正中神经掌-指Ⅲ与腕-掌段感觉传导速度比值在腕管综合征中的诊断价值

Value of ratio of sensory nerves conductive velocity along palm-median finger/wrist-palm in diagnosing the carpal tunnel syndrome

目的评价正中神经掌一指Ⅲ与腕一掌段传导速度比值在腕管综合征中的诊断价值。方法将正中神经掌-指Ⅲ与腕一掌段的感觉传导速度比值与1的差值定义为腕管综合征指数（index—CTS），以此指数评估正中神经在跨腕段神经传导阻滞的程度。健康对照组100侧掌来自江苏盛泽医院2014年1—12月期间体检中心的100名16～80岁健康受试者，腕管综合征组（CTS组）58侧掌来自2013年7月至2015年7月期间同院神经内科门诊临床确诊的58例轻中度腕管综合征（CTS）患者。采用t检验比较两组间index—CTS均值，多元回归分析index—CTS的相关因素；以ROC曲线来评价不同index—CTS取值在诊断CTS中的敏感性和特异性。结果健康对照组和CTS组的index—CTS值均符合正态分布，平均值分别为-0．0534-0．042和0．0554-0．074，差异有统计学意义（P〈0．01）。多元线性回归分析发现Tinel征、Phalen征、手掌侧别、环指正中一尺神经感觉传导潜伏期差、临床严蕈程度分级、电生理学分级均是index—CTS可识别影响因素。ROC曲线提示当环指正中一尺神经感觉传导潜伏期差〉0．395，index—CTS〉0．001时，两者诊断特异性均为92％，但index—CTS有更高的诊断敏感性（98．3％比89．7％）。结论正中神经掌一指Ⅲ与腕一掌段传导速度比与1的差值作为CTS指数评价正中神经在腕部传导阻滞的程度具有重要价值，index—CTS升高是腕管综合征显著的电生理学特衙之一，

Objective To Verify the value of the ratio of sensory nerves conductive velocity along palm-median finger/wrist-palm minus 1 for diagnosis of the mild-moderate carpal tunnel syndrome （CTS）. Methods The different value between 1 and the ratio of sensory nerves conductive velocity along palmmedian finger/wrist-pahn was defined as index-CTS which was used to assess the severity of CTS. The index- CTS of 100 pahns from healthy controls and 58 palms from mild-moderate CTS patients were calculated and compared. Multiple regression was used to identify the relative factors of index-CTS. The ROC curve was used to evaluate the sensitivity and specificity of index-CTS at different values. Results The value of index-CTS from healthy controls and patients both fitted Gaussian distribution. The mean value were - 0. 053 ±0. 042 vs 0. 055 ± 0. 074 in the controls and the patients respectively. The difference was statistically significant between the two groups by T-test（ P 〈 0. 001 ）. Multiple regression analysis showed that Tinel sign, Phalen sign, laterality, clinical grade, electrical grade were identifiable factors related to index-CTS. When index- CTS was over 0. 001 and 1V-DL over 0. 395 ms , specificity of diagnosis by both can get 92% , but index- CTS showed more higher sensitivity（98.3% vs 89. 7% ）. Conclusions Rising index-CTS could be the most signifieant electrophysiological feature in CTS. It can be used as a sensitive marker to assess the extent of conduction block of median nerve in carpal tunnel.