温通膏外敷和局部封闭治疗桡骨茎突狭窄性腱鞘炎的疗效观察

摘要

[目的]观察温通膏外敷及局部封闭治疗桡骨茎突狭窄性腱鞘炎的疗效.[方法]将108例桡骨茎突狭窄性腱鞘炎患者随机分为封闭组、 联合组和温通膏组,每组各36例.封闭组给予腱鞘内局部封闭治疗,联合组给予温通膏(主要由当归、补骨脂、 独活、 羌活等药物组成)外敷联合局部封闭治疗,温通膏组给予单纯温通膏外敷治疗.分别于治疗前、 治疗1周后、治疗2周后测定3组患者的疼痛视觉模拟评分(VAS)、 腕关节尺偏的活动度(ROM),评价3组临床疗效及不良反应,随访3个月,观察3组复发率.[结果](1)治疗1周后,封闭组、 联合组和温通膏组的总有效率分别为77.8%、100.0%、72.2%;治疗2周后,3组的总有效率分别为86.1%、100.0%、86.1%;联合组疗效均优于封闭组和温通膏组(P<0.05).(2)治疗1周和2周后,3组的VAS评分均明显降低,ROM均明显升高,差异均有统计学意义(P<0.05);且联合组的VAS评分均明显低于封闭组和温通膏组,ROM均明显高于封闭组和温通膏组,差异均有统计学意义(P<0.05).(3)治疗过程中,3组均无不良反应情况发生.(4)随访3个月,封闭组、 联合组、 温通膏组的复发率分别为30.61%、10.20%、20.41%,联合组的复发率明显低于封闭组和温通膏组(P<0.05).[结论]温通膏外敷联合局部封闭疗法治疗桡骨茎突狭窄性腱鞘炎具有较好的疗效,能显著缓解疼痛,增加腕关节活动度,减少复发率;单用温通膏外敷在治疗1周内的疗效逊于单纯局部封闭疗法,但在2周后的疗效与单纯局部封闭相当,且温通膏能明显降低复发率.%Objective To observe clinical curative effect of the external application of Wentong Paste plus local block therapy for the treatment of stenosing tendovaginitis at radial styloid. Methods A total of 108 cases of patients with stenosing tendovaginitis at the radial styloid were randomly divided into local block therapy group, combination group and Wentong Paste group, 36 cases in each group. The local block therapy group was given injection of blocking liquid into the tendon sheath, combination group was given external application of Wentong Paste(mainly composed of Radix Angelicae Sinensis, Fructus Psoraleae, Radix Angelicae Pubescentis, and Rhizoma et Radix Notopterygii) plus local block therapy, and Wentong Paste group was only given external application of Wentong Paste. Before treatment and after treatment for one and 2 week(s), visual analogue scale (VAS) scores of pain and range of motion (ROM) of wrist joint were observed for the evaluation of clinical effectiveness and safety. The patients were followed up for 3 months for the assay of recurrence rate. Results (1) After treatment for one week, the total effective rate of local block therapy group, combination group and Wentong Paste group was 77.8%, 100.0%, 72.2%respectively, and the total effective rate after treatment for 2weeks was 86.1%, 100.0%, 86.1% respectively. The combination group had better clinical efficacy than local block therapy group and Wentong Paste group (P < 0.05). (2) After treatment for one and 2 week (s), VAS scores of the 3 groups were obviously increased while ROM was much increased (P < 0.05 compared with those before treatment). The combination group had the lowest VAS scores and highest ROM(P < 0.05).(3) No adverse reaction was found in the 3 groups during the treatment. (4) The 3 month follow-up results showed that the recurrence rate of the three groups was 30.61%, 10.20%, 20.41% respectively, and the combination group had the lower rate than local block therapy group and Wentong Paste group(P<0.05). Conclusion The external application of Wentong Paste plus local block therapy is effective for the treatment of stenosing tendovaginitis at radial styloid by relieving pain, increasing the ROM, and reducing the recurrence rate. The one-week efficacy of Wentong Paste alone was inferior to that of local block therapy alone, but their two-week efficacy showed no obvious difference. Moreover, Wentong Paste has an obvious advantage in reducing the recurrence rate.