Semmes-Weinstein单丝检测在腕管综合征术前术后评估中的应用  

Application of Semmes-Weinstein monofilament examination for preoperative and postoperative evaluation in patients with carpal tunnel syndrome

作　　者：卓高豹[1] 徐灵凤 余方正 朱君毅[1] 倪晓[1] 金永龙[1] 卢颖枫 杜胜虎 蔡莉莉 张怀保[1] 邱海胜[1] 王健[1] Zhuo Gaobao;Xu Lingfeng;Yu Fangzheng;Zhu Junyi;Ni Xiao;Jing Yonglong;Lu Yingfeng;Du Shenghu;Cai Lili;Zhang Huaibao;Qiu Haisheng;Wang Jian(Department of Hand Surgery and Peripheral Neurosurgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 3250O0,China)

机构地区：[1]温州医科大学附属第一医院手外科周围神经外科,温州325000

出　　处：《中华手外科杂志》2020年第6期430-434,共5页Chinese Journal of Hand Surgery

基　　金：温州市科技局公益性科技计划项目(Y20160375)。

摘　　要：目的探讨Semmes-Weinstein单丝检测(Semmes-Weinstein monofilament examination,SWME)在腕管综合征(carpal tunnel syndrome,CTS)患者术前筛查、分型及术后感觉评估中的应用。方法自2017年5月至2018年1月,我们前瞻性收集了56例97腕通过症状及电生理检查确诊的CTS患者的一般资料,Levine评分、SWME、神经传导速度等,行腕管切开减压术后随访或保守治疗。使用美国North Coast Medical单丝测量5指末节感觉阈值,单丝从细到粗取等级1~20为感觉阈值(SW)。拇指至小指分别记为D1~D5,阈值取34,5,设定10种筛查CTS的方法。结果电生理分型轻中重度各21,46,30腕,感觉阈值取3,4,5,10种筛查CTS方法的阳性率均随电生理分型显著升高。筛查CTS的标准设定为:SW(D1或D2或D3)≥4,或SW(D1+D2+D3)≥9,阳性率分别为78.35%,76.29%。SW(D1+D2+D3)与远端运动电位潜伏期(distal motor latency,DML),感觉电位潜伏期(distal sensory latency,DSL),复合肌肉动作电位(compound muscle action potential,CMAP)波幅,感觉神经传导速度(sensory nerveconduction velocity,SNCV),Levine评分存在显著相关,正中神经支配手指SW与同部位静止两点分辨觉(static two-point discrimination,82 PD),动态两点分辨觉(moving two-point discrimination,M2PD)存在显著相关。根据受试者工作特征曲线,轻中重度CTS最佳截断点为SW(D1+D2+D3)≤11,12~18,≥19,诊断轻度CTS的曲线下面积.敏感度﹑特异度,准确度分别为0.71、68.42%、66.67%、68.04%,重度为0.82、56.67%、92.54%、81.44%。行腕管减压术68腕,随访6个月以上47腕,正中神经支配手指SW术后较术前均显著改善,SW(D1+D2+D3)只有在中重度CTS患者中获得显著改善。结论SWME能够评估CTS患者术前,术后感觉障碍程度,尤其是中重度CTS患者,可以作为筛查,分型指标,诊断重度CTS准确度高于轻度。Objective To study the application of Semmes-Weinstein monofilament examination(SWME)for preoperative screening,classification and postoperative sensory evaluation in patients with carpal tunnel syndrome(CTS).Methods From May 2017 to January 2018,we prospectively collected the general data,Levine score,SWME,nerve conduction velocity,elc.of 56 patients(97 wrists)with CTS diagnosed by symptoms and electrophysiological examination,who were followed up after conservative trealment or carpal tunnel decompression.The fingertip sensory threshold of 5 fingers was measured with North Coast Medical monofilament,and the grade 1 to 20 of the monofilament was taken as the sensory threshold(SW).The thumb to little finger were recorded as D1 to D5 respectively.The thresholds were 3,4 and 5.Ten methods of CTS screening were set.ResultsThe electrophysiological classification was 2l,46 and 30 wrists for mild,moderate and severe.When the sensory threshold was 3,4 and 5,the positive rate of 10 screening methods for CTS increased significantly with the electrophysiological classification.The criteria of CTS screening was:SW(D1 or D2 or D3)≥4,or Sw(D1+D2+D3)≥9,the positive rates were 78.35%and 76.29%,respectively.sW(D1+D2+D3)was significantly correlated with distal motor Ilatency(DML),distal sensory latency(DSL),compound muscle action potential(CMAP)amplitude,sensory nerve conduction velocity(SNCV)and Levine scores,while SW of median innervated fingers was significantly correlated with sltatic two-point discrimination(S2PD)and moving two-point discrimination(M2PD).According to the receiver operating characteristic curve(ROC curve),the best cutoff point of mild,moderate and severe CTS was Sw(D1+D2+D3)≤11,12 to 18,≥19.The area under curve(AUC),sensitivity,specificity and accuracy of diagnosing mild CTS were 0.71,68.42%,66.67%,68.04%,and those of severe CTS were 0.82,56.67%,92.54%,81.44%,respectively.47 wrists of 68 wrists underwent carpal tunnel decompression were follow-up for more than 6 months.The SW of median nerve innervati

关 键 词：腕管综合征 诊断技术和方法 感觉阈 单丝检测 

分 类 号：R688[医药卫生—骨科学]