黄芪桂枝五物汤对肘管综合征气血两虚证术后患者手内肌功能及尺神经运动传导功能的影响

Effect of Huangqi Guizhi Wuwu Decoction on hand muscle function and ulnar nerve motor conduction function in patients with qi-blood deficiency cubital tunnel syndrome after operation

关键词:  肘管综合征  尺神经松解前置术  黄芪桂枝五物汤  手内肌功能  尺神经运动传导功能

Key words:  cubital tunnel syndrome  ulnar nerve release and anterior transposition surgery  Huangqi Guizhi Wuwu Decoction  internal hand muscle function  ulnar nerve motor conduction

摘要:

[目的] 探讨尺神经松解前置术联合黄芪桂枝五物汤对肘管综合征（CTS）气血两虚证患者手内肌功能及尺神经运动传导功能的影响。[方法] 采用真实世界回顾性队列研究，收集2021年3月—2023年3月河北省沧州中西医结合医院行尺神经松解前置术的100例CTS气血两虚证患者，根据治疗方案不同分成联合组50例，手术组50例。手术组接受尺神经松解前置术+甲钴胺治疗，联合组在手术组基础上联合黄芪桂枝五物汤治疗。比较两组患者临床疗效、手内肌功能、尺神经运动传导功能、手握力、上肢功能评定表（DASH）评分。[结果] 联合组的临床疗效总有效率为80.00%，高于手术组的62.00%，差异有统计学意义（P＜0.05）。手内肌功能总优良率为86.00%，高于手术组的66.00%，差异有统计学意义（P＜0.05）。尺神经功能优良率为78.00%，高于手术组的58.00%，差异有统计学意义（P＜0.05）。治疗后，两组尺神经运动传导速度（MCV）及手握力均升高，且联合组高于手术组（P＜0.05），DASH评分均降低，且联合组低于手术组（P＜0.05），差异有统计学意义。两组治疗前后病情分度比较差异均无统计学意义（P>0.05），且治疗后两组均无重度患者。[结论] 尺神经松解前置术联合黄芪桂枝五物汤能促进CTS气血两虚证患者手内肌功能及尺神经运动传导功能的恢复，疗效优于术后联合西药治疗。

Abstract:

[Objective] To investigate the effects of anterior ulnar nerve release and preposition combined with Huangqi Guizhi Wuwu decoction on internal hand muscle function and ulnar nerve motor conduction in patients with qi-blood deficiency cubital tunnel syndrome（CTS）. [Methods] A real-world retrospective cohort study was used. A total of 100 CTS qi-blood deficiency patients who underwent ulnar nerve release and anterior transposition surgery in Chengde Central Hospital from March 2021 to March 2023 were collected. They were grouped into a combined group of 50 patients and a surgical group of 50 patients according to different treatment plans. The surgical group received ulnar nerve release and anterior transposition surgery combined with mecobalamin treatment，and the combined group received Huangqi Guizhi Wuwu Decoction treatment on the basis of the surgical group. The clinical efficacy，hand muscle function，ulnar nerve motor conduction function，hand grip strength，and upper limb function evaluation scale（DASH） scores of the two groups were compared. [Results] The total clinical efficacy rate of the combined group was 80.00%，which was higher than that of the surgical group，62.00%，and the difference was statistically significant（P＜0.05）. The overall excellent and good rate of hand muscle function of the combined group was 86.00%，which was higher than 66.00% in the surgical group，and the difference was statistically significant（P＜0.05）. The excellent and good rate of ulnar nerve function of the combined group was 78.00%，which was higher than 58.00% in the surgical group，and the difference was statistically significant（P＜0.05）. After treatment，the motor conduction velocity（MCV） and grip strength of the ulnar nerve increased in both groups，and the combined group were higher than that of the surgical group（P＜0.05）. The DASH score decreased in both groups，and the combined group was lower than that of the surgical group，and the difference was statistically significant（P＜0.05）. There was no significant difference in the degree of illness between the two groups before and after treatment（P>0.05），and there were no severe patients in the two groups after treatment. [Conclusion] The combination of ulnar nerve release and anterior transposition surgery with Huangqi Guizhi Wuwu Decoction can promote the recovery of hand muscle function and ulnar nerve motor conduction function in qi-blood deficiency CTS patients，and the therapeutic effect is better than that of postoperative combined with western medicine treatment.