第二蚓状肌-骨间肌记录法在腕管综合征的诊断价值研究

The diagnostic value of second lumbrical and interossei latency difference in carpal tunnel syndrome

目的探讨第二蚓状肌-骨间肌记录法在不同程度腕管综合征(carpal tunnel syndrome;CTS)中的诊断价值。方法以符合纳入标准的CTS患者44例(56只患手)为病例组,年龄、性别匹配的30例健康志愿者的非利手为对照组。表面电极刺激和记录,分别进行正中、尺神经的运动和感觉传导检测。主要参数包括,(1)掌-拇短展肌的末端运动潜伏时(DML)、腕-拇短展肌DML(APB-DML)、腕-掌段运动传导速度(wpMCV),以及腕-食指末端感觉潜伏时(DSL)、感觉传导速度(SCV);(2)腕-小指展肌DML、腕-第二骨间肌DML;(3)腕-环指正中/尺神经末端感觉潜伏时的差值(dDSL);(4)腕-第二蚓状肌DML(2L-DML)及其与腕-第二骨间肌DML的差值(2LI-DML)。根据腕-拇短展肌DML以及腕-食指SCV,将CTS患者分为轻、中和重度组。结果在44例患者56只患手中轻度CTS19肢,中度22肢,重度15肢;其中7例CTS患者合并下肢周围神经病。与对照组相比,3个病例组的APB-DML延长、wpMCV减慢、dDSL增大、2L-DML延长、2LI-DML增大,均有统计学差异(P<0.01)。在轻度组以及中度组2LI-DML诊断的敏感性与APB-DML、wpM-CV、dDSL无明显差异(P>0.05);在重度组,2LI-DML诊断的敏感性与APB-DML、wpMCV无差异(P>0.05),与dDSL的差异有显著性(χ2=7.03,P<0.05)。结论第二蚓状肌-骨间肌记录法可有效检出各种程度的CTS,在重度CTS尤其是合并多发性神经病者,则是很有价值的检测方法。

Objective To evaluate the diagnostic significance of second lumbrical and interossei distal motor latency difference（2LI-DML） on varied illness severity of carpal tunnel syndrome（CTS）.Methods Consecutive 44 patients（56 hands） clinically defined in accordance with CTS took part in the study,and the age-and gender-matched 30 healthy volunteers（30 non-dominant hands） were served as controls.Motor and sensory nerve conduction studies of median and ulnar nerve were performed,respectively,using surface electrodes for both stimulating and recording.The main electrophysiological parameters included： 1）distal motor latency（DML） of palm-abductor pollicis brevis,DML of wrist-abductor pollicis brevis（APB-DML）,wrist-palm motor conduction velocity（wpMCV）,distal sensory latency（DSL） and sensory conduction velocity（SCV） of wrist-index finger;2）DML of wrist-abductor digiti minimi and wrist-second interosseus（2I-DML）;3）the DSL difference（dDSL） between median and ulnar nerve from wrist to ring finger;（4）DML of wrist-second lumbrical（2L-DML）,the difference between 2L-DML and 2I-DML（2LI-DML）.The patients were divided into three groups（mild,moderate and severe） by abnormal severity of APB-DML and SCV of wrist-index finger.Results In 44 patients with 56 hands involved,there were 19 hands with mild,22 with moderate and 15 with severe CTS,among which 7 cases complicated with peripheral nerve impairments of lower extremities.Compared with the control group,APB-DML prolonged,wpMCV slowed down,and dDSL and 2LI-DML increased significantly in all three patient sub-groups（P0.01）.In the mild and moderate CTS patient sub-groups,there was no significant difference of diagnostic sensitivity among 2LI-DML with dDSL,wpMCV,APB-DML（P0.05）.While in severe CTS sub-group,the diagnostic sensitivity of 2LI-DML showed significant difference compared to dDSL（P0.05）.Conclusions Second lumbrical and interossei latency difference is an efficient approach for diagnosis of varied illness severity of CTS,especially helpful in the severe CTS complicated with polyneuropathies.