肌电图在早期腕管综合征诊断中的应用

Application of Electromyography in Early Diagnosis of Carpal Tunnel Syndrome

目的比较肌电图不同检测方法在腕管综合征(carpal tunnel syndrome,CTS)诊断中的阳性率,探讨不同检测方法在早期腕管综合征诊断中的应用价值。方法选取2019年4月至2020年12月期间锦州医科大学附属第三医院门诊收治的临床诊断为CTS的患者108例。常规行正中神经、尺神经的运动和感觉传导检测,正中神经感觉刺激拇指、环指;正中神经加做腕-掌运动传导测定(掌刺激法);并对拇短展肌、小指展肌行针电极肌电图检测和分析;比较常规神经传导检测法(常规法)、腕-掌刺激法(掌刺激法)、环指和拇指对比法在早期CTS中的诊断的阳性率。结果掌刺激法中的腕-掌运动神经传导速度(motor nerve conduction velocity,MCV)低于36 m/s即考虑诊断为CTS;掌刺激法阳性率为89%,明显高于常规检测法53%、环指刺激对比法、拇指刺激对比法64%。结论腕-掌运动神经传导检测在腕管早期诊断中非常敏感,腕-掌MCV低于36 m/s,可考虑诊断为轻度CTS,加做掌刺激可提高腕管综合征检出的阳性率。

Objective To compare the positive rate of electromyography(EMG)in the diagnosis of carpal tunnel syndrome(CTS),and to explore the value of different detection methods in the diagnosis of carpal tunnel syndrome.Methods From April 2019 to December 2020,108 patients with clinical diagnosis of CTS were selected from the Outpatient Department of the Third Affiliated Hospital of Jinzhou Medical University.The motor and sensory conduction of median nerve and ulnar nerve were measured routinely.Median nerve sensory was tested by stimulating finger 1 and finger 3.The test of carpal-palmar motor conduction(palmar stimulation method)was added on median nerve.The abductor polis brevis and abductor little finger were detected and analyzed by electromyography with needle electrode.The positive rates of conventional nerve conduction detection(routine),carpal-palmar stimulation(palmar stimulation),finger 3 and finger 1 contrast in early diagnosis of CTS were compared.Results CTS was diagnosed when MCV of wrist-palm was less than 36 m/s;the positive rate of palm stimulation method was 89%,which was significantly higher than that of conventional detection method(53%),ring finger stimulation method and thumb stimulation method(64%).Conclusion Carpometacarpal motor nerve conduction test is very sensitive in the early diagnosis of carpal tunnel.The MCV of carpometacarpal tunnel is less than 36 m/s,which can be considered as mild CTS,and palmar stimulation can be added to improve the positive rate of carpal tunnel syndrome.