手术与未手术腕管综合征患者临床和电生理回顾性分析

Retrospective analysis of clinical and electrophysiological features in carpal tunnel syndrome patients with or without surgical treatment

目的分析本院接受手术或未手术腕管综合征(CTS)患者的临床、电生理特征及其相关性,并探讨其可能的原因。方法回顾性分析2008年6月至2011年12月就诊于我科,经临床和肌电图诊断的CTS患者,分为接受手术和未手术两组;比较分析两组在例数、性别和年龄的分布以及电生理结果的差异。结果 (1)3.5年期间共327例CTS患者、579只腕,其中男46例、女281例(85.9%)(χ2=333.768,P=0.000);年龄22～81(岁)、平均年龄(50.1±11.3)岁;40～49、50～59岁组分别占33.0%(88/327)、38.5%(126/327),共71.5%,高于其他年龄组(χ2=62.391,P=0.000);(2)接受手术治疗者19例(男/女=4/15)、34只腕(5.87%),未手术者308例(男/女=42/266)、545只腕(95.9%)(χ2=510.832,P=0.000);年龄分别为38～64(岁)、22～81(岁),平均年龄(49.5±7.0)、(50.2±10.6)岁(t=-0.286,P=0.775);(3)手术和未手术组腕-拇短展肌远端运动潜伏期分别为(5.28±1.51)、(4.99±1.33)(ms)(t=0.922,P=0.421);复合肌肉动作电位波幅(8.11±3.101)、(8.13±3.22)(mV)(t=0.028,P=0.978);腕-食指感觉传导速度(41.29±7.97)、(38.29±8.04)(m/s)(t=1.58,P=0.114);正中-尺神经感觉潜伏期差(1.21±0.56)、(1.17±0.70)(ms)(t=-0.414,P=0.683);感觉神经动作电位波幅(18.18±15.32)、(19.72±13.86)(μV)(t=0.515,P=0.607);(4)手术与非手术组轻、中、重度患者比例的差异明显(χ2=6.294,P=0.043),轻度者接受手术治疗的比例低于非手术组(χ2=6.253,P=0.012)。结论CTS患者女性占绝大多数,好发年龄40～60岁;本院CTS患者接受手术治疗的比率远低于西方国家,可能与我国社会、文化背景(例如患者多为经济条件差的劳动女性或不愿接受手术)、医疗资源、医生的认识程度等因素有关。CTS电生理分级程度有助于指导患者选择治疗方式。

[Abstract] Objective To analyze the clinical and electrophysiological features and their correlations in carpal tunnel syndrome （CTS） patients with or without surgical treatment, and to compare the proportion of the two sub- groups and explore the possible reasons. Methods CTS patients confirmed by clinical and electromyographic diagno- sis, who were referral to our department between June 2008 and December 2011, were retrospectively analyzed. The patients were divided into two subgroups： surgical and non-surgical group; in which the difference of numbers, the distribution of gender and age, and the electrophysiological findings were compared. Results （ 1 ） During 3. 5-year period, there was a total of 327 cases （579 wrists） of CTS patients of which 46 were male and 281 （85. 9%）were fe- male （χ2 = 333. 768,P= 0. 000） ; the age ranged from 22-81 years, with an average of 50. 1 ± 11.3; those aged 40-49 and 50-59 years accounted for 26. 9% （88/327） and 38. 5%（126/327） respectively, and 65.4%o totally, which was significantly higher than that in other age groups （χ2 = 510. 832,P= 0. 000）. （2） There were 19 patients （male/female = 4/15） with surgical treatment, involving 34 wrists （5. 87%）, and 308 cases （male/female = 42/266） without surgical treatment, involving 545 wrists （95. 9%） （χ2 = 510. 832,P = 0. 000） ; and the age ranged from 38 to 64. 22 to 81 years, with an average of （49. 5 ± 7. 0）, （50. 2± 10. 6）, respectively （t = - 0. 286,P = 0. 775）. （3） A-mong the patients with and without surgical treatment, median nerve DML was （5. 28 ± 1.51 ） and （4. 99 ± 1.33） （t = 0. 922, P= 0. 4211 ; the amplitude of CMAP, （8. 11 ± 3. 101） and （8. 13 ± 3. 22） （t= 0. 028, P= 0. 978） ; SCV, （41.29±7.97） and （38. 29±8.041 （t =1.58, P =0.1141; DSL, （1.21±0.561 and （1.17± 0. 70） （t= - 0. 414, P= 0. 683） ; the amplitude of SNAP, （18. 18 ± 15. 32） and （19. 72 ± 13. 86） （t = 0. 515, P = 0. 607） re- spectively. （4） Among the patients with and without surgical treatment, the proportion of patients with mild, moder- ate and severe CTS was statistically significant（χ2 = 6. 294,P = 0. 0431, the proportion of mild CTS underwent sur- gery is less than that of the non-surgical group（χ2 = 6. 253,P -= 0. 0121. Conclusions Women accounted for the vast majority among CTS patients, the age distribution concentrated in 40-60 years. The ratio of CTS patients receiving surgery in our province was much lower than that in Western countries, which might be associated with multiple fac- tors, such as Chinese social and cultural background （for example, most patients were labor women female labor with poor economic conditions or reluctant to undergo surgery）, medical resources and physicians level of awareness. The electrophysiological grading scheme for the severity of CTS can guide the patient in choosing the treatment.