腕管综合征262例的回顾性分析

Aretrospectiveanalysisof262casesofcarpaltunnelsyndrome

通过对２６２例腕管综合征（ＣＴＳ）的回顾性分析，以期获得对该疾病较全面的认识，从而有利于早期诊断和适当治疗。近１０年来就诊于我科的病人，根据其临床表现结合电生理检查的结果，其中符合ＣＴＳ诊断者共２６２例。本文从病因、临床表现及电生理三个方面进行总结、分析。所得结果如下：８４％的患者为女性，以中老年女性尤为多见，优势手更常受累。激素水平的变化、反复强迫性手臂的运动、手腕持续处于不适当的位置，以及其它较多不同因素与ＣＴＳ的发病可以有关。典型的临床表现为腕以下正中神经分布区域的疼痛与感觉异常，症状常在夜间或清晨及劳累后加重，甩手活动后减轻。但应注意许多病人的不适并非局限于正中神经分布区，感觉检查变化较多且不完全可靠。电生理检查显示为选择性的腕远侧段正中神经感觉、运动传导的异常。从此认为ＣＴＳ的诊断应根据病史、神经系体检并结合客观的电生理检查的结果，其中电生理检查对于ＣＴＳ的诊断常常起着几乎决定性的作用。

casesofcarpaltunnelsyndrome(CTS)wereanalyzedretrospectivelyinorderthatthediseasecouldberecognizedmorecomprehensivelyandearlydiagnosisandpropertreatmentcouldbefacitated.These262patientswhowerereferedtoourdepartmentduringrecenttenyearswerediagnosedasCTSaccordingtotheclinicalmanifestationsandelectrophysiologicalfindings.Theywereparticularlyanalyzedfromthreeaspectswhichconsistedofpossibleinducingfactorsandaetiology,clinicalmanifestationandelectrophysiology.Thesesultsshowedthat84%ofthepatientswithCTSwerefemales,amongwhomthewomenofweremiddleandold-agesbyfarpredominantinsuferringfromthedisease.Thedominanthandsweremorefrequentlyafected.Hormonalchanges,repetedforcefulmovementsandsustainedlyawkwardpositionsofthewristsandhandsandsomeoth-erfactorsmightbeassociatedwiththepathogenesisofCTS.Typicaly,theclinicalmanifestationsofCTSconsistedpainandparesthesiaintheareassuppliedbythemediannerves,whichbecamemoresevereatnightorintheearlymorning,andmightberelievedoraleviatedbyshakingthehands.Thepatientsmightlocalizedthediscomfortbeyondthedefinedareasandsensorychangeswerevariableandnotentirelyreliable.SensoryandmotorconductionabnormalitiesoftenappearedselectivelyintheareassuppliedbythemediannervesinthedistalpartstoofthewristsinthepatientswithCTS.ThediagnosisofCTSrequiresconfirmationofilnesshistory,symptomsandsignswithobjectiveelectrodiagnostictests.Theelectrophysiologicalstudieswouldbeofmajorsignificancetothediagno-sisofCTS.