神经肌电图与MRI诊断早期腕管综合征的功用  

The application and effectiveness of neuroelectrophysiology and MRI in the early diagnosis of carpal tunnel syndrome

作　　者：陈欣[1] 田德润[5] 王植[2] 袁宇[3] 宫可同[4] 

机构地区：[1]天津医院肌电图室,天津300211 [2]天津医院放射科,天津300211 [3]天津医院超声科,天津300211 [4]天津医院手显微外科,天津300211 [5]天津医科大学研究生院

出　　处：《中华手外科杂志》2016年第1期12-15,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨神经肌电图和MRI在腕管综合征中的应用及相关性。方法对36例腕管综合征患者行神经肌电图检查，按照电生理分期标准分为3期；对3期患者和40例健康对照者行MR／检查，测量记录正中神经肿胀率（MNSR）和正中神经扁平率（MNFR），将检查结果进行比较；对中、晚期患者进行手术，并将术中所见与术前MRI检查结果进行比较。结果对于早期患者，MNSR、MNFR与对照组相比变化不明显。对于中、晚期患者，MNSR、MNFR与对照组相比差异有统计学意义（P〈0．05）。经手术证实正中神经的病变情况与术前MRI检查结果相符。正中神经末端运动潜伏期（DML）与MNSR、MNFR呈正相关，正中神经感觉传导速度（SCV）与MNSR呈负相关，而SCV与MNFR的相关性不大。结论神经肌电图检查能为早期诊断腕管综合征提供依据。对于中、晚期腕管综合征患者，MRI检查可以明确正中神经卡压的部位、原因，为手术治疗提供依据，因此MRI对于腕管综合征是有价值的检查方法。但对于腕管综合征的诊断，MRI不能代替神经肌电图检查。Objective To study the application of neural electromyogram （EMG） and MR/ in the diagnosis of carpal tunnel syndrome （CTS） and their correlation. Methods Neuroelectmphysiologic examination was conducted in 36 CTS patients. Based on the electrophysiological staging criteria, these eases were divided into early, intermediate and late stage CTS. These patients along with 40 healthy volunteers were subject to MR/examination to measure and record median nerve swelling rate （MNSR） and median nerve flatness ratio （MNFR）. These measurements were compared between these two groups of individuals. Patients with intermediate and late stage CTS underwent surgical carpal tunnel release. Intraoperative findings of the median nerve were compared with the preoperative MR/examination results. Results For early stage CTS patients, MNSR and MNFR were not significantly different from those of the healthy controls. For intermediate and late stage CTS patients, MNSR and MNFR were higher than those of the healthy controls, the difference being statistically significant （ P 〈 0.05）. Intraoperative observation of the pathological changes of the median nerve was consistent with the preoperative MR/examination results. There was a positive correlation between the distal motor latency （DML） of the median nerve and MNSR and MNFR, and a negative correlation between sensory nerve conduction velocity （SCV） of the median nerve and MNSR. There was no correlation between SCV and MNFR. Conclusion Neural EMG examination can provide evidence for early stage CTS. For intermediate and late stage CTS patients, MRI examination can identify median nerve compression site and etiology, and also provide guidance for surgical decompression. Therefore, MRI is a valuable examination for CTS. However, it cannot replace neural EMG examination for the diagnosis of CTS.

关 键 词：腕管综合征 磁共振成像 神经传导速度 

分 类 号：R688[医药卫生—骨科学] R741.044[医药卫生—外科学] R445.2[医药卫生—临床医学]