感觉神经节段法在腕管综合征中的诊断价值  

Diagnostic value of median nerve sensory segmental methods in carpal tunnel syndrome

作　　者：周媛媛[1] 何帆[1] 牛家苑 王珏[1] Zhou Yuanyuan;He Fan;Niu Jiayuan;Wang Jue(Department of Functional Examination,Jiangsu Province Hospital of Traditional Chinese Medicine,Nanjing City,Jiangsu Province,210019,China;Department of Neurology,Nanjing Red Cross Hospital,Nanjing City,Jiangsu Province,210000,China)

机构地区：[1]江苏省中医院功能检查科,南京市210009 [2]南京市红十字医院神经内科,南京市210000

出　　处：《现代电生理学杂志》2022年第4期222-225,共4页Journal of Modern Electrophysiology

摘　　要：目的:观察和分析正中神经指-腕、指-掌、腕-肘感觉神经节段法在腕管综合征(CTS)中的诊断价值。方法:选取江苏省中医院2021年3月至2021年11月符合CTS诊断标准的患者46例作为CTS组,其中女39例,男7例,年龄29~83岁;单侧病变6例,双侧病变40例,共86例侧。同时选取健康志愿者33例(共63例侧)作为对照组。两组均进行正中神经和尺神经运动传导速度(MCV)和感觉传导速度(SCV)检测及肌电图检测,其中正中神经采用4种节段性感觉传导检测。观察电生理结果,并比较两组正中神经四种感觉检测方法的感觉神经动作电位(SNAP)波幅和SCV。结果:CTS组中,86例侧正中神经中指-腕、环指-腕SCV减慢或SNAP波幅未引出,异常率为100%;36例侧正中神经中指-掌SCV减慢或SNAP波幅未引出,异常率为41.9%(36/86例侧);正中神经腕-肘SCV和SNAP均正常。对照组和CTS组中指-腕、环指-腕和中指-掌三种节段法SCV和SNAP波幅比较,差异有统计学意义(P<0.05)。MCV仅在中度和重度CTS中异常,异常率为69.8%(60/86例侧)。中度和重度CTS针极EMG异常率为12.8%(11/86例侧)。结论:正中神经指-腕、指-掌、腕-肘节段法在CTS中有早期定位诊断作用,需结合MCV和针极肌电图等给予最终定性诊断,对早期CTS的诊断和评估具有重要的临床价值。Objective:To observe and analyze the diagnostic value of finger-wrist,finger-palm,carpal and elbow sensory segmental methods in carpal tunnel syndrome(CTS).Methods:A total of 46 patients who met the diagnostic criteria of CTS in Jiangsu Province Hospital of Traditional Chinese Medicine from March 2021 to November 2021 were selected as CTS group,including 39 females and 7 males,aged 29-83 years old.There were 6 cases of unilateral lesions and 40 cases of bilateral lesions.Thirty-three healthy volunteers were enrolled as the control group.Motor conduction velocity(MCV)and sensory conduction velocity(SCV)of the median nerve and ulnar nerve and electromyography(EMG)were detected in both groups.Four segmental sensory conduction detections were used in the median nerve.The electrophysiological results were observed,and the amplitude and SCV of four sensory detection methods were compared between the two groups.Results:In the CTS group,the SCV of median nerve in 86 hands from middle finger to wrist and ring finger to wrist slowed down or amplitude of SNAP was not elicited,and the abnormal rate was 100%.The SCV of median nerve in 36 hands from middle finger to palm slowed down or amplitude of SNAP was not elicited,and the abnormal rate was 41.9%(36/86 hands).There were statistically significant differences in SCV and SNAP of median nerve from middle finger to wrist,ring finger to wrist and middle finger to palm between the two groups(P<0.05).MCV was abnormal only in moderate and severe CTS,the abnormal rate was 69.8%(60/86 hands),and the abnormal rate of needle EMG in moderate and severe CTS was 12.8%(11/86 hands).Conclusion:The median nerve digital-wrist,digital-palm,and carpet-elbow segmental methods have a role in the early localization and diagnosis of CTS,which should be combined with MCV and needle electromyography to give the final qualitative diagnosis.It has important clinical valu e in the diagnosis and evaluation of early CTS.

关 键 词：腕管综合征 正中神经 神经传导 肌电描记术 

分 类 号：R688[医药卫生—骨科学]