手工劳动者BMI及腕关节指数与腕管综合征的关系

Relationship of BMI and wrist joint index with carpal tunnel syndrome in manual laborers

目的评价腕管综合征(CTS)患者的正中神经损害程度,分析其与人体质量指数(BMI)、腕关节指数的关系。方法于2016年5月至2017年1月,收集CTS轻度组患者23例,中重度组35例;选取性别、年龄相匹配的健康志愿者22例作为对照组。利用神经电生理检测技术对受试者进行正中神经运动及感觉神经传导检测,计算BMI及腕关节指数,分析CTS患者神经电生理检测指标、BMI、腕关节指数之间的关系。结果与对照组比较,CTS轻度组及中重度组患者腕关节指数增高,正中神经运动末端潜伏期(DML)延长,指1-腕及指3-腕感觉神经传导速度(SCV)和感觉神经动作电位(SNAP)波幅减低,差异均有统计学意义(P<0.01);与对照组比较,中重度组患者BMI增高,复合肌肉动作电位(CMAP)波幅下降,差异均有统计学意义(P<0.01)。受试者腕关节指数及BMI与正中神经DML均呈正相关,与指1-腕、指3-腕SCV及SNAP波幅均呈负相关(P<0.05)。腕关节指数大于0.73者相对于小于0.73者,发生CTS的风险增加(OR=30.67,95%CI:3.79~248.36)。结论腕关节指数增高是手工劳动者发生CTS的独立危险因素,应关注高腕关节指数且BMI增高的手工劳动者。

Objective To evaluate the severity of median nerve damage in patients with carpal tunnel syndrome (CTS), and to analyze its relationship with body mass index (BMI) and wrist joint index. Methods From May 2016 to January 2017, 23 patients with mild CTS (mild group) and 35 patients with moderate to severe CTS (moderate to severe group) were enrolled in this study. And 22 healthy volunteers matched for sex and age were selected as control group. The neuroelectrophysiological monitor was used to measure the median nerve movement and sensory nerve conduction in the subjects. The BMI and wrist joint index were calculated. The relationship of neuroelectrophysiological parameters with BMI and wrist joint index was analyzed in the CTS patients. Results Compared with the control group, the mild group and the moderate to severe group had significantly higher wrist joint index, significantly longer distal motor latency (DML) of the median nerve, and significantly lower sensory nerve conduction velocity (SNCV) and sensory nerve action potential (SNAP) amplitude of the finger 1-wrist and finger 3-wrist (P<0.01);the moderate to severe group had significantly higher BMI and significantly lower composite muscle action potential (CMAP) amplitude (P<0.01). The wrist joint index and BMI were positively correlated with DML of the median nerve and negatively correlated with SCV and SNAP amplitude of the finger 1-wrist and finger 3-wrist (all P<0.05). The patients with a wrist joint index of >0.73 had a significantly higher risk of CTS than those with a wrist joint index of <0.73 (odd ratio=30.67, 95% confidence interval: 3.79-248.36). Conclusion A wrist joint index of >0.73 is an independent risk factor for CTS in manual laborers. CTS should be prevented in the manual laborers with high wrist joint index and BMI.