神经电生理检测在腕管综合征诊断中的应用价值研究

The applied value of electrophysiological detection in carpal tunnel syndrome

目的探讨神经电生理检测在腕管综合征(carpel tunnel syndrome,CTS)的应用价值以及不同严重程度CTS的神经电生理特点。方法选择71例(122只手)CTS患者和年龄、性别与CTS患者匹配的16例(32只手)健康人,分析CTS患者的临床资料,使用肌电图诱发电位仪对患者及健康人的正中神经、尺神经进行常规神经肌电图检测、F波检测并根据患者正中神经运动神经远端潜伏期(distalmotorlatency,DML)对患者病情进行分级,分析不同严重程度CTS患者的神经电生理检测指标的特点。结果 71例CTS患者病因以务农(33.8%)、家务(31.0%)及电脑办公族(7.0%)多见。病程12天至10年。CTS组与对照组正中神经感觉神经传导速度(sensory nerve conduction velocity,SCV)、运动神经传导速度(motor nerve conduction velocity,MCV)、F波传导速度(F wave conduction velocity,Fcv)、F波出现率(F wave present,Fp)、尺神经SCV减慢,差异有显著性(P<0.05)。CTS组外展拇短肌神经源性损害率为46.4%。不同严重程度各组比较中,轻度组与重度组比较,正中神经和尺神经SCV、MCV,正中神经Fcv、Fp差异均有显著性(P<0.05)。轻度组与中度组中,正中神经SCV、DML、Fp,尺神经SCV、DML差异有显著性(P<0.05)。重度组与中度组比较,正中神经SCV、DML、MCV(腋-肘)、Fp差异有显著性(P<0.05)。结论常规神经电生理检测联合F波检测在诊断CTS具有较高的准确性,有利于判断患者的病情及预后,值得临床应用。

Objective To investigate the applied value of electrophysiological detection in CTS and the electroneuro-myography significance in different severitys . Method A total of 71 patients （122 hands） with CTS as controls （32 hands） were selected and the clinical informations of patients were analysed. The conventional electrophysiological detection and F-wave detection of the median nerve and ulnar nerve in the patients and controls detected EMG by e-voked potential instrument. These patients were divided into different severity of groups according to the medial nerve DML . The characteristics of the neurological related indicators are analysed in patient to controls and different severitys. Result Main Causes of 71 cases of the CTS patients are farming works （33. 8%）,housework （31. 0%） and computer works （7. 0%）. Course is span 12 days to 10 years. Compared to controls, the median nerve SCV, MCV, Fcv is slower, DML was lengthened（P〈0. 05）,and ulnar nerve SCV is also slower（P〈0. 05）（but in normal range ）in the CTS patients. Neurogenic damage rate of abductor pollicis brevis muscle was 46. 4% in patients. Com-paring different severity groups, median and ulnar nerve SCV and MCV, median nerve Fcv, Fp were statistically significant（P〈0. 05） between mild group and severe group . The median nerve SCV, DML and ulnar nerve SCV and DML, median nerve Fp were statistically significant（P〈0. 05） between Mild and moderate group. The median nerve SCV, DML, the MCV （axillary-elbow）, Fp were statistically significant（P〈0. 05） between severe and mod-erate group. Conclusion The conventional electrophysiological detection combining with F-wave detection is worth applying in clinical with more veracity value in CTS diagnosis and advantages to judge the condition and prognosis of patients.