elbow and functional outcomes after anterior subcutaneous transposition.Methods：A total of 115 patients （78 male and 37 female;mean age：46.6 years） who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively;mean follow-up was 13.5 years.Elbow ROM was measured as flexion arc,flexion,and extension preoperatively and at the final follow-up,and compared via a mixed analysis of variance adjusting for age.Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria.An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors.Results：Preoperative McGowan grades were Grade 1 in 14 patients （12.2%）,Grade 2A in 28 （24.3%）,Grade 2B in 53 （46.1%）,and Grade 3 in 20 （17.4%） patients.Postoperatively,66 patients （57.4%） had excellent results,26 （22.6%） had good results,16 （13.9%） had fair results,and 7 （6.1%） had poor results at the final follow-up,as per the Wilson-Krout criteria.There were no complications.Pre-and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without （P 〈 0.05）.Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM （P 〉 0.05）,after adjusting for age.Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes （P 〈 0.05）,after adjusting for covariates.Conclusions：Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.
