Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Arch Phys Med Rehabil. 2020 Nov;101(11):1857-1864. doi: 10.1016/j.apmr.2020.06.018. Epub 2020 Jul 16.
OBJECTIVES: To evaluate whether the therapeutic effect of ultrasound-guided injections with 10 mg or 40 mg triamcinolone acetonide (TA) was dose-dependent in patients with idiopathic mild to moderate carpal tunnel syndrome (CTS). DESIGN: Prospective, double-blind, randomized controlled study with 12 weeks of follow-up. SETTING: Rehabilitation outpatient clinic of a single medical center. PARTICIPANTS: Patients with CTS (N=56). INTERVENTION: Participants were randomly assigned to 2 treatment groups for injection: (A) 40 mg TA+2% lidocaine hydrochloride or (B) 10 mg TA+2% lidocaine hydrochloride. MAIN OUTCOME MEASURES: Participants were evaluated using visual analog scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ, including Symptom Severity Scale [SSS] and Functional Status Scale [FSS]) at baseline and 6 and 12 weeks after injection). Nerve conduction studies, including parameters of distal motor latency, amplitude of compound motor action potential, amplitude of sensory nerve action potential and sensory nerve conduction velocity of median nerve, and the patient's subjective impression of improvement, were recorded before injection and 6 and 12 weeks after injection. RESULTS: No significant differences were observed in baseline demographic characteristics and clinical evaluations. The parameters in group A and B at baseline, 6 weeks, and 12 weeks were (1) SSS: 2.17±0.14, 1.19±0.04, and 1.34±0.09 and 1.87±0.11, 1.21±0.07, and 1.26±0.04; (2) FSS: 1.63±0.07, 1.27±0.06, and 1.33±0.08 and 1.50±0.10, 1.18±0.05, and 1.26±0.05; (3) VAS: 6.4±0.3, 2.2±0.3, and 3.0±0.1 and 6.7±0.3, 2.0±0.3, and 3.1±0.3, respectively, and significantly decreased after 6 and 12 weeks in both treatment groups (P<.05). All parameters of nerve conduction studies improved in both groups after 12 weeks (P<.05). VAS, BCTQ, and nerve conduction studies did not show significant intergroup differences after 6 and 12 weeks. CONCLUSION: In patients with idiopathic mild to moderate CTS, ultrasound-guided injection with 10 and 40 mg TA yield similar improvements in BCTQ, VAS, and nerve conduction studies at the 12-week follow-up.
目的：评估超声引导注射 10mg 或 40mg 曲安奈德（TA）治疗特发性轻中度腕管综合征（CTS）患者的疗效是否与剂量有关。
设计：前瞻性、双盲、随机对照研究，随访 12 周。
地点：单家医疗中心的康复门诊。
参与者：CTS 患者（N=56）。
干预：参与者被随机分配到 2 个注射治疗组：（A）40mg TA+2%盐酸利多卡因或（B）10mg TA+2%盐酸利多卡因。
主要观察指标：在基线、注射后 6 周和 12 周时，使用视觉模拟量表（VAS）和波士顿腕管问卷（BCTQ，包括症状严重程度量表[SSS]和功能状态量表[FSS]）评估参与者。在注射前和注射后 6 周和 12 周时，记录神经传导研究，包括正中神经远端运动潜伏期、复合运动动作电位幅度、感觉神经动作电位幅度和感觉神经传导速度等参数，以及患者的主观改善印象。
结果：基线人口统计学特征和临床评估无显著差异。A 组和 B 组在基线、6 周和 12 周时的参数为：（1）SSS：2.17±0.14、1.19±0.04、1.34±0.09 和 1.87±0.11、1.21±0.07、1.26±0.04；（2）FSS：1.63±0.07、1.27±0.06、1.33±0.08 和 1.50±0.10、1.18±0.05、1.26±0.05；（3）VAS：6.4±0.3、2.2±0.3、3.0±0.1 和 6.7±0.3、2.0±0.3、3.1±0.3，两组在治疗后 6 周和 12 周时均显著下降（P<.05）。两组在治疗后 12 周时神经传导研究的所有参数均有所改善（P<.05）。治疗后 6 周和 12 周时，VAS、BCTQ 和神经传导研究在两组间均无显著差异。
结论：在特发性轻中度 CTS 患者中，超声引导注射 10mg 和 40mg TA 在 12 周随访时均可改善 BCTQ、VAS 和神经传导研究。
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