腕管综合征和颈椎病F波及神经传导分析差异研究  

F wave and nerve conduction analysis in carpal tunnel syndrome and cervical spondylosis

作　　者：冯建华[1] 刘英[1] 邹艺[1] 李素荣[1] 胥勋成[1] 羊洁[1] Feng Jianhua;Liu Ying;Zhou Yi;Li Surong;Xu Xuncheng;Yang Jie(Department of Neurology,Sichuan Provincial People＇s Hospital,Chengdu 610072,China)

机构地区：[1]四川医学科学院四川省人民医院神经内科,成都610072

出　　处：《山西医药杂志》2018年第14期1644-1647,共4页Shanxi Medical Journal

摘　　要：目的探讨F波及神经传导分析的各参数在腕管综合征(CTS)和神经根型颈椎病(CRS)中的异同,增加对手麻患者的电生理诊断准确性。方法回顾性分析了四川省人民医院2014年6月至2015年12月收治的CSR患者50例,CTS 41例,健康对照组41名,分别收集各组患者的正中神经F波出波率(FR)、最短潜伏期(Fmin)、最长潜伏期(Fmax)、传导速度(FWV)、潜伏时离散度(Fchd=Fmax-Fmin)及运动神经远端潜伏期(DML),运动神经传导速度(MCV),运动神经复合肌肉动作电位(CMAP),感觉神经传导速度(SCV),感觉神经动作电位(SNAP)波幅等数据进行统计学分析。结果 CSR组FR下降2%(1/50),CTS组FR下降41%(17/41),N组无FR降低。CTS组CMAP与FR呈正相关。Fchd和DML在3组间差异有统计学意义。CTS组与健康对照组比较,SCV、MCV差异有统计学意义。结论 CSR患者相较健康人,正中神经Fchd明显延长,而在CTS中则无此显著改变。可以推测正中神经Fchd在鉴别手麻患者的周围段与C6/7神经根损害中存在重要意义;Fchd在CSR、CTS鉴别诊断的价值优于Fmin、Fmax。CTS严重时可出现CMAP波幅明显降低(轴索损害的改变),FR下降,据此推测轴索损害可能对运动神经的逆向传导有影响;CTS组FR降低,但Fchd无明显下降、FWCV无明显减慢,也为CTS与近端神经损害的鉴别提供依据。DWL、SCV、MCV作为CTS诊断的电生理指标,其重要性不可取代,而SCV和DML在CTS诊断的敏感性更高。Objective This study was designed to investigate F wave and nerve conduction analysis of the similarities and differences in carpal tunnel syndrome（CTS） and cervical spondylotic radiculopathy（CRS）,then find more parameters to increase the physiological electrical diagnostic accuracy. Methods A retrospective analysis of patients from Sichuan Provincial People＇s Hospital in June 2014 to December 2015 were performed,50 cases of CRS,41 cases of CTS and 41 cases of normal control were included. This study collected the median nerve ＇s F wave minimum latency,maximal latency,F wave conduction velocity（FWV）,F wave latency dispersion（Fchd） and distal motor latency（DML）,motor conduction velocity（MCV）,motor nerve compound muscle action potential（CMAP）,sensory nerve conduction velocity（SCV） and sensory nerve action potential（SNAP） amplitude data for statistical comparisons. This study chosen ANOVA analysis to analyze three groups of parameters（bilateral,P〈0. 05）,the correlation analysis of the parameters was performed by linear regression analysis. Results FR in CSR group decreased by 2%（1/50）,FR in CTS group decreased by 41%（17/41）,and there was no decrease in FR in N group. There was a positive correlation between CMAP and FR in CTS group. There was a positive correlation between CMAP and FR in CTS group. There was a significant difference in Fchd and DML among the three groups. There was a significant difference in SCV and MCV between the CTS group and the N group. Conclusion In patients with CSR,Fchd in the median nerve was significantly longer than in normal subjects,but not in the CTS. It can be inferred that the median nerve Fchd has important significance in identifying the nervous segmental damages from proximal（C6/7 nerve root） damages in hand numb patient;Fchd is superior to Fmin and Fmax in the differential diagnosis of CSR and CTS. Severe decrease in CMAP amplitude（change in axonal damage） can occur in severe CTS,and FR declines. It is speculated that

关 键 词：颈椎病 腕管综合征 电生理学 

分 类 号：R681.55[医药卫生—骨科学] R688[医药卫生—外科学]