两种不同神经电生理检查法对桡管综合征的鉴别诊断  

Differential Diagnosis Using Two Electrophysiological Testing Methods for Radial Tunnel Syndrome

作　　者：胡月新[1] 罗秋[2] 唐梅[2] 黄芩[3] 韦焘[4] 敖丽娟[5] HU Yue-xin LUO Qiu TANG Mei HUANG Qin WEI Tao AO Li-juan(） Experiment Center for Medical Science Research, Kunming Medical University, Kunming Yunnan 650500 ） Dept. of Orthopedic Rehabilitation, The Rehabilitation Medicine Center of the Second Affiliated Hospital of Kunming Medical University, Kunmin Yunnan 650101 ） Dept. of Teaching Affairs of Kunming Medical university ） The Library of Kunming Medical University, Kunming Yunnan 650500 ） The Rehabilitation Medicine Center of the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan 650101, China)

机构地区：[1]昆明医科大学科研实验中心,云南昆明650500 [2]昆明医科大学第二附属医院康复医学部骨科康复科,云南昆明650101 [3]昆明医科大学教务处,云南昆明650500 [4]昆明医科大学图书馆,云南昆明650500 [5]昆明医科大学第二附属医院康复医学部,云南昆明650101

出　　处：《昆明医科大学学报》2016年第9期91-95,共5页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(40112053)

摘　　要：目的比较常规神经电生理检查方法和改良法对桡管综合征(radial tunnel syndrome,RTS)的诊断作用.方法选取经康复医学科门诊或骨科门诊初步诊断为肱骨外上髁炎(lateral epicondylitis,LE)或网球肘(tennis elbow,TE)的患者87人,进行常规病史询问,体格检查,桡浅神经感觉神经电位(sensory nerve action potential,SNAP)检查和常规桡神经混合肌肉动作电位(compound muscle action potential,CMAP)检查,常规针极肌电图检查(electromoygraphy,EMG);同时所有患者接受改良的桡神经CMAP检测,即在3个不同体位下(前臂中立位,前臂旋前位和前臂旋后位)检测桡神经CMAP值,比较3个CMAP潜伏期值之差,如果差异值≥0.3ms,可确诊为RTS.采用χ2检验比较2种检测方法对桡管综合症的阳性检出率.结果 87例患者中有13例确诊为RTS,其中常规肌电图检测明确的后骨间神经神经源性损害有3例,桡浅神经损害有1例;而其余9例患者为常规肌电图检测结果阴性而由改良桡神经检测方法发现桡神经CMAP远端潜伏期之差值异常,确诊为RTS.改良法阳性结果检出率高于传统法,两者相比差异有统计学意义(P<0.05).结论对RTS的鉴别诊断中,改良神经电生理检测方法可以获得更高的阳性率.Objective To compare the traditional electrophysiological testing with modified methods for differential diagnosis of Radial Tunnel Syndrome（RTS）. Methods A total of 87 selected patients were initially diagnosed as Lateral Epicondylitis（LE） or Tennis Elbow（TE） by doctors from the Outpatient Department of Orthopedics and Rehabilitation. Medical history was asked. Patients received physical examination and examinations for the sensory nerve action potential（SNAP） of superficial radial nerve, the compound muscle action potential（CMAP） of radial nerve and needle electromyography（EMG） to record the muscle Motor Unit Action Potentials（MUAPs）. Then, the modified methods for CMAP of radial nerve were conducted on the forearm in the neutral,pronation and supination positions. Three values of CMAP latency were compared. RTS was diagnosed when the difference value≥0.3 ms. The χ2 test was used to compare the positive detectable rates of the two methods for the RTS diagnosis. Results Thirteen out of 87 patients were diagnosed as RTS,among which three had interosseous nerve lesion and one had superficial radial nerve lesion. The traditional EMG failed to diagnose the remaining 9 RTS cases. These patients were finally diagnosed due to their latency difference of radial nerve CMAP ≥0.3ms when their forearms were examined in three positions. Conclusion The modified electrophysiology method shows a higher positive rate for the diagnosis of RTS.（P〈0.05）.

关 键 词：桡管综合征 肌电图检查 后骨间神经 

分 类 号：R684[医药卫生—骨科学]