中度腕管综合征的体外冲击波治疗效果研究

目的评估体外冲击波(extracorporeal shock wave therapy,ESWT)这一新型的无创性方法对中度腕管综合征(carpal tunnel syndrone,CTS)的治疗效果。方法选取2014年6月-2016年6月收治的CTS患者80例,随机分为A、B两组(n=40)。A组给予ESWT治疗,每周一次,疗程共4周;B组给予口服塞来昔布(200 mg)和维生素B1片(300 mg),2次/d,疗程共4周。两组夜间均采用腕部支具固定。在治疗前和治疗后1、3、6个月采用视觉模拟评分(VAS)、波士顿问卷量表评分(BCTQ)以及中华医学会手外科学会上肢功能评定标准评价患者的临床疗效。结果两组在治疗后1、3、6个月的VAS评分均较治疗前显著改善(P<0.05),但A组的改善程度较同期B组更为显著(P<0.05);A组的Boston SYMPT评分和FUNCT评分均较治疗前显著改善,而B组的Boston SYMPT评分和FUNCT评分仅在治疗后3个月有明显差别,并且均低于同期A组;A组在治疗6个月后的各项评分几乎保持不变,基本趋于稳定,而B组的各项评分却明显增加;随访终末期评价,虽然两组有效率相比差异无统计学意义(P>0.05),但A组的优良率明显高于B组(P<0.05),复发率也明显低于B组(P<0.05)。结论在临床上可以推荐ESWT作为中度CTS患者的一种保守治疗手段。

Clinical study of extracorporeal shock wave in the treatment of moderate carpal tunnel syndrome

Objective To investigate the efficacy of the novel non-invasive method of extracorporeal shock wave therapy(ESWT)in moderate CTS.Methods Eighty patients who were diagnosed in our department from June 2014 to June 2016 were randomly divided into A and B groups(n=40).Group A was treated with ESWT once a week for 4 weeks.Group B was given oral celecoxib(200 mg)and vitamin B1 tablets(300 mg)twice daily for 4 weeks.Both groups were fixed with a wrist brace at night.The clinical efficacy of the patients was evaluated with visual analog scale(VAS),Boston questionnaire scale(BCTQ),and the Chinese Society of Hand Surgery Upper Limb Function Assessment before and after treatment at 1,3,and 6 months.Results The VAS scores of the two groups were significantly improved at 1,3,and 6 months after treatment(P<0.05),but the improvement of group A was more significant than that of group B(P<0.05).After 1,3,and 6 months,the Boston SYMPT score and FUNCT score of group A were significantly improved compared with those before treatment,while the Boston SYMPT score and FUNCT score of group B were only significantly different after 3 months of treatment(P<0.05),and were lower than group A at the same period(P<0.05).The scores of group A remained almost unchanged and basically stabilized after 6 months of treatment,while the scores of group B increased significantly.At the end of the follow-up evaluation,although there was no significant difference in the effective rate between the two groups(P>0.05),but the excellent rate of group A was significantly higher than that of group B(P<0.05),and the recurrence rate was also significantly lower than that of group B(P<0.05).Conclusion ESWT can be recommended as a conservative treatment for patients with moderate CTS.