中藥膠布萬應膏對重複性使力傷害引起上肢肌腱炎之療效

THERAPEUTIC EFFECTS OF CHINESE HERBAL PATCH WAN-YIN-GAO ON THE UPPER EXTREMITY TENDINITIS INDUCED BY REPETITIVE STRAIN INJURY

重複性使力傷害（Repetitive Strain Injury, RSI ）如腕隧道症候群、網球肘（Tennis elbow ）及奎緬氏病（de Quervain’s disease ）等疾患愈來愈普遍，又容易復發，常影響生活品質及工作效率，已成為重要的醫療課題。本項研究以市面上最常用之中藥膠布萬應膏對重複性使力傷害引起之上肢肌腱炎進行療效評估。在林口長庚醫學中心門診篩選上肢肌腱炎（網球肘與奎緬氏病）病患，隨機分成二組，中藥組給予萬應膏膠布。西藥組給予Indomethacin 膠布。貼敷方式為每日2 次，每次1 片，敷貼6 小時，持續2 週。治療前後均以視覺類比等級法（VAS ）及療效評估簡表（SF-36 ）評估病情。並在用藥前後記錄病患對藥膠布是否有不良反應。實際完成療程之病患共64 人，中藥組41 人，西藥組23 人。兩組年齡、性別與疾病嚴重度方面均無顯著差異；流失及退出比率亦無顯著差異。療效方面：兩組疼痛及活動困難程度之VAS治療前後均無顯著差異，但中藥組對奎緬氏病的療效不僅較網球肘佳，也較西藥組的療效為佳。肌力評估方面：西藥組治療後改善（p = 0.03 ），而中藥組的改善則未達統計上的顯著水準。以SF-36 評估健康狀態的八個面向而言，中藥組僅在身體疼痛一項稍低於西藥組（p = 0.04 ），其餘各個面向均無顯著差異。不良反應之發生率在兩組間並無顯著差異。中藥萬應膏膠布與Indomethacin 膠布對上肢肌腱炎具有相近的療效，應可作為臨床輔助治療。Chinese herbal patchs have not been extensively studied to date; thus, it is difficult to ascertain their clinical effects. In an effort to shed light on the potential risks and benefits of herbal patchs, our team designed a study to compare the safety and efficacy of the Chinese herbal patch Wan Yin Gao with an Indomethacin patch in the treatment of upper extremity tendinitis induced by Repetitive Strain Injury (RSI). In this double-blind, randomized controlled trial, we recruited 64 patients with tennis elbow or de Quervain’s disease from outpatient clinics at Chang Gung Memorial Hospital. The herbal patch, Wan Yin Gao, was given to the experimental group, while the Indomethacin patch was given to the control group; these were applied twice a day, six hours each time, over the course of two weeks. In both groups, we assessed the therapeutic effects via the parameters of range of motion, pain relief, and muscle strength, as well as monitoring the prevalence of adverse reactions. There were 41 cases in the experimental group, with an average age of 40.4 (40.4 ± 11.8). Twenty-three patients were assigned to the control group, with an average age of 40.7 (40.7 ± 11.2). There was no significant difference between the two groups in terms of age, sex and severity. Tests utilizing the Visual Analogue Scale showed that the patients in the experimental group that had de Quervain’s disease (p < 0.001; p = 0.001) fared better than the other subgroups in terms of pain relief and range of motion. Muscle power was significantly improved after treatment in the control group (p = 0.03), and tended to improve in the experimental group as well (p = 0.09). Assessment based on the Medical Outcome Survey Short Form-36 revealed that the control group experienced greater pain relief (p = 0.04); however, fewer adverse reactions were reported in the experimental group. In conclusion, the herbal patch Wan Yin Gao and the Indomethacin patch used in this study demonstrated similar therapeutic effects based on clinical evaluation, with no significant difference in the prevalence of adverse effects.