Comparison of the efficacy of ultrasound-guided acupotomy visualization and traditional blind acupotomy in the treatment of carpal tunnel syndrome
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摘要:
目的 超声可视化为腕管综合征(CTS)的针刀精准治疗提供技术支持，本研究探讨与传统盲法针刀比较超声可视化引导下针刀疗法治疗CTS的应用优势。 方法 选取2022年1月—2025年2月于东阳市人民医院康复医学科就诊并接受针刀疗法治疗的94例CTS患者，依据治疗方法不同分成对照组(接受传统盲法针刀疗法)和超声组(接受超声可视化引导下针刀疗法)，各47例，均治疗2次后随访4周。比较2组治疗前后疼痛视觉模拟(VAS)评分、超声测量指标[腕横韧带厚度(TTCL)、正中神经横截面积(CSA)、钩状骨横截面正中神经前后径(D)]和肌电图测量指标[正中神经末端运动潜伏期(DML)、正中神经感觉神经传导速度(SNCV)、复合肌肉动作电位波幅(CMAP)]变化情况，并评估2组疗效和并发症发生情况。 结果 治疗后2组日间、夜间麻木疼痛VAS评分均低于治疗前(P＜0.05)，且超声组日间[(2.04±0.61)分vs.(2.61±0.70)分]、夜间麻木疼痛VAS评分[(2.23±0.64)分vs.(2.87±0.75)分]均低于对照组(P＜0.05)。治疗后2组TTCL、CSA、D、DML均低于治疗前，SNCV、CMAP均高于治疗前(P＜0.05)，且超声组TTCL、CSA、D、DML均低于对照组，SNCV、CMAP均高于对照组(P＜0.05)。超声组疗效优于对照组(Z=4.506，P=0.003)，2组并发症发生率比较差异无统计学意义(P＞0.05)。 结论 与传统盲法针刀相比，超声可视化引导下针刀疗法能更充分地缓解CTS患者麻木疼痛症状，改善超声和肌电图相关检测指标，提高临床疗效。 Abstract:Objective Ultrasound visualization provides technical support for the precise application of acupotomy in treatment of carpal tunnel syndrome (CTS). This study explores the application advantages of ultrasound-guided acupotomy in the treatment of CTS compared with traditional blind acupotomy. Methods A total of 94 patients with CTS who received acupotomy therapy at the Department of Rehabilitation in Dongyang People ' s hospital from January 2022 to February 2025 were enrolled. According to different treatment methods, they were divided into a control group (receiving traditional blind acupotomy therapy) and an ultrasound group (receiving ultrasound-guided acupotomy therapy), with 47 cases in each group. They were both received twice treatment sessions and followed up for 4 weeks. Pain visual analogue scale (VAS) scores, ultrasonic measurements [thickness of transverse carpal ligament (TTCL), median nerve cross-sectional area (CSA), and anterior and posterior diameter of median nerve (D) in the cross section of uncinate bone], EMG measurements [median nerve end motor latency (DML), median sensory nerve conduction velocity (SNCV), and compound muscle action potential (CMAP)] were compared between the two groups before and after treatment. Pre- and post-treatment comparisons were performed to evaluate the therapeutic efficacy and the complications. Results The VAS scores of numbness and pain in daytime and nighttime after treatment were lower than those before treatment (P < 0.05). In addition, the daytime [(2.04±0.61) points vs. (2.61±0.70) points] and nighttime numbness VAS scores [(2.23±0.64) points vs. (2.87±0.75) points] of the ultrasound group were lower than those of the control group (P < 0.05), respectively. After treatment, TTCL, CSA, D, and DML were significantly decreased, while SNCV and CMAP were higher than before treatment (P < 0.05). Improvements were more pronounced in the ultrasound group than in the control group, while SNCV and CMAP were higher than control group (P < 0.05). The therapeutic grade composition of the ultrasound group was better than that of the control group (Z=4.506, P=0.003), with no significant difference in the complication rates between the two groups (P>0.05). Conclusion Compared with traditional blind acupotomy, ultrasound-guided acupotomy provides better symptoms relief of numbness and pain in CTS patients, improves the ultrasonography and EMG indicators, and improves clinical efficacy. -
图 1 超声引导下针刀正中神经上方松解腕横韧带
Figure 1. Image of the release of the transverse carpal ligament above the median nerve with a needle knife under ultrasound guidance
表 1 2组CTS患者一般资料比较
Table 1. Comparison of general data between the two groups of CTS patients
组别 例数 性别
(男性/女性，例)年龄
(x±s，岁)CTS病程
(x±s，月)CTS测别
(单侧/双侧，例)肥胖
[例(%)]CTS职业因素
[例(%)]对照组 47 10/37 51.47±10.91 14.85±4.02 38/9 8(17.02) 27(57.45) 超声组 47 17/30 52.70±9.76 15.27±4.13 40/7 11(23.40) 30(63.83) 统计量 2.546a 0.332b 0.488b 0.301a 0.594a 0.401a P值 0.111 0.740 0.627 0.583 0.441 0.527 注：a为χ2值，b为t值。 
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表 2 2组CTS患者治疗前后日间和夜间VAS评分比较(x±s，分)
Table 2. Comparison of daytime and nighttime VAS scores of the two groups of CTS patients before and after treatment(x±s, points)
组别 例数 日间VAS评分 夜间VAS评分 治疗前 治疗后 治疗前 治疗后 对照组 47 5.21±1.18 2.61±0.70b 5.92±1.23 2.87±0.75b 超声组 47 5.17±1.20 2.04±0.61b 5.87±1.26 2.23±0.64b 统计量 0.163a 4.052c 0.195a 4.813c P值 0.871 0.013 0.846 0.004 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 3 2组CTS患者治疗前后TTCL、CSA及D比较(x±s)
Table 3. Comparison of TTCL, CSA and D before and after treatment between the two groups of CTS patients(x±s)
组别 例数 TTCL(mm) CSA(mm2) D(mm) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 47 3.66±0.13 2.91±0.16b 10.78±0.57 9.62±0.59b 2.98±0.27 2.36±0.25b 超声组 47 3.68±0.15 2.60±0.13b 10.75±0.60 9.10±0.45b 2.96±0.31 1.94±0.20b 统计量 0.691a 5.219c 0.249a 11.025c 0.334a 10.526c P值 0.492 0.002 0.804 ＜0.001 0.740 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 4 2组CTS患者治疗前后DML、SNCV、CMAP比较(x±s)
Table 4. Comparison of DML, SNCV and CMAP before and after treatment between the two groups of CTS patients(x±s)
组别 例数 TTCL(mm) CSA(mm2) D(mm) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 47 6.21±1.23 4.31±1.10b 34.06±3.17 37.83±3.26b 5.08±0.79 6.15±0.83b 超声组 47 6.24±1.27 3.18±0.95b 33.97±3.12 40.16±3.34b 5.10±0.81 6.53±0.87b 统计量 0.116a 7.380c 0.139a 14.156c 0.121a 5.012c P值 0.908 ＜0.001 0.890 ＜0.001 0.904 0.008 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 5 2组CTS患者疗效比较[例(%)]
Table 5. Comparison of efficacy between the two groups of CTS patients[cases(%)]
组别 例数 优 良 可 差 对照组 47 13(27.66) 22(46.81) 10(21.28) 2(4.26) 超声组 47 19(40.43) 24(51.06) 4(8.51) 0 注：2组疗效比较，Z=4.506，P=0.003。
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