论文部分内容阅读
Objectives: Carpal tunnel syndrome(CTS)is one of the most common nerve entrapment syndromes.Several therapeutic methods have been recommended,including splinting,physical therapy,steroid injection,surgical release and so on,in which steroid injection is the most commonly used strategy.However,simple steroid injection is effective only through its local anti-inflammatory mechanism.So this method inevitably has some limitations on the efficacy of carpal tunnel decompression,especially for those patients with obvious carpal tunnel stenosis and nerve entrapment.Therefore,sometimes,it is still necessary to loosen the transverse ligament of wrist and reduce mechanical compression.Take into account the side effects of surgical release,percutaneous release has been introduced.Miniscalpel-needle(MSN),developed in China,is a medical instrument similar to acupuncture needle,which can release fascia ligament and is minimally invasive.Furthermore,as the multidisciplinary approaches permeate with each other,the technology of ultrasound guidance has been gradually used in treating with several conditions.So,the aim of this study was to evaluate the effectiveness of steroid injection combined with MSN release for treatment of CTS under ultrasound guidance.We hypothesized it could be more beneficial than steroid injection alone.Methods: A randomized controlled trial was conducted and subjects with CTS were recruited.Sixty-one wrists in 54 patients with CTS were randomly allocated into two groups,namely,simple steroid injection group and steroid injection combined with MSN release group.All the procedures were performed in an out-of-plane manner under ultrasound guidance.The therapeutic effectiveness was evaluated using Boston carpal tunnel questionnaire(BCTQ),cross-sectional area(CSA)of the median nerve and five electrophysiological parameters,including distal motor latency(DML),compound motor action potential(CMAP),sensory nerve action potential(SNAP),motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)at pretreatment,4 and 12 weeks after treatment.All the staffs collecting and organizing outcome data were blinded to the group assignment.Results: Fifty-six wrists in 50 patients completed the study.Both of the two groups had obvious therapeutic effect at week 4 and 12 than before(P <0.05).However,at week 4 after treatment,CMAP and SNAP showed statistically significant improvement only in steroid injection combined with MSN releases group(P <0.05)but not in simple steroid injection group(P >0.05).Besides,when compared with simple steroid injection group at week 12 after treatment,combination therapy group showed a statistically significant improvement in BCTQ scores,CMAP and SNCV values(P <0.05).The average improvement of DML,MNCV,SNAP and CSA in combination therapy group was more than that in simple steroid injection group after 12 weeks,but there was no statistically significant difference(P >0.05).There was no significant difference between the two groups in terms of side effects(P >0.05).Conclusions: The effectiveness of ultrasound-guided steroid injection combined with MSN release for CTS is superior to that of steroid injection alone,which may have important implications for future clinical practice.