• 四川大學(xué)華西醫(yī)院康復(fù)醫(yī)學(xué)科(成都,610041);

【摘要】 目的  比較正中神經(jīng)壓迫試驗對腕管綜合征(carpal tunnel syndrome,CTS)患者正中神經(jīng)傳導(dǎo)速度的影響。 方法  設(shè)置CTS組和對照組兩個組別,共29例受試者納入研究。CTS組為14例CTS患者,對照組為15例健康受試者。神經(jīng)傳導(dǎo)速度測定包括正中神經(jīng)和尺神經(jīng)的感覺傳導(dǎo)末端潛伏期(distal sensory latency,DSL)、感覺神經(jīng)動作電位(sensory nerve action potential, SNAP)、跨腕關(guān)節(jié)感覺傳導(dǎo)速度(sensory conduction velocity,SCV)、運動傳導(dǎo)末端潛伏期(distal motor latency,DML)及復(fù)合肌肉動作電位(compound muscle action potential,CMAP)。先測感覺傳導(dǎo),再測運動傳導(dǎo)。正中神經(jīng)壓迫試驗5 min后再次測量上述指標(biāo)。 結(jié)果  正中神經(jīng)壓迫試驗前后電生理檢查考慮診斷CTS分別為22側(cè)和24側(cè)。壓迫正中神經(jīng)后,CTS組正中神經(jīng)DSL較壓迫前顯著延長(P lt;0.05)。CTS組尺神經(jīng)和對照組正中神經(jīng)及尺神經(jīng)的各參數(shù)在壓迫前后均無顯著改變(P gt;0.05)。與對照組相比,在壓迫試驗前后CTS組的正中神經(jīng)DSL和DML均明顯延長(P lt;0.05),尺神經(jīng)DSL和DML均無顯著改變(P gt;0.05)。 結(jié)論  正中神經(jīng)壓迫試驗5 min能使CTS患者正中神經(jīng)的感覺傳導(dǎo)末端潛伏時明顯延長,有助于提高神經(jīng)傳導(dǎo)測定對早期CTS的診斷率。
【Abstract】 Objective  To determine the effect of median nerve compression on median nerve conduction speed in patients with carpal tunnel syndrome (CTS). Methods  In this case-control study, 29 subjects were enrolled. CTS group included 14 patients (22 hands) with CTS confirmed by electrodiagnostic studies, while the control group included 15 healthy subjects (30 hands). The across wrist nerve conduction of median and ulnar nerve was measured when the wrist was in neutral position. Measured parameters included distal sensory latency (DSL), sensory nerve action potential (SNAP), sensory conduction velocity (SCV), distal motor latency (DML) and compound muscle action potential (CMAP). Sensory nerve conductions were tested first, and then the motor nerve conduction. The patients were asked to perform the median nerve compression test by flexing elbows, pronating forearm and pushing the dorsal surfaces of both hands together into maximum wrist flexion for 5 minutes. Then the above parameters were measured again. Results  By electrodiagnostic studies, 22 hands and 24 bands were diagnosed with CTS before and after the median nerve compression test, respectively. After the compression test, the median nerve DSL were significantly prolonged in CTS group (P lt;0.05) but no significant differences were found in the median nerve DML (P gt;0.05). The parameters of ulnar nerve in group CTS and median nerve and ulnar nerve in control group failed to show any significant change (P gt;0.05). The CTS group had longer median nerve DSL and DML than the control groups (P lt;0.05), but the differences in ulnar nerve DSL and DML were not significantly between the two groups. Conclusion  A 5-minute median nerve compression test may make the median nerve DSL prolonged and may be a helpful diagnosis of early CTS.

引用本文: 許驚飛,王勁松,何成奇. 正中神經(jīng)壓迫試驗對腕管綜合征神經(jīng)傳導(dǎo)速度的影響. 華西醫(yī)學(xué), 2011, 26(12): 1839-1841. doi: 復(fù)制

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2.  Urbano FL. Tinel′s sign and Phalen′s maneuver: physical signs of carpal tunnel syndrome[J]. Hospital Physician, 2000, 39(7): 39-44.
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8.  湯曉芙. 腕管綜合征(CTS)的電生理診斷要點[J]. 臨床神經(jīng)電生理學(xué)雜志, 2003, 3(12): 55-56.
9.  盧祖能, 湯曉芙. 腕管綜合征262例的回顧性分析[J]. 中華神經(jīng)科雜志, 1996, 29(2): 115-118.
10.  Emad MR, Najafi SH, Sepehrian MH. The effect of provocative tests on electrodiagnosis criteria in clinical carpal tunnel syndrome[J]. Electromyogr Clin Neurophysiol, 2010, 50(6): 265-268.
11.  Tetro AM, Evanoff BA, Hollstien SB, et al. A new provocative test for carpal tunnel syndrome. Assessment of wrist flexion and nerve compression[J]. J Bone Joint Surg(Br), 1998, 80(3): 493-498.
12.  Wiederien RC, Feldman TD, Heusel LD, et al. The effect of the median nerve compression test on median nerve conduction across the carpal tunnel[J]. Electromyogr Clin Neurophysiol, 2002, 42(7): 413-421.
13.  史定偉, 謝幼專, 王友. 腕管內(nèi)壓力測定在內(nèi)鏡下微創(chuàng)治療腕管綜合征中的應(yīng)用[J]. 醫(yī)用生物力學(xué), 2008, 23(3): 234-236.
14.  Lundborg G, Gelberman RH, Minteer-Convery M, et al. Median nerve compression in the carpal tunnel: functional response to experimentally induced controlled pressure[J]. J Hand Surg(Am), 1982, 79(3): 252-259.
  1. 1.  Gorkhaly MP. A review of the carpal tunnel syndrome: clinical and diagnostic aspects[J]. Sgh Proceedings, 2003, 12(1): 8-11.
  2. 2.  Urbano FL. Tinel′s sign and Phalen′s maneuver: physical signs of carpal tunnel syndrome[J]. Hospital Physician, 2000, 39(7): 39-44.
  3. 3.  Mondelli M, Filippou G, Gallo A, et al. Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome[J]. Arthritis Rheum, 2008, 59(3): 357-366.
  4. 4.  吳英, 陳巖, 耿志偉, 等. 掌到腕正中神經(jīng)感覺傳導(dǎo)速度在輕、中度腕管綜合征診斷中的應(yīng)用[J]. 臨床神經(jīng)電生理學(xué)雜志, 2007, 16(3): 139-141.
  5. 5.  王冰, 車峰遠(yuǎn), 任士卿, 等. 應(yīng)用環(huán)指感覺神經(jīng)傳導(dǎo)速度測定診斷腕管綜合征[J]. 中華手外科雜志, 2004, 20(3): 143-144.
  6. 6.  姜榮剛, 黃秋海. 神經(jīng)電生理常規(guī)法和環(huán)指法檢測腕管綜合征的對比研究[J]. 現(xiàn)代電生理學(xué)雜志, 2007, 14(3): 140-141.
  7. 7.  盧祖能. 腕管綜合征的研究進展[J]. 臨床神經(jīng)病學(xué)雜志, 1995, 8(3): 187-189.
  8. 8.  湯曉芙. 腕管綜合征(CTS)的電生理診斷要點[J]. 臨床神經(jīng)電生理學(xué)雜志, 2003, 3(12): 55-56.
  9. 9.  盧祖能, 湯曉芙. 腕管綜合征262例的回顧性分析[J]. 中華神經(jīng)科雜志, 1996, 29(2): 115-118.
  10. 10.  Emad MR, Najafi SH, Sepehrian MH. The effect of provocative tests on electrodiagnosis criteria in clinical carpal tunnel syndrome[J]. Electromyogr Clin Neurophysiol, 2010, 50(6): 265-268.
  11. 11.  Tetro AM, Evanoff BA, Hollstien SB, et al. A new provocative test for carpal tunnel syndrome. Assessment of wrist flexion and nerve compression[J]. J Bone Joint Surg(Br), 1998, 80(3): 493-498.
  12. 12.  Wiederien RC, Feldman TD, Heusel LD, et al. The effect of the median nerve compression test on median nerve conduction across the carpal tunnel[J]. Electromyogr Clin Neurophysiol, 2002, 42(7): 413-421.
  13. 13.  史定偉, 謝幼專, 王友. 腕管內(nèi)壓力測定在內(nèi)鏡下微創(chuàng)治療腕管綜合征中的應(yīng)用[J]. 醫(yī)用生物力學(xué), 2008, 23(3): 234-236.
  14. 14.  Lundborg G, Gelberman RH, Minteer-Convery M, et al. Median nerve compression in the carpal tunnel: functional response to experimentally induced controlled pressure[J]. J Hand Surg(Am), 1982, 79(3): 252-259.