短节段神经传导检测法在肘管综合征中的应用价值

Application of short-segment nerve conduction studies in the cubital tunnel syndrome

目的：探讨短节段神经传导检测法（寸进法）在肘管综合征的应用价值。方法分析46例临床确诊为肘管综合征患者的临床及神经电生理检测资料。其中男性32例，女性14例，年龄19～59岁，平均（41.2±12.7）岁。一侧有症状或体征者41例（41肢），其中左侧30肢，右侧11肢；双侧有症状或体征者5例（10肢）。46例患者无症状肢体41肢，共92个肢体。双侧均行长节段分段尺神经运动神经传导及寸进法检测。对30名健康志愿者行双侧寸进法检测，作为正常值对照。结果常规长节段分段运动神经传导异常的有51条尺神经，均为有症状肢体。寸进法检测中，有68条尺神经存在异常，包括51个有症状肢体及17个无症状肢体。髁上2 cm 至髁部节段异常的有41条（44.6％）尺神经，髁部至髁下2 cm节段异常的有23条（25％）尺神经，髁上4 cm至髁上2 cm节段异常的有18条（19.6％）尺神经，髁上6 cm至髁上4 cm节段异常的有9条（9.8％）尺神经，髁下2 cm至髁下4 cm节段异常的有8条（8.6％）尺神经，髁下4 cm至髁下6 cm节段异常的有6条（6.5％）尺神经。各异常率比较发现，肘上2 cm至肘与其他节段均存在差异，有统计学意义（经卡方检验，均P＜0.05）。结论寸进法较常规长节段分段神经传导检测在肘管综合征的诊断中敏感度较高，能发现轻微病变，能精确定位病变部位，在肘管综合征的诊断及定位病变发生部位中都有较高的临床价值。

Objective To evaluate the value of the short-segment nerve conduction studies （SSCSs, inching test） in the diagnosis and localization of cubital tunnel syndrome （CubTS）.Methods The clinical and electrophysiologic data of 46 patients （92 limbs from 32 men and 14 women, aged from 19 to 59 years, with average age of 41.2 years） with CubTS were collected.The symptoms occurred in unilateral arm in 41 patients and bilateral arms in 5 patients, involving 35 left arms and 16 right arms.SSCSs were performed in both arms in all the 46 patients.Sixty ulnar nerves were studied in 30 healthy control subjects using SSCSs.Results The 51 symptomatic arms with CubTS were abnormal in long segment motor nerve conduction studies.There were 68 abnormal arms （ 51 symptomatic arms, 17 asymptomatic arms ） in SSCSs.The lesions were located 2 cm proximal to the elbow-the elbow segment （ AE2-E ） in 41 arms （44.6%）,the elbow-2 cm distal to the elbow segment （E-BE2） in 23 arms （25%）, 4 cm proximal to the elbow-2 cm proximal to the elbow segment （AE4-AE2） in 18 arms （19.6%）, 6 cm proximal to the elbow-4 cm proximal to the elbow segment （AE6-AE4） in 9 arms （9.8%）, 2 cm distal to the elbow-4 cm distal to the elbow segment （BE2-BE4） in 8 arms（8.6%） and 4 cm distal to the elbow-6 cm distal to the elbow segment （BE4-BE6） in 6 arms（6.5%）,respectively.Conclusions SSCSs are more sensitive in detecting CubTS than the conventional long segment motor conduction studies.SSCSs could precisely localize the entrapment lesions in patients with CubTS ,might be a useful tool for the detection of ulnar mononeuropathy at the elbow, especially for diagnosing the patients with CubTS who have no clinical features or have a normal long segmental nerve conduction findings.