腕管综合征类固醇腕管局部注射的临床和电生理评估  

The clinical and electrophysiological evaluation of local steroid injection in patients with carpal tunnel syndrome

作　　者：翁超[1] 彭彬[1] 戴敏[1] 初红[1] 卢祖能[1] 

机构地区：[1]武汉大学人民医院神经内科,湖北武汉430060

出　　处：《癫痫与神经电生理学杂志》2010年第6期337-341,共5页Journal of Epileptology and Electroneurophysiology(China)

基　　金：基金项目：湖北省自然基金重点项目（2009CDA070）

摘　　要：目的：运用临床评分和神经传导检测（NCS）评估类固醇腕管局部注射对腕管综合征（CTS）的疗效。方法：2009年4月至2010年1月间就诊的CTS患者共66例，符合纳入标准者41例（64只腕）。进行症状严重程度评分（SSS）、功能状态评分（FSS）以及常规NCS，记录腕-拇短展肌末端运动潜伏期（DML）、拇短展肌复合肌肉动作电位（CMAP）波幅，腕-食指／环指感觉传导速度（SCV）、正中／尺神经感觉潜伏期差（△DSL）和感觉神经动作电位（SNAP）波幅。嘱患者改变生活方式且行夜间腕部夹板，2周后症状无好转者行类固醇腕管局部注射。紧挨掌长肌腱尺侧、腕皱褶近侧，用25号针头以30。角朝向腕管进针，注射利多卡因1ml（20mg）和甲基强的松龙1ml（40mg）。注射前、注射（3．23±0．56）个月后分别进行临床评分和NCS。结果：①18例（28只腕）进行了注射，12例（19只腕）完成随访。与注射前比较，注射后SSS和FSS减少、DML缩短、△DSL减小、腕-环指SCV增快、SNAPCMAP波幅增高。注射前、注射后SSS分别为（2．31±0．45）、（1．89±0．46）（t=5．82，P=0．000：FSS为（2．29±0．64）、（1．79±0．59）（t=5．21，P=0．000）；DML（ms）为（5．08±1．58）、（4．66±1．76）（t=2．81，P=0．012）；△DSL（ms）为（1．25±40．67）、（0．93±0．67）（t=3．90，P=0．002）；SCV（m／s）为（40．55±11．48）、（44．70±13．66）（t=-2．55，P=0．029）；SNAP波幅（uV）为（12．72±10．83）、（15．07±11．00）（t=-2．17，P=0．048）；CMAP波幅（mV）为（5．31±3．37）、（6．13±3．04）（t=-2．42，P=0．026）；3例（4只腕、21％）注射后临床评分无改善。②SSS、FSS与NCS各参数之间均无相关性（P均〉0．05）。结论：CTS患者类固醇腕管局部注射治疗至少在短期内有效；临床评分与NCS无相关性，两者共同评估疗效更有意�Objective： To evaluate the effectiveness of local steroid injection on carpal tunnel syndrome （CTS） by clinical scores and nerve conduction studies （NCS）. Methods.. Sixty-six patients with consecutive CTS were performed from April, 2009 to January, 2010; and 41 patients （64 wrists） up to the inclusion criteria were involved. The subjects were clinically evaluated by symptom severity scale （SSS） and functional status scale （FSS）, and were electrodiagnostically evaluated by conventional NCS. The following parameters were measured： 1） distal motor latency （DML） from wrist to abductor pollicis brevis （APB） ; 2） the amplitude of compound muscle action potential （CMAP） of APB; 3） sensory conduction velocity （SCV） from wrist to index / ring finger; 4） the difference of distal sensory latency between median and ulnar nerves （△ DSL）; 5） the amplitude of sensory nerve action potential （SNAP） was recorded on ring finger. The patients were instructed to modify their lifestyles and apply nocturnal wrist splinting for 2 weeks, and then those without improvement of symptoms after wrist splint application were treated with steroid injection into the carpal tunnel. A 25 -gauge needle was used to inject lidocaino （1 ml, 20 mg） and methylprednisolone （1 ml, 40 mg） just to the ulnar side of the palmaris longus tendon, proximal to the wrist crease. The needle is aimed toward the carpal tunnel at a 30-degree angle of entry. SSS, FSS and NCS were evaluated before and （3.23 ± 0. 56） months after the treatment. Results： （1） Local steroid injection was performed in 18 patients （28 wrists） and the follows up of clinical scores and NCS were completed in 12 patients （19 wrists）. Compared with those before injection, SSS, FSS, DMI and △ DSL decreased, and SCV, the amplitudes of SNAP and CMAP increased significantly after injection. The mean values before and after injection were（2. 31 ± 0.45） and （1.89 ± 0.46） （t= 5.82., P = 0.000） in SSS; �

关 键 词：腕管综合征(CTS) 局部类固醇注射 临床评分 神经传导检测(NCS) 

分 类 号：R745[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]