探讨腕管综合征电生理分期的定量指标  

Investigation of quantitative index for electrophysiology stage in carpal tunnel syndrome

作　　者：顾雁浩[1] 张凯莉[1] 朱艺[1] 田东[1] 黄霄云[1] 

机构地区：[1]复旦大学华山医院手外科,上海200040

出　　处：《中华手外科杂志》2004年第3期145-147,共3页Chinese Journal of Hand Surgery

摘　　要：目的　探讨并制定腕管综合征早、中、晚 3期电生理的分期定量指标 ,为临床分期提供电生理依据。方法　对临床诊断为腕管综合征患者的 74例 12 0侧 ,测定拇短展肌的肌电图 (EMG) ,正中神经远端运动电位的潜伏期 (distalmotorlatency ,DML) ,1～ 3指的感觉电位 (SNAP) ,以及环指在正中、尺神经上SNAP潜伏期的差值及感觉神经传导速度 ,并对其结果进行分析。结果　早期 :EMG( -)。DML <4 5ms。感觉电位 :正中、尺神经环指感觉电位潜伏期差值异常 (≥ 0 4ms) ,1～ 3指中至少有 1指的波幅较健侧下降超过 1/2。中期 :EMG(± )。DML≥ 4 5ms。感觉电位 :1～ 3指的感觉电位可引出 ,但传导速度减慢 ( <40 0ms)。晚期 :EMG( +)。DML明显延长或消长。感觉电位 :1～ 4指中至少有 1指的感觉电位消失。结论　早期和中期腕管综合征的分期指标为DML ,而中期和晚期腕管综合征的分期指标为运动或感觉电位的存在与否。Objective To investigate the quantitative index for the early, middle and late stage in carpal tunnel syndrome (CTS)electromyographically, and to provide the basis for determination of clinical stage. Methods Seventy-four cases in 120 sides with clinical diagnosis of CTS were involved in the study. The electromyography (EMG) in the abductor pollicis brevis,the disal motor latancy(DML) in the median nerve the sensory nerve action potential (SNAP) in the thumb, index and middle finger, the difference of SNAP in the median and ulnar nerve in the ring finger, and its sensory nerve conduction velocity were detected. Then the results were analyzed. Results At the early stage, negative EMG result was found, with the number in DML less than 4.5ms. The amplitude difference of SNAP in the median and ulnar nerve in the ring finger was abnormal(no less than 0.4ms). Of the thumb, index and middle finger, the amplitude in more than 1 finger decreased more than half when compared with that in the contralateral side. At the middle stage, the results of EMG were either positive or negative. The number in DML was no less than 4.5ms. The sensory potential in the 1-3 finger can be detected, but the conduction velocity was decreased(<40.0ms). At the late stage, the result in EMG was positive. The DML was markedly lengthened or disappeared. Of 1-4 finger, the sensory potential at least in 1 finger disappeared. Conclusion The staging index between the early and middle stage in CTS is DML, and that between the middle and late stage is whether there is motor or sensation potential.

关 键 词：腕管综合征 EMG 电生理 分期 潜伏期 中期 尺神经 结论 差值 感觉 

分 类 号：R651[医药卫生—外科学]