腕管综合征的电生理与超声定量检测

目的前瞻性研究正中神经超声定量测定在诊断腕管综合征（CTS）中的意义，探索其诊断标准。方法以符合纳入标准的CTS患者24例（共46只腕）为病例组，年龄、性别与之匹配的健康志愿者24名为对照组，行电生理和腕部正中神经超声检测。结果（1）病例组电生理结果符合CTS，阳性率91．3％（42／46）。（2）超声测定的正中神经横截面积（CSA）增大，神经内径（D）增粗；当豌豆骨水平CSA临界值取0．105cm。时，敏感性及特异性分别为90．5％和96．0％；D取0．195cm时敏感性及特异性分别为90．5％和82．0％。（3）CSA、D均与感觉传导速度呈负相关，CSA与末端运动潜伏期呈正相关。结论超声测量正中神经是诊断CTS的一种新的可靠方法，豌豆骨水平CSA临床诊断价值较大；超声与电生理检测具有良好的相关性。

Prospective study on electrophysiologic and sonographic detection on carpal tunnel syndrome

Objective To assess prospectively the significance of sonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome (CTS), and to look for a proper cut-off value for the sonographic diagnosis, and to compare with the electrophysiologic findings. Methods The study involved 24 patients (46 wrists), who were clinically diagnosed as CTS by neurologists merely basing on their symptoms and signs; and 24 healthy age- and gender-matched volunteers were served as controls. Eligible subjects underwent sonographic and electromyographic detection, and the examiners were blind to the sonographic or electrodiagnostic results. Results (1) In the patient group, median nerve distal motor latency (DML) prolonged; sensory conduction velocity (SCV,wrist-index finger and wrist-ring finger) slowed; the difference of distal sensory latency between the median and ulnar nerve increased. The electrophysiological findings were consistent with CTS, with a positive rate of 91.3% (42/46). (2) Among the sonographic parameters of the median nerve, cross-sectional area (CSA) at the pisiform bone level (CSA2) and the diameter (D) of median nerve increased in the patient group. When the cut-off values of CSA2 and D were 0.105 cm2 and 0.195 cm, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the diagnosis were 90.5%, 90.5%, 95.0%, 92.3%, 93.5%, and 90.5%, 82.0%, 95.0%, 33.3% and 87.0 %, respectively (ROC analysis). (3) CSA and D were both negatively related to sensory conduction velocity, while CSA was positively related to distal motor latency. Conclusions The quantitative sonographic measurement of the median nerve is a new and reliable method for the diagnosis of CTS, of which CSA2 is of the highest diagnostic significance; and there is a good association of sonography with electrodiagnosis.