腕管综合征电诊断敏感性研究

The study of electrodiagnostic sensitivity in carpal tunnel syndrome

目的研究腕管综合征(CTS)更敏感的电诊断指标,并结合电生理探讨CTS特征性体征与病变程度的关系。方法2009年2月～2010年2月间就诊于本科,符合纳入标准的CTS患者72例(121只腕)行神经传导检测(NCS),记录腕-拇短展肌/小指展肌末端运动潜伏期(DML)、拇短展肌复合肌肉动作电位(CMAP)波幅、腕-食指/环指/小指感觉传导速度(SCV)、正中/尺神经感觉潜伏期差(?DSL)和感觉神经动作电位(SNAP)波幅。结果(1)拇短展肌CMAP波幅(mV)低于小指展肌(7.40±3.25v.s.10.74±2.23,t=-9.22、P<0.001),环指记录的正中神经SNAP波幅(μV)低于尺神经(9.77±7.46v.s.23.67±9.92,t=-10.70、P<0.001);(2)腕-拇短展肌DML延长、腕-食指和腕-环指SCV减慢、?DSL增加,阳性率分别为89.1%(106/119)、79.6%(78/98)、85.1%(57/67)和95.5%(64/67)(χ2=9.66,P=0.022);(3)与阴性者比较,Tinel征阳性者DML(ms)延长更多(5.65±1.62v.s.4.89±1.61,t=2.13、P=0.035),Phalen征阳性者腕-食指SCV减慢更多(35.57±7.49v.s.39.84±7.66,t=-2.39、P=0.019),其余各参数均无差异(P>0.05)。结论?DSL诊断CTS最敏感,怀疑CTS时可作为首选的方法;Tinel征和Phalen征不能完全反映CTS严重程度。

Objective To investigate prospectively a more sensitive parameter of electrodiagnosis in carpal tunnel syndrome（CTS）,and to explore the correlation between the characteristic signs and severity of CTS combined with electrophysiological findings.Methods Seventy-two consecutive CTS patients（121 wrists） who met the inclusion criteria were enrolled between February,2009 and February,2010.The enrolled subjects were electrophysiologically evaluated by nerve conduction studies（NCS）,and the following parameters were measured： 1） distal motor latency（DML） from wrist to abductor pollicis brevis（APB） and abductor digiti minimi（ADM） of median and ulnar nerve,respectively;2） the amplitude of compound muscle action potential（CMAP） of APB and ADM;3） sensory conduction velocity（SCV） from wrist to index / ring / little finger;3） the difference of distal sensory latency between the median and ulnar nerve（⊿DSL）;4） the amplitude of sensory nerve action potential（SNAP） recorded on ring finger.Results （1） CMAP amplitude（mV） of APB was lower than that of ADM（7.40±3.25 v.s.10.74±2.23;t=-9.22,P0.001）,SNAP amplitude（μV） of median nerve was lower than that of ulnar nerve （9.77±7.46 v.s.23.67±9.92;t=-10.70,P〈0.001）.（2） DML（wrist-APB） prolonged,SCV from wrist to index and ring finger became slowed,and ⊿DSL increased,significantly;the abnormality rates were 89.1%（106/119）,76.9%（78/98）,85.1%（57/67） and 95.5%（64/67）（χ^2 =9.66,P=0.022）,respectively.（3） Compared with those in negative group,DML（ms） prolonged more in those with positive Tinel＇s sign（5.65±1.62 v.s.4.89±1.61;t=2.13,P=0.035）,SCV（m/s） from wrist to index became slowed more in those with positive Phalen＇s sign（35.57±7.49 v.s.39.84±7.66;t=-2.39,P=0.019）;and there were no difference among the remaining parameters（P〉0.05）.Conclusions ⊿DSL is the most sensitive in the electrodiagnosis of CTS,which can be the first choice when CTS is suspected.Both Tinel＇s sign and Phalen＇s sign are not able to reflect completely the lesion severity of CTS.