正中神经前臂段运动传导与腕管综合征严重程度的相关性研究

Forearm median motor conduction and severity of carpal tunnel syndrome： Correlation study

目的：探讨正中神经前臂段运动传导（fMCV）与腕管综合征（CTS）疾病严重程度的相关性，并初步探讨其发生机制。方法：以符合纳入标准的CTS患者66例（126只患手）为病例组，年龄、性别匹配的96例健康志愿者的非利手为对照组，均行神经电生理检测。采用正中神经末端运动潜伏期（DML）和复合肌肉动作电位（CMAP）作为CTS严重程度指标，并研究其与fMCV的相关性。结果：①尺神经：病例组与对照组的各电生理参数间比较差异均无显著意义（t检验，P〉0．05）；②正中神经：在病例组（n=126）和对照组（n=96），DML（ms）分别为5．0±1．3、3．0±0．3，腕-掌段正中神经运动传导速度（m／s）分别为22．2±7．3、56．9±8．3，fMCV（m／s）分别为53．7±5．5、59．2±3．6，拇短展肌CMAP波幅（mV）分别为7．3±2．9、10．1±1．9。以上所有参数的值均经t检验，P〈0．05，差异有显著意义；③相关性：在病例组，fMCV与DML呈负相关（r=-0．35，P〈0．05），与拇短展肌CMAP呈正相关（r=0．18，P〈0．05）。结论：fMCV的异常与CTS患者的严重程度相关，且正中神经逆行性变为其可能的发生机制。

Objective：To investigate the correlation between the slowing of median nerve conduction velocity at the segment of forearm （ fMCV ） and the severity of the entrapment neuropathy in CTS, and to explore the possible pathogenesis of the slowed fMCV. Methods.. Consecutive 66 CTS patients （126 hands） that satisfied the diagnostic criteria were enrolled and the age-and gender-matched 96 volunteers （96 non-dominant hands） served as controls. Routine nerve conduction studies were performed. The distal motor latency （DML） of median nerve and thenar compound muscle action potentials （CMAP） amplitude were taken as indications of CTS severity, and the correlation between the severity and fMCV was analyzed. Results： As for ulnar nerves, there was no difference of motor and sensory conduction between patients group and controls. In the patients group,the median DML （ms） was 5.0 ± 1.3, significantly longer （P= 0. 000） ; the CMAP amplitude （mV） of abductor pollicis brevis was 7.3 ± 2.9, decreasing significantly （P=0.000） ; the wrist-palm MCV （m/s） was 22.2 ± 7.3, slowing down significantly （P= 0. 000） ; the fMCV （m/s） was 53.7 ± 5.5, slowing significantly （P= 0. 000）, compared with the controls; and there was a significantly negative correlation between the fMCV and DML （r=-0.35, P〈 0.01, n= 126） and positive correlation between fMCV and CMAP amplitude （r= 0.18,P〈0. 05, n= 96） . Conclusion： The conduction abnormality of median nerves at the segment of forearm may be associated with the lesion severity in the patient with CTS, in which the pathogenesis may he retrograde axonal degeneration.