神经肌电图在腕管综合征患者中的应用价值

Application value of electromyography in the diagnosis of carpal tunnel syndrome

目的 探讨神经肌电图在腕管综合征(CTS)患者中的诊断应用价值。方法 收集2021年9月至2023年2月在桂林医学院附属医院门诊就诊的患者55例,性别不限,根据临床表现初步诊断为CTS,病程3 d~3年,对其进行肌电图检查,记录正中神经支配拇指、示指感觉纤维的波幅和传导速度、运动传导潜伏期、波幅和传导速度,尺神经的运动及感觉传导,正中神经和尺神经的环指差值,观察肌肉静息状态下有无自发电位。结果 被检的110条正中神经中,有105条(95.4%)正中神经/尺神经环指感觉电位潜伏期差值≥0.4 ms,有104条(94.5%)感觉传导速度减慢,有66条(60%)神经运动传导潜伏期延长,有28条(25.4%)感觉传导波幅降低,有13条(11.8%)神经运动动作电位波幅降低。被检的110块拇短展肌中针极肌电图异常有13块(11.8%),其中有8块出现自发电位(纤颤电位、正锐波),有10块出现运动单位时限延长。尺神经的神经传导及小指展肌等肌肉的针极肌电图结果均正常。55例患者中,8例为轻度异常,26例为中度异常,21例为重度异常。结论 对临床初步诊断CTS的患者进行神经肌电图检查可以提供正中神经受损的依据,对CTS的诊断、分级及治疗都有重要作用。

Objective To explore the application value of electromyography in the diagnosis of carpal tunnel syndrome(CTS).Methods A total of 55 patients in the outpatient department of the Affiliated Hospital of Guilin Medical University from September 2021 to February 2023 were enrolled in the study.According to the clinical manifestations,they were diagnosed as CTS with a course of 3 days to 3 years.Electromyography was performed to record the amplitude and conduction velocity,motor conduction latency,amplitude and conduction velocity of the sensory fibers of the thumb and index finger innervated by the median nerve,the motor and sensory conduction of the ulnar nerve,the ring finger difference between the median nerve and the ulnar nerve,and observe whether there was spontaneous potential in the resting state of the muscle.Results Among the 110 median nerves examined,latent difference of ring finger sensory potential of 105(95.4%)median nerve/ulnar nerve was≥0.4 ms,104 nerves(94.5%)sensory conduction velocity slowed down,66 nerves(60.0%)motor conduction latency prolonged,28 nerves(25.4%)sensory conduction amplitude decreased,and 13 nerves(11.8%)with reduced amplitude of motor action potential.Among the 110 examined abductor pollicis brevis muscles,13(11.8%)had abnormal needle electromyography,of which 8 had spontaneous potentials(fibrillation potential,positive sharp wave)and 10 had prolonged motor unit time limit.The nerve conduction of ulnar nerve and the needle electromyography of abductor of little finger were normal.Among the 55 patients,8 cases were mild abnormalities,26 cases moderate abnormalities and 21 cases severe abnormalities.Conclusion Electromyography can provide evidence for median nerve damage,which plays an important role in the diagnosis,classification and treatment of CTS.