神经电生理检查在腕管综合征患者中的应用价值

Application value of neuroelectrophysiological examinations in patients with carpal tunnel syndrome

目的:探讨神经电生理检查在腕管综合征(CTS)中的应用价值。方法:收集2019年3月至2019年7月潍坊市中医院收治的CTS患者120例,单纯左侧病变10例,单纯右侧病变21例,双侧病变89例。行正中神经、尺神经运动和感觉传导检测,并对拇短展肌、小指展肌行针电极肌电图检测和分析。结果:209条受检正中神经中,200条(95.7%)正中/尺神经环指潜伏期差值≥0.4 ms,127条(60.8%)感觉传导速度(SCV)减慢,125条(59.8%)感觉神经动作电位(SNAP)波幅降低,112条正中神经(53.6%)复合肌肉动作电位(CMAP)远端潜伏期(DML)延长,14条(6.7%)正中神经CMAP波幅降低,10条(4.8%)运动神经传导速度减慢。针电极肌电图所检209块拇短展肌中,其中30块(14.4%)静息位可见纤颤波、正锐波,8块(3.8%)轻度收缩时运动单位时限延长,16块(7.7%)重度收缩时募集相呈单纯相。尺神经感觉、运动传导检测均正常。各项电生理异常指标阳性率比较差异具有统计学意义(P<0.05)。结论:神经电生理检查对CTS的诊断、分期及治疗具有重要的指导意义。

Objective:To explore the application value of neuroelectrophysiological examinations in patients with carpal tunnel syndrome(CTS).Methods:A total of 120 patients in Weifang Traditional Chinese Hospital from March 2019 to July 2019 were enrolled in the study.The motor conduction and sensory conduction of median nerve and ulnar nerve were detected in all patients,the needle electrode electromyography was performed in the abductor thumb and abductor pinkie and the results were analyzed.Results:Among 209 median nerves examined,the latency difference of 200(95.7%)median and ulnar nerve ring finger was greater than or equal to 0.4 ms,the sensory conduction velocity(SCV)of 127 nerves(60.8%)decreased,the amplitude of 125(59.8%)sensory nerve action potential(SNAP)decreased,the distal motor latency(DML)of 112 median nerves(53.6%)compound muscle action potential(CMAP)prolonged,the CMAP amplitude of 14 median nerve(6.7%)decreased,the motor nerve conduction velocity of 10 nerves(4.8%)decreased.Among 209 thumb abductor muscles detected by electromyography with needle electrode,fibrillation and positive sharp waves of 30 muscles(14.4%)were found at resting position,the duration of motor unit of 8 muscles(3.8%)was prolonged when mild contraction,the recruited phase of 16 muscles(7.7%)was simple phase.The sensory and motor conduction of ulnar nerve were normal.There were significant differences in the positive rates of various electrophysiological abnormalities(P<0.05).Conclusion:Neuroelectrophysiological examinations plays an important guiding significance in the diagnosis,clinical staging and treatment of CTS.