| The median nerve is one of the most important nerves innervating the forearm and hand and accounts for the highest proportion of peripheral nerve injuries in the upper limb.Although there are numerous treatment options for median nerve injuries,they have not yet achieved fully satisfactory results.Electrical stimulation has gradually become a common method of synergistic treatment in clinical practice,and its efficacy has been recognised.Current clinical electrical stimulation modalities lack precise localisation of the extent of nerve injury and are unable to precisely electrically stimulate the location,making it difficult to improve the targeting and efficiency of stimulation and achieve precise treatment.In this study,electroacupuncture was used for electrical stimulation treatment,using high-frequency ultrasound to determine the location and morphology of median nerve injury,precisely locate the median nerve injury site,control the range and depth of electrical stimulation,achieve targeted treatment,precise stimulation,and combine with conventional rehabilitation training to assess its effectiveness on median nerve nerve injury repair.Objective:To observe the clinical efficacy of precision electrical stimulation therapy under high frequency ultrasound guidance in patients with median nerve injury.To evaluate the effectiveness of precision electrical stimulation treatment,to provide new treatment ideas and methods to promote nerve regeneration and functional recovery after median nerve injury,and to fill the gaps in existing studies.Methods:Thirty patients who met the experimental criteria were randomly divided into experimental group(n=15)and control group(n=15)The experimental group underwent high frequency ultrasound guided precision electrical stimulation+conventional rehabilitation training,and the control group underwent transcutaneous electrical nerve stimulation+conventional rehabilitation training.Both groups received60 minutes of electrical stimulation followed by 30 minutes of conventional rehabilitation training,five times a week for a total of 5 weeks of intervention.Nerve conduction function,nerve cross-sectional area,motor function,sensory function and activities of daily living were assessed before and after the intervention.The Nicolet EXD EMG evoked potential system was used to measure the complex muscle action potential wave amplitude,distal motor latency and motor nerve conduction velocity,and the sensory nerve action potential wave amplitude,sensory potential latency and sensory nerve conduction velocity;the nerve cross-sectional area was measured using a Kaili X5 portable high frequency ultrasound device to measure the difference in ultrasound nerve cross-sectional area under the needle,and the difference in ultrasound nerve cross-sectional area at the maximum.Motor function was assessed by grip strength,pinch strength,and the BMRC scale;sensory function was assessed by touch,two-point discrimination,and the BMRC scale;activities of daily living were assessed by the Chinese Medical Association Society of Surgery of the Hand,and the Upper Extremity Function Rating Scale(The disabilities of the arm,shoulder and hand(DASH)scale was used.The data were statistically analysed using the statistical software SPSS23.0.The chi-square test was used for counting data;t-test was used for data that conformed to a normal distribution and rank sum test was used for data that did not conform to a normal distribution.Results:1.Nerve conduction functionCompared with the pre-intervention period,the amplitude of compound muscle action potential(mv)increased from 5.40±2.59 to 9.07±3.09,the distal motor latency(ms)decreased from 5.10(3.9,8.4)to 3.90(5.1,8.4),the motor nerve conduction velocity(m/s)increased from 52.20±11.51 to 58.59±10.34,in the experimental group after the intervention.Sensory nerve action potential wave amplitude(mv)increased from 5.30(4.2,10.8)to 14.00(6.3,28.4)and sensory nerve conduction velocity(m/s)increased from 48.1(36.5,56.1)to 54.3(40.5,58.3),with significant differences(p<0.05)in intra-group comparisons.In the control group,the wave amplitude of compound muscle action potentials(mv)increased from 5.39±3.78 to 6.19±3.66,the wave amplitude of sensory nerve action potentials(?v)increased from 5.00(2.4,9)to5.9(4.4,10.1)and the conduction velocity of sensory nerves increased from52.5(27.9,57.8)to 54.1(44.9,60)after the intervention,and the difference between the groups was The difference was significant(P<0.05).After the intervention,the experimental group showed an increase in compound muscle action potential wave amplitude of 9.07±3.09,distal motor latency of3.90(5.1,8.4)and sensory nerve action potential wave amplitude of 14.00(6.3,28.4)compared to the control group with compound muscle action potential wave amplitude of 6.19±3.66,distal motor latency of 7.1(4.1,5.1)and sensory nerve action potential wave amplitude of 14.00(6.3,28.4).14.00(6.3,28.4)respectively were compared between groups and the differences were all significant(p<0.05).2.Nerve ultrasound cross-sectional areaCompared with the pre-intervention period,the difference in nerve cross-sectional area(cm2)under the needle in the experimental group decreased from 0.084±0.043 to0.054±0.021,and the difference in nerve cross-sectional area(cm2)at the largest point decreased from 0.148±0.085 to 0.066±0.048,with significant differences within the group(p<0.05).In the control group,the difference in nerve cross-sectional area(cm2)under the needle decreased from 0.072±0.035 to 0.062±0.040 after the intervention,with a significant difference within the group(P<0.05).After the intervention,the difference in nerve cross-sectional area under the needle in the experimental group was 0.054±0.021 compared to 0.062±0.040 in the control group,with a significant difference between groups(P<0.05).3.Motor function indexesCompared with the pre-intervention period,the grip strength coefficient in the experimental group increased from 0.13±0.05 to 0.26±0.10 and the pinch strength coefficient increased from 0.09±0.06 to 0.20±0.08.The intra-group differences in the motor function recovery scale(BMRC)were all significant(p<0.05).In the control group,the grip strength coefficient increased from 0.14±0.05 to 0.22±0.09 and the pinch strength coefficient increased from 0.08±0.06 to 0.11±0.06 after the intervention,with significant differences within the BMRC group(p<0.05).After the intervention,the experimental group had a pinch coefficient of 0.20±0.08 compared to the control group of 0.11±0.06.The difference between the two groups was significant(P<0.05)when comparing each group on the motor function recovery scale(BMRC).4.Sensory function indexesCompared with the pre-intervention period,the middle finger tactile threshold(g),index finger tactile threshold(g),and greater interfascicular tactile threshold(g)decreased from 4.24±1.09,4.58±1.33,and 5.06±1.39 to 3.61±0.72,3.66±0.69,and3.71±0.71,respectively,in the experimental group after the intervention,and the intra-group differences were all significant(P<0.05);after the intervention In the control group,the tactile threshold(g)of the index finger and the tactile threshold(g)of the greater pisiformis decreased from 5.04±1.40 and 5.20±1.26 to 4.32±1.21 and4.35±1.12,respectively,and the intra-group differences in the sensory function recovery scale(BMRC)were significant(P<0.05).In the experimental group,the two-point discrimination threshold(g)of the index finger and the two-point discrimination threshold(g)of the greater pisiformis decreased from 11.67±4.27 and13.13±3.18 to 8.67±3.60 and 9.20±2.93,respectively,after the intervention,and the intra-group differences were significant(P<0.05);in the control group,the two-point discrimination threshold(g)of the greater pisiformis decreased from 14.87±2.26 to11.87±2.72 in the control group after the intervention,with significant differences within the group(P<0.05).The intra-group differences in BMRC were significant in both the experimental and control groups after the intervention(P<0.05).After the intervention,the differences were significant(P<0.05)when comparing the tactile thresholds of 3.61±0.72 for the middle finger,3.66±0.69 for the index finger,and 3.71±0.71 for the greater pisiformis in the experimental group compared with4.32±1.12,4.32±1.21,and 4.35±1.12 in the control group,respectively.The difference was significant(P<0.05)between the two-point discrimination thresholds of 9.20±2.93 in the experimental group compared to 11.87±2.72 in the control group after the intervention.The difference was not significant(P>0.05)when comparing between groups on the sensory function recovery scale(BMRC).5.Activities of daily living abilityCompared with the pre-intervention period,the median nerve score of the Chinese Society of Hand Surgery Upper Limb Function Rating Scale increased from 7.80±2.0to 11.39±2.85 and the DASH score of the Upper Limb Function Rating Scale decreased from 55.33± 19.92 to 34.11±17.03 in the experimental group after the intervention,and the differences within the groups were significant(P<0.05).In the control group,the median nerve score increased from 8.47±2.13 to 10.87±2.53 and the DASH score decreased from 63.22 ±21.18 to 51.50± 18.37 after the intervention,with significant differences within the group(P<0.05).After the intervention,the DASH score of the upper limb function scale in the experimental group was 34.11±17.03 compared to 51.50±18.37 in the control group,and the difference between groups was significant(P<0.05)Conclusions:1.Both high-frequency ultrasound-guided precision electrical stimulation and transcutaneous electrical nerve stimulation can improve nerve cross-sectional area,nerve conduction function,motor and sensory function,and the ability to perform activities of daily living in patients with median nerve injury,promote nerve repair,and improve function.2.Ultrasound-guided precision electrical stimulation has a good promotion effect on the repair of median nerve injury,and the effect is better than that of transcutaneous electrical nerve stimulation. |
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