手掌混合神经电位潜伏时差诊断轻度腕管综合征的价值

Value of median-ulnar mid palm mixed nerve latency difference in the diagnosis of mild carpal tunnel syndrome

目的:分析正中及尺神经手掌-腕混合神经电位潜伏时差在诊断轻度腕管综合征的价值。方法:回顾性分析经新加坡国家脑神经科学院神经内科门诊神经内科医生临床确诊且临床症状符合腕管综合征的62例患者的正中及尺神经掌-腕混合神经电位潜伏时差,并与同期52例正常对照组的各项神经传导检测结果进行比较。对照组与腕管综合征组患者均检测正中神经、尺神经运动及感觉传导。采用片状表面电极记录运动传导末端潜伏时;采用反向法检测正中神经腕-示指感觉神经电位,主要观察感觉神经电位潜伏时;用顺向法检测正中及尺神经手掌混合神经传导,观察正中神经及尺神经混合神经电位潜伏时差。正中神经运动传导末端潜伏时、腕-示指感觉神经传导电位潜伏时、手掌正中及尺神经混合神经电位混合神经电位潜伏时差大于本实验室同期所做的52例对照组的正常参考值x±1.96s为延长。结果:腕管综合征患者62例及对照组52人均采集到各项指标,全部进入结果分析。①腕管综合征组患者正中神经运动传导末端潜伏时、腕-示指感觉神经电位潜伏时均与对照组接近,差异无显著性意义(P值分别为0.494和0.144)。②腕管综合征组患者正中及尺神经手掌-腕混合神经电位潜伏时差与对照组比较明显延长,差异有显著性意义[(2.078±0.316),(1.706±0.121)ms,t=8.998,P=0.000]。③当正中及尺神经手掌-腕混合神经电位潜伏时差大于对照组x±1.96s时为延长,可得到正常值上限为0.398ms,腕管综合征组患者中此潜伏时差>0.398ms者55例,占88.7%,即采用正中及尺神经手掌-腕混合神经电位潜伏时差明显的提高了腕管综合征的诊断率,但仍有7例(11.3%)腕管综合征患者其正中及尺神经手掌-腕混合神经电位潜伏时差在0.4ms以内。结论:正中及尺神经手掌-腕混合神经电位潜伏时差在诊断轻度腕管综合征时具有较高的诊断价值。

AIM： To explore the diagnostic values of median ulnar mid-palm mixed nerve action potential latency difference in mild carpal tunnel syndrome （CTS）. METHODS： The median ulnar mid-palm mixed nerve action potential latency difference of 62 CTS patients with typical clinical features of CTS in National Neuroscience Institute of Singapore were analyzed retrospectively. And compared with the results of nerve conduction tests in the 52 cases of normal control group. Median nerve, ulnar nerve motor and sensory conduction were detected in subjects of control group and CTS patients. Motor nerve conduction was recorded using bar-surface electrodes to observe median motor distal latency. ＂ Median nerve wrist-index finger sensory nerve potential latency was measured by antidromiC recording. Median ulnar midpalm mixed nerve action potential latency was analyzed by orthodromic recording. It was longer than that of 52 cases of control group at the same time in this laboratory, because that was longer than the normal reference x^-± 1.96s. RESULTS： Each index was collected from 62 CTS patients and 52 cases from the control group, and all involved in the result analysis. ①There were no significant differences in median motor distal latency and index finger to wrist sensory nerve action potential latency between two groups （P=0.494,0.144）.②There was a significant difference in median ulnar mid palm mixed nerve action potential latency difference between two groups. It was prolonged obviously in CTS group [（2.078±0.316）, （1.706±0.121） ms, t=8.998,P=0.000]. ③Compared to the normal controls, median ulnar mid palm mixed nerve action potential latency difference was considered to be prolonged when it was beyond x^-±1.96s, the upper limits should be 0.398 ms In CTS group, the latency difference of 55 （88.7%） patients was prolonged beyond upper limits, which indicated that the median ulnar mid palm-wrist mixed nerve action potential latency difference significantly enhanced the diagnostic rate of CTS. However, the latency difference of another 7 （11.3%） patients was within 0.4 ms. CONCLUSION： The median ulnar mid palm-wrist mixed nerve action potential latency difference has high diagnostic value for detecting mild CTS.