前臂尺神经干动作电位与短段传导时间测定诊断肘管综合征的价值研究

Value of Forearm Ulnar Nerve Trunk Action Potential and Short Segment Conduction Time for the Diagnosis of Cubital Tunnel Syndrome

目的探讨前臂尺神经干动作电位(NAP)与短段传导时间测定(SSCT)诊断肘管综合征(CTS)的临床价值。方法选取2014年6月—2016年6月石河子市人民医院收治的CTS患者71例,其中典型症状50侧(其中单侧26例,双侧12例),不典型症状38侧(其中单侧28例,双侧5例)。患者均进行常规电生理检查、NAP和SSCT。结果典型症状常规电生理检查异常36侧(72.0%),SSCT异常46侧(92.0%)。SSCT异常率高于常规电生理检查异常率(χ~2=6.775,P=0.009)。常规电生理检查单侧异常18侧(69.2%),NAP单侧异常23侧(88.5%),SSCT单侧异常23侧(88.5%)。NAP单侧异常率、SSCT单侧异常率与常规电生理检查单侧异常率比较,差异均无统计学意义(χ~2=2.882,P=0.090;χ~2=2.882,P=0.090)。不典型症状常规电生理检查异常24侧(63.2%),SSCT异常32侧(84.2%)。SSCT异常率高于常规电生理检查异常率(χ~2=4.343,P=0.037)。常规电生理检查单侧异常16侧(57.1%),NAP单侧异常24侧(85.7%),SSCT单侧异常22侧(78.6%)。NAP单侧异常率高于常规电生理检查单侧异常率(χ~2=5.600,P=0.018);SSCT单侧异常率和常规电生理检查单侧异常率比较,差异无统计学意义(χ~2=2.947,P=0.086)。结论对于早期临床症状不典型的CTS患者,通过行SSCT可提高临床检测异常率。如有条件对于单侧尺神经损害者可联合行NAP检查,可以提高CTS的早期诊断。

Objective To investigate the clinical value of forearm ulnar nerve action potential（ NAP） and short segment conduction time（ SSCT） for the diagnosis of carpal tunnel syndrome（ CTS）. Methods The enrolled participants were71 cases of CTS [typical symptoms of CTS in 50 limbs（ 26 cases of unilateral,12 cases of bilateral）,atypical symptoms in 38limbs（ 28 cases of unilateral,5 cases of bilateral） ]receiving treatment in Shihezi People＇ s Hospital from June 2014 to June2016. The patients underwent the conventional electrophysiological examination. And the measurement of forearm ulnar NAP and SSCT were performed in them. Results For the patients with typical symptoms of CTS,the electrophysiological results were abnormal in 36（ 72. 0%） limbs,SSCT was abnormal in 46（ 92. 0%） limbs. The rate of abnormal SSCT was higher than that of the abnormal electrophysiologic results（ χ2= 6. 775, P = 0. 009）. The electrophysiological results were abnormal in 18（ 69. 2%） unilateral limbs,forearm ulnar NAP was abnormal in 23（ 88. 5%） unilateral limbs and SSCT was abnormal in 23（ 88. 5%） unilateral limbs. The rate of abnormal forearm ulnar NAP of unilateral limb was not significantly different from that of abnormal electrophysiological results of unilateral limb（ χ2= 2. 882,P = 0. 090）. The rate of abnormal SSCT of unilateral limb was similar to that of abnormal electrophysiological results of unilateral limb（ χ2= 2. 882,P = 0. 090）. The electrophysiological results were abnormal in 24 limbs（ 63. 2%） of atypical cases, SSCT was abnormal in 32 limbs（ 84. 2%）. The rate of abnormal SSCT was higher than that of abnormal electrophysiologic results（ χ2= 4. 343,P = 0. 037）. The electrophysiological results were abnormal in 16（ 57. 1%） unilateral limbs,forearm ulnar NAP was abnormal in 24（ 85. 7%） unilateral limbs,SSCT was abnormal in 22（ 78. 6%） unilateral limbs. The rate of abnormal forearm ulnar NAP of unilateral limb was higher than that of abnormal electrophysiological results of unilateral limb（ χ2= 5. 600, P = 0. 018）. The rate of abnormal SSCT of unilateral limb was not significantly different from that of abnormal electrophysiological results of unilateral limb（ χ2= 2. 947,P= 0. 086）. Conclusion For CTS patients with atypical early clinical symptoms, the diagnostic rate increases by using SSCT. The rate of early diagnosis of CTS can be improved by the measurement of SSCT combined with forearm ulnar NAP for patients with unilateral ulnar nerve damage if available.