加速康复理念用于腕管综合征正中神经卡压慢性损伤中的效果及对神经肌电图和日常生活能力的影响

目的观察加速康复理念用于腕管综合征正中神经卡压慢性损伤中的效果及对神经肌电图和日常生活能力的影响。方法将2017年3月—2018年10月石家庄市第一医院收治的60例腕管综合征正中神经卡压慢性损伤患者随机分为对照组和观察组,每组30例。2组均行正中神经减压和神经外膜松解,术后给予神经营养药物和功能锻炼。观察组在术前进行健康教育;术中松解完成后对神经进行电刺激,在神经周围注射复方倍他米松注射液;术后7 d开始行经皮神经电刺激治疗,疗程为2周。记录2组手术时间和住院时间,采用疼痛视觉模拟评分(VAS)比较2组术前及术后次日手和腕关节的疼痛程度;于术前及术后1个月、3个月使用肌电图检测2组患者正中神经的感觉传导速度(SCV)、感觉神经动作电位波幅(SNAP)、运动神经末端运动潜伏期(DML),并使用DASH上肢功能评分表比较2组的上肢功能;术后3个月时,根据腕管综合征功能评定标准评价2组治疗效果。结果2组手术时间比较差异无统计学意义(P>0.05),观察组住院时间明显短于对照组(P<0.05)。术后次日2组VAS分级和评分均明显改善(P均<0.05),且观察组改善情况明显优于对照组(P均<0.05)。2组术后1个月和3个月SCV和SNAP均明显提高(P均<0.05),DML和DASH评分均明显降低(P均<0.05),且观察组变化的程度明显大于对照组(P均<0.05)。观察组的优良率为93.3%(28/30),明显高于对照组的83.3%(25/30)(P<0.05)。结论加速康复理念用于腕管综合征正中神经卡压慢性损伤的治疗,可明显减轻手及腕关节疼痛,缩短住院时间,改善神经功能和上肢功能。

Effect of accelerated rehabilitation concept on chronic injury of median nerve entrapment in the carpal tunnel syndrome and effect on neuromyogram and daily living ability

Objective It is to observe the effect of accelerated rehabilitation concept on chronic injury of median nerve entrapment in carpal tunnel syndrome and its effect on neuromyogram and daily living ability.Methods Sixty patients with chronic injury of median nerve entrapment in carpal tunnel syndrome treated in the First Hospital of Shijiazhuang from March 2017 to October 2018 were randomly divided into control group and observation group,30 cases in each group.Both groups were treated with median nerve decompression and neuroepicardial release,and were given neurotrophic drugs and functional exercises after surgery.The observation group received health education before the operation;After intraoperative release,the nerves were electrically stimulated,and compound betamethasone injection was injected around the nerves.Percutaneous electrical nerve stimulation was started on the 7th postoperative day,and the course of treatment was 2 weeks.The operation time and hospitalization time of the two groups were recorded,and the pain degree of the hand and wrist before surgery and on the next day after surgery were compared by VAS scores;the sensory conduction velocity(SCV),sensory nerve action potential(SNAP),and distal motor latency(DML)of the median nerve were detected by electromyography before surgery and at 1 month and 3 months after surgery in the two groups.The upper limb function of the patients in the two groups was compared according to their DASH score.At 3 months after surgery,the treatment effects of the two groups were evaluated according to the carpal tunnel syndrome functional evaluation criteria.Results There was no significant difference in surgical time between the two groups(P>0.05),and the hospital stay in the observation group was significantly shorter than that in the control group(P<0.05).The VAS classification and score of the two groups were significantly improved on the next day after surgery(P<0.05),and the improvement in the observation group was significantly better than that in the control group(P<0.05).SCV and SNAP were significantly increased while DML and DASH scores were significantly reduced at 1 and 3 months after surgery in both groups(P<0.05),and the degree of change in the observation group was more significant than that in the control group(P<0.05).The excellent rate in the observation group was 93.3%(28/30),which was significantly higher than that 83.3%(25/30)in the control group(P<0.05).Conclusion The concept of accelerated rehabilitation can significantly relieve pain of the hands and wrist joints,shorten the length of hospital stay,and improve nerve function and upper limb function in the treatment of chronic injury of median nerve entrapment in carpal tunnel syndrome.