罗哌卡因鞘内注射治疗腕管综合征伴正中神经卡压症状的效果

摘要

目的 探讨罗哌卡因鞘内注射对腕管综合征伴正中神经卡压症状的影响.方法 选取腕管综合征患者164例,按随机数字表法分组,对照组82例采用利多卡因+甲泼尼龙+维生素B1鞘内注射治疗,研究组82例予以罗哌卡因+甲泼尼龙+维生素B1鞘内注射治疗,观察并记录2组间治疗前后症状评分、神经电生理检测指标、高频超声定量参数,并对临床疗效、总复发率进行比较.结果 对照组治疗有效率(74.39%)低于研究组治疗有效率(87.81%)(P<0.05);与对照组比较,研究组治疗后视觉模拟评分法(visual analogue scale,VAS)、整体症状分数表(global symptom score,GSS)、功能状态量表评分(fatigue severity scale,FSS)及Levine腕管综合征问卷评分较低,治疗后正中神经(distal motor latency,DML)水平较低,感觉神经电位(sensory nerve action potential,SNAP)及感觉传导速度(sensory conduction velocity,SCV)水平较高,治疗后正中神经内径(D)、豌豆骨水平正中神经横径(a)、前后径(b)、横截面积(cross sectional area,CSA)较低(P<0.05);对照组总复发率(53.66%)高于研究组总复发率(37.80%)(P<0.05).结论 罗哌卡因鞘内注射治疗腕管综合征伴正中神经卡压症状的临床疗效明显,能够有效减轻疼痛,改善正中神经卡压症状,恢复正中神经传导速度和功能,降低复发率.%Objective To investigate the effect of intrathecal injection of ropivacaine in the treatment of carpal tunnel syndrome with nervi medianus entrapment syndrome. Methods 164 patients with carpal tunnel syndrome were selected and divided into two groups, 82 cases in the control group were given intrathecal injection of lidocaine + methylprednisolone + vitamin B1, 82 cases in the experimental group received injection of ropivacaine + methylprednisolone + vitamin B1, the symptom score, nerve electrophysiological examination index, high frequency ultrasound quantitative parameters, the clinical effect and total recurrence rate were compared after treatment. Results The effective rate in the control group(74.39%)was lower than the experimental group(87.81%)(P<0.05); compared with the control group, the visual analogue scale (VAS), global symptom score (GSS), fatigue severity scale (FSS) and Levine carpal tunnel syndrome questionnaire score were lower in the experimental group after treatment, the nervi medianus distal motor latency (DML) level was lower, sensory nerve action potential (SNAP) and sensory conduction velocity (SCV) levels were higher after treatment, the diameter of the nervi medianus, the transverse diameter (a), anteroposterior diameter (b) of nervi medianus and cross sectional area (CSA) were lower after treatment, with significant difference (P<0.05); the total recurrence rate in the control group(53.66%)was higher than the experimental group(37.80%), with significant difference (P<0.05). Conclusion The clinical effect of intrathecal injection of ropivacaine in the treatment of carpal tunnel syndrome with nervi medianus entrapment syndrome was obvious, can effectively alleviate pain, improve the symptoms of nervi medianus entrapment, restore the nervi medianus conduction velocity and function, and reduce the recurrence rate.