| Purpose:In this research,neuromuscular electrical stimulation was administered to carpal tunnel syndrome(CTS)patients after the commonly used procedure of carpal incision and median nerve decompression to assess the efficacy and the necessity of postoperative neuromuscular electrical stimulation,to explore an effective postoperative adjunctive therapeutic strategy and to provide guidance to the postoperative management of carpal tunnel syndrome through observing the changes in the course of treatment and analyzing the clinical follow-up data.Carpal tunnel syndrome is one of most common peripheral nerve compression disease in the upper-extremity,which is easy to be diagnosed but has very complicated causes.It is widely agreed upon that conservative treatment is recommended for patients with milder cases while surgery is used in patients with moderate or severe cases and patients responding not well to conservative therapy.The surgical methods are various but all make longitudinal incision in the transverse ligament and release median nerve,which usually produces satisfying clinical benefit.However,the postoperative condition needs to be improved for patients who fail to have rehabilitation due to the prolonged courses of disease or postoperative pains,because an aggressive rehabilitation and adjuvant therapy in the postoperative period proved helpful to functional and sensory recovery.This research aims to provide a better postoperative adjuvant therapy option by examining the efficacy of postoperative neuromuscular electrical stimulation in carpal tunnel syndrome.Methods: The inclusion criterions are:(1)diagnosed with CTS by history inquiry,physical exams,electrophysiological examination or imaging test(Fig.1-6),(2)identified as moderate or severe cases(based on the staging system ofcarpal tunnel syndrome proposed by Gu Yudong)for which surgical treatment is indicated(3)without pregnancy,metabolic disorder or a history of arthritis,fracture,or surgery in the affected wrist(4)without systemic diseases that may potentially influence the treatment.In consistence with this criterion,85 patients who were admitted to The Third Hospital of Hebei Medical University from January 2015 to June 2016 were recruited.Among them,27 cases in non-electric stimulation group: blank control group(NS group);29cases in neuromuscular electrical stimulation group 1: simple electrical stimulation group(S1 group);29 cases in neuromuscular electrical stimulation group 2: medical chitosan+electrical stimulation treatment group(S2 group).The patients of three groups were divided into the median nerve lysis,the S2 group were evenly coated with medical chitosan in the carpal tunnel after hemostasis,the other two groups(NS group and S1 group)only done the wound hemostasis,not to use medical chitosan gel.The patients of S1 and S2 groups received neuromuscular electrical stimulation at the 5th day after operation: both groups were treated with electrical stimulation of 20 min daily for 14 days.The neuromuscular electrical stimulation of stimulator was used to stimulate the surface of the abductor pollicis brevis.the intensity of stimulation was adjusted according to the intensity of the patient,and 20 mA was the average strength that the most patients could endured,.The stimulus was 0.6Hz and the pulsewidth was 10 ms.A routine treatment to nourish nerves and improve circulation was given to all of the patients in the three groups.The patient's grip strength in the affected side was evaluated before the procedure and at 1st,3rd,6th month after the procedure.The patients quality of postoperative life was assessed using a DASH scale.SPSS 21.0 was used to analyze the data collected in this research and the data were presented using(? x±s).Variance analysis and t-test were used for group comparison.Chi-squared test was used for measurement data.?=0.05Result:1 General ResultThree groups with altogether 72 patients were followed for six monthsafter the surgery: including 23 patients in NS group,24 in S1 group and 25 in S2 group.Stitches were removed 12-14 days after the surgery in all patients whose incisions were all healed by primary intention without infection or hematoma.6th month after surgery,all patients' symptoms improved at varying degrees without bowstring deformity of flexor tendons,severe pillar pain or hand dysfunction.The tinel sgin of median nerve and phalen test were all negative and all electrodiagnostic testing result were back to normal or nearly normal.2 Therapeutic benefit in the postoperative period.According to Yudong Gu's CTS type,group NS has 18 patients leveled as good,2 patients moderate,3 patients acceptable and 0 patient disappointing,the rate of good and moderate is 86.9%;group S1 has 20 patients leveled as good,2 patients moderate,2 patients acceptable and 0 patient disappointing,the rate of good and moderate cases is 91.7%;group S2 has 22 patients leveled as good,1 patients moderate,2 patients acceptable and 0 patient disappointing,the rate of good and moderate cases is 92.0%.There was no statistical difference(P>0.05)in the number of cases leveled as good or moderate among the three groups.3 Evaluation of EMG resultsThere was no significant difference between the 3 groups in the motor potential,MCV and SCV after the operation in the 1st months,3rd months and6 th months(P>0.05)4 Grip strength in the affected wristBefore surgery,there was no statistical difference(P>0.05)in the grip strength among 3 groups.1month after surgery,there was no statistical difference(P>0.05)in the grip strength of patients among 3 groups.3 months after surgery,it was found that between NS and S1,NS and S2,there was statistical difference(P<0.05)in the grip strength of patients.But there was still no statistical difference between group S1 and S2.6 month after surgery,a statistical difference(P<0.05)was foundbetween NS and S1,NS and S2.But it was not found between group S1 and S2(P>0.05).5 DASH results among patientsBefore surgery,there was no statistical difference(P>0.05)in DASH among 3 groups1 month after surgery,there was no statistical difference(P>0.05)in DASH among 3 groups3 months after surgery,there was no statistical difference(P>0.05)in DASH among 3 groups6 month after surgery,there were statistical difference(P<0.05)in DASH among 3 groups.But a statistical difference was found in DASH between NS and S1,NS and S2,S1 and S2.Conclusions:Neuromuscular electrical stimulation was administered to carpal tunnel syndrome(CTS)patients after carpal incision and median nerve decompression(20min/day,14days).It was more effective in speeding up repairs of nerve function,alleviating muscle atrophy,enhancing functional recovery in the affect wrist and improving postoperative condition.Neuromuscular electrical stimulation can be easily administered with lower cost,less pains,shortened course of treatment and improved clinical benefit.It is advisable that neuromuscular electrical stimulation be generalized as a first-line adjunctive therapy in the postoperative period in peripheral nerve compression patients. |
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