Research On The Diagnostic Significance And Application Of "Three-line Location Method" In Pronator Teres Syndrome

Objective:To explore the correlation between median nerve(MN),pronator teres(PT),flexor digitorum superficialits(FDS)and the etiology and pathogenesis of pronator teres syndrome(PTS).The three-line localization method was used to explore the surface projection of the nerve easy entrapment point,and the nerve easy entrapment point combined with pericardium channel,heart channel and others were tested to carry out acupuncture treatment for acupoints closely related to the anatomical basis of the disease,so as to determine the therapeutic value for improving the clinical symptoms of PTS.Methods:1.The palmar forearm of 10 cadavers fixed with formalin was dissected,and the tissue structures of MN trunk,PT and FDS tendon arch in the forearm area were fully exposed,and the anatomical relationship between MN and PT and FDS tissue structures was observed in detail.By observing the above tissue structure,especially FDS tendon arch,whether there is variation or deformity can be determined.The diameter of the MN at the point where it passes through the PT was measured,and the point where the MN passes through the PT(D),the point where the MN meets the lower edge of the PT(E),the point where the MN passes through the FDS tendon arch(F),and the point where the MN passes through the FDS(G)could be confirmed.The lateral epicondyle of the humerus was taken as point A,the medial epicondyle of the humerus was taken as point B,the styloid process of the radius was taken as point C,and all three points were located at the highest point.The vernier caliper was used to measure the vertical distance from the points D,E,F,G to the line AB(L1),AC(L2),BC(L3).Then,the vertical distance from point C to line AB was taken as the length of the forearm,and the vertical distance from points D,E,F,G to L1 was used to divide the length of the forearm,so as to obtain the corresponding position ratio of each point on the forearm,and the surface projection of each observation point.2.From January 2020 to December 2020,50 patients who voluntarily participated in clinical trials and met the diagnostic criteria of PTS were randomly divided into treatment group and control group,with 25 patients in each group.Both groups took 1 week as a course of treatment and carried out 4 courses of treatment.In the treatment group,the surface projection of the experimental observation point(namely the nerve easy entrapment point and the place where tenderness is obvious)was taken as Ashi point,combined with Quze point,Ximen point,Jianshi point,Neiguan point,Shaohai point and Erbai point for acupuncture treatment.The control group was treated with Haitongpi Decoction for external fumigation and washing.The data were recorded and analyzed by SPSS24.0 statistical software.If P < 0.05,the experimental study was considered to be statistically significant.Results:1.In the 10 specimens observed,the MN distributed between the caput humeri and the caput ulnae of the PT,and crossed the FDS obliquely downward along the MN.Among them,7 cadavers were found to have FDS combined with tendon arch,FDS fiber arch was found in 3 cadavers,and no FDS without lateral head was found.2.Structural abnormalities such as PT aponeurosis or tendon bundle with thickening or tension.Abnormal thickening or fibrosis of fascia at FDS tendon arch and abnormal tendon structure can produce entrapment factors to adjacent MN.3.The diameter of MN passing through PT was(3.12±0.12)mm on the left and right sides of adult males and(2.87±0.11)mm on the left and right sides of adult females.4.The three-line positioning method and the position ratio of the forearm are used to the surface projection of forearm at each observation point could be obtained,so as to provide anatomical basis for clinical diagnosis and treatment.5.The general data,VAS evaluation,MN symptom evaluation,nerve motor conduction velocity and forearm and hand function evaluation of the patients in the treatment group and the control group were all greater than 0.05 before treatment,P values were not statistically different,with comparability.6.After treatment,VAS was(1.48±0.65)in the treatment group and(2.76±0.66)in the control group.The MN symptom evaluation was(12.72±0.84)in the treatment group and(10.96±0.98)in the control group.Nerve motor conduction velocity was(60.14±1.84)in the treatment group and(55.20±1.67)in the control group.Three months after treatment,the functional evaluation of forearm and hand was(74.28±3.32)in the treatment group and(70.32±3.47)in the control group.After statistical analysis of the above data,and the difference was statistically significant(all P<0.05),indicating that the treatment plan in the treatment group is better than that in the control group.7.After treatment,the total effective rate of the treatment group was92%(23/25),and the obvious cure rate was 56%(14/25).In the control group,the total effective rate was 80%(20/25),and the obvious cure rate was 24%(6/25).The difference was statistically significant(P<0.05),indicating that the efficacy in the treatment group is significant.Conclusion:1.The histological structure of the tendon arch of MN,PT and FDS is of great significance to the etiology,pathogenesis and treatment of PTS.The structural variation at the tendon arch of PT and FDS is easy to form a mechanism of entrapment of MN,which results in the related pathological manifestations of PTS.2.The three-line location method can accurately locate the nerve easy entrapment point,which is of positive significance for the definite diagnosis and treatment of PTS.3.The nerve easy entrapment point combined with pericardium channel,heart channel and others were tested to carry out acupuncture treatment for acupoints closely related to the anatomical basis of the disease,which is of positive significance to the efficacy of PTS,relieving tissue structure tension,relaxing nerve entrapment degree,and restoring nerve conduction.