腕管综合征合并神经根型颈椎病的临床与电生理特点  

Carpal tunnel syndrome with cervical spondylotic radiculopathy：a clinical and electrophysiological study

作　　者：汪仁斌[1] 刘尊敬[1] 汪伟[1] 董明睿[1] 孙少杰[1] 毛坤[1] 焦劲松[1] 严莉[1] 

机构地区：[1]中日友好医院神经内科,北京100029

出　　处：《中华医学杂志》2015年第35期2846-2850,共5页National Medical Journal of China

摘　　要：目的 分析腕管综合征（CTS）合并神经根型颈椎病（CSR）与单纯CTS患者的临床与电生理特征,比较双重卡压和单卡压对神经影响的差异,探讨CTS和CSR之间的关联性.方法 对2011年1月至2014年8月在中日友好医院神经内科门诊和住院诊治的96例双卡综合征（DCS,即CTS合并CSR）患者和165例单纯CTS患者的临床资料和电生理数据进行分析比较.结果 96例DCS患者中女性占多数（58例）,颈肩部疼痛或同时伴有上肢痛麻痛感者34例,上肢麻痛感、手无力、痛麻感和（或）手肌萎缩62例;共检测124条正中神经传导异常,其中单侧68例,双侧28例;颈神经根性损害（CSR）以C5、C6、C7为主,单纯C8损害较少.单纯CTS患者165例中,共检测正中神经传导异常223条,其中107例为单侧,58例为双侧CTS.DCS和单纯CTS患者正中神经指1感觉传导速度（SCV1）、运动传导速度（MCV）、末端运动潜伏期（DML）分别为（32±7） m/s和（35±5） m/s、（55±7） m/s和（57±5） m/s、（4.6±1.6） ms和（4.0±0.8） ms,其相应平均波幅（中位数）分别为6.4 μV和9.5 μV、10.9 mV和13.1 mV、11.3 mV和14.1 mV.与单纯CTS相比,DCS患者正中神经SCV和MCV减慢、DML延长以及相应的波幅减低更明显（均P＜0.01）.结论 DCS是一个常见的临床综合征,其表现除了CTS常见症状外,部分患者还有颈肩痛或同时伴上肢感觉异常,神经电生理上正中神经的感觉运动传导的异常程度较单纯CTS更显著.双重卡压比单卡压对神经的损伤更为严重,支持双卡压损伤机制.Objective To study the clinical and electrophysiological characteristics of carpal tunnel syndrome （CTS） with cervical spondylotic radiculopathy （CSR） and simple-CTS,and compare the effect of double crush with that of simple entrapment on a nerve and investigate the association between CTS and CSR.Method From January 2011 to August 2014,clinical data from 96 patients with double crush syndrome （DCS,CTS with CSR） and 165 patients with simple-CTS were examined,and the electrophysiologic parameters of median nerve in patients with DCS were compared with that in patients with simple-CTS.Results In 96 patients with DCS,most of them were female;neck and shoulder pain or simultaneously accompanied by numbness and pain of upper limb was observed in 34 patients,upper limb symptoms and hand weakness and muscle atrophy were observed in the other 62 patients,124 median nerves with abnormal conduction were found in these DCS patients,including 68 cases with unilateral abnormalities and 28 cases with bilateral abnormalities.Cervical radiculopathies of the C5-7 mainly involved in patients with DCS.223 median nerves with abnormal conduction found in the 165 patients with simple-CTS,including 107 cases with unilateral abnormalities and 58 cases with bilateral abnormalities.The average sensory nerve conduction velocity （SCV）,motor nerve conduction velocity （MCV） and distal motor latency （DML） of median nerve for DCS and simple-CTS were（32 ±7） m/s vs （35 ±5） m/s,（55 ±7） m/s vs （57 ±5） m/s and （4.6 ± 1.6） ms vs （4.0 ± 0.8） ms,respectively,and their corresponding amplitudes were 6.4 μV vs 9.5 μV,10.9 mV vs 13.1 mV and 11.3 mV vs 14.1 mV,respectively.The SCV,MCV and DML and their corresponding amplitude of DCS were significantly greater decreased than that of simple-CTS （P 〈 0.01）.Conclusion DCS is a common clinical syndrome,and patients with DCS may have neck and shoulder symptoms in addition to the common manifestations of simple-CTS.Abnormal conduction of median nerve of

关 键 词：腕管综合征 神经根病 双卡综合征 

分 类 号：R688[医药卫生—骨科学]