腕管综合征主要症状体征敏感性与特异性的比较

目的　比较腕管综合征 (carpaltunnelsyndrome ,CTS)主要症状、体征的敏感性与特异性。方法　对 10 1例 ( 162只手 )进行症状严重程度与功能状况的询问 ,感觉、运动功能的检查 ;其中 62只手在术后 6周再次测定。结果　 162只患手中 15 8只具有典型症状 ( 98% )。Phalen征、前臂正中神经加压征、Semmes Weinstein单丝纤维测试阳性率分别为 98%、96%、82 %。 87%的患手出现肌力下降 ,拇短展肌肌力测定 (定量法 )结果显示 ,与徒手法相比 ,不同性别间、术前与术后的差异均具非常显著意义 (P <0 .0 1)。结论　典型症状、Phalen征、前臂正中神经加压征、拇短展肌肌力变化的敏感性与特异性最高 ,拇短展肌肌力定量法测定是判断腕管综合征严重程度、评定疗效的一个良好的客观指标。

Comparison of sensitivity and specificity of main symptoms and signs in carpal tunnel syndrome

Objective To compare the sensitivity and specificity of main symptoms and clinical tests in carpal tunnel syndrome (CTS). Methods One hundred and sixty-two hands in 101 patients with CTS were examined including filling out a self-administered questionnaire for the assessment of severity of symptoms and functional status, sensory and motor functions testing. A convenience sample of 62 hands were reevaluated 6 weeks after carpal tunnel release. Results Typical Symptoms were complained in 158 of 162 hands(98%). The positive rates of Phalen's sign, forearm compression test (FCT), Semmes-Weinstein monofilament test (SWMF) were 98%, 96% and 82% respectively. The muscle power decreased in 87% affected hands. The differences were statistically significant for gender, manual muscle testing (MMT), pre versus post surgery with quantitative abductor pollicis bervis (APB) strength testing. Conclusion Typical symptoms, Phalen's sign, FCT and APB strength testing showed higher sensitivity and specificity in the diagnosis of CTS sequentially. Quantitative APB strength testing can be used to more objectively evaluate the degree of severity of CTS. It is useful for objective documentation of change in strength in response to treatment as well.