腕管综合征的神经电生理特征

目的:探讨腕管综合征(CTS)患者的神经电生理特征。方法:对临床症状、体征符合CTS的患者22例(31侧)行正中神经,尺神经.桡神经运动和感觉传导速度测定,以及拇短展肌,小指展肌,伸指总肌肌电图检测。结果:在31条患病正中神经中9条感觉传导未引出反应波、22条正中神经感觉潜伏期延长、波幅降低、或(和)感觉传导速度减慢;23条正中神经运动传导远端潜伏期延长、波幅降低;18块正中神经支配肌拇短展肌呈神经源改变。结论:神经电生理检测中以正中神经感觉潜伏期异常阳性率最高(100%);其次是正中神经运动传导远端潜伏期延长(74%)和拇短展肌神经源性改变(58%)。     

60例腕管综合征患者的神经电生理检测与临床分析

目的 探讨腕管综合征(CTS)患者的神经电生理特征.方法 对临床症状、体征符合CTS的60例患者进行正中神经、尺神经的运动和感觉传导速度测定,及拇短展肌、小指展肌的肌电图检测.结果 60例患者中,双侧病变18例,单侧病变42例.60例CTS患者中78条正中神经感觉传导潜伏期均延长和感觉传导速度均减慢,60条正中神经感觉诱发波幅降低,74条正中神经运动远端潜伏期延长,4条正中神经运动远端潜伏期和诱发波幅正常.58块正中神经支配的拇短展肌呈神经源性损害.结论 神经电生理检查在CTS的诊断与鉴别诊断中有重要意义.     

104例腕管综合征患者的临床表现与神经电生理相关分析

目的探讨腕管综合征（CTS）的临床表现与电生理的相关性，以期获得对腕管综合征较全面的认识。方法对104例腕管综合征患者的临床表现及神经电生理检测进行回顾性分析。结果76．0%的患者为女性，以中老年居多，优势手受累为主。典型表现为腕以下正中神经分布区域疼痛与感觉异常，症状常在夜间或清晨及劳累后加重，甩手活动后减轻。神经电生理检测：104例148只手正中神经复合肌肉动作电位末端运动潜伏期和波幅、肘至腕的运动传导速度、腕部至中指的感觉传导速度及感觉神经动作电位波幅等5项指标检测异常率分别为83．1％、20．3％、6．1％、92．6％及53．4％。结论CTS的诊断除病史、神经系统体检外，电生理检测正中神经感觉传导速度测定是诊断CTS的敏感指标。     

45例正中神经腕管卡压神经电生理检测与临床分析

目的探讨正中神经腕管卡压(CTS)神经电生理检测价值。方法对临床的症状及体征符合CTS的45例患者行正中神经运动神经的传导速度与尺神经运动神经的传导速度检测;桡神经与正中神经拇指-腕感觉潜伏期时差值;正中神经与尺神经无名指-腕感觉潜伏期时差值;双侧正中神经F波的检测;拇短展肌、小指展肌的肌电图检测。结果 45例患者中63只异常,双侧病变18例,单侧病变27例,正中神经运动末端潜伏期延长或(及)传导速度减慢异常率31.5%,波幅减低异常率28.3%;正中神经拇指-腕感觉神经潜伏期延长异常率71.5%;合并波幅减低者异常率占79.3%;正中神经环指-腕感觉神经传导潜伏期延长异常率81.6%,合并波幅减低异常率89.4%;正中神经F波异常率33.6%;拇短展肌呈神经源性改变异常率20.1%。结论神经电生理的常规检测联合运用感觉神经潜伏期时差值法对CTS有更敏感、更精确的诊断价值。     

探讨神经电生理检查对腕管综合征手术治疗的指导意义

目的 探讨神经电生理检查对中、重度腕管综合征(CTS)患者手术治疗预后的疗效判定.方法 对33例中度及18例重度腕管综合征患者术前和术后3个月分别测定正中神经感觉神经传导速度( SCV)和运动神经末梢潜伏时(Mlat),示指到腕的正中神经感觉神经动作电位(SNAP),以及腕到拇对掌肌的复合肌肉动作电位(CMAP),将以上结果进行对比分析.结果 中度CTS组患者手术后SCV、M-lat、SNAP和CMAP均明显改善,差异有统计学意义(P＜0.01);而重度CTS组患者术后SCV、M-lat、SNAP和CMAP均无明显改变,差异无统计学意义(P＞0.05).结论 中度CTS组患者手术后恢复十分明显,而重度CTS组患者术后恢复较差.     

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。     

腕管综合征的临床表现与神经电生理改变

腕管综合征(CTS)是正中神经于腕管内受压而引起神经功能障碍,是常见嵌压性周围神经病,早期治疗预后良好.现将我院2006年3月～2007年6月收治的78例CTS患者的临床及电生理资料回顾性分析如下.     

48例腕管综合征患者的神经电生理分析

腕管综合征(carp tunnel syndrome,CTS)是正中神经在腕管内受压而表现的一组症状和体征,是周围神经卡压综合征中最常见的一种。现将我科2004-06~2007-10门诊48例临床诊断的腕管综合征患者的肌电图,报告如下。1资料与方法1·1一般资料本组48例,男13例,女35例,男女比例约为1:3;年     

30例腕管综合征患者的神经电生理分析

目的 观察神经电生理检测对腕管综合征(CTS)的诊断价值.方法 对30例腕管综合征患者进行神经传导速度(NCV)和肌电图检测和分析.结果 30例CTS患者共有50条患病神经,其中7条正中神经诱发波形消失,43条正中神经潜伏期延长,波幅降低或(和)感觉神经传导速度减慢.30例患者的36条正中神经运动末梢潜伏期延长或(和)动作电位波幅降低.19块正中神经支配肌有去神经电位.结论 神经电生理检查对腕管综合征的诊断与鉴别诊断有重要意义.     

MRI、DTI和神经电生理检查对腕管综合征的诊断价值

目的 探讨MRI、DTI和神经电生理检查对不同程度腕管综合征(CTS)的诊断价值。方法 对40例不同程度腕管综合征患者及30名健康志愿者进行电生理,MRI,DTI检查。结果 轻度CTS患者只有平均部分各向异性指数(FA)与对照组比较有明显差异(P<0.05),中重度CTS患者正中神经肿胀率(MNSR)、正中神经扁平率(MNFR)及FA与对照组比较有明显差异(P<0.05),其中只有FA与电生理指标有良好的线性关系。结论 MRI,DTI与电生理检查在诊断CTS方面有较好的一致性,FA是评估CTS严重程度的一个敏感指标。     

Clinical-electrophysiological correlations in the carpal tunnel syndrome

56 patients with carpal tunnel syndrome (CTS) with 84 hands affected were investigated. All patients were assessed clinically and electromyographically in order to find out whether there is a correlation between clinical signs and/or symptoms and the EMG data. A highly significant correlation was found between sensory deficit (hypoesthesia to touch and/or pain) and the amplitude of SAP and a significant correlation between motor deficits (weakness and/or atrophy) and distal motor latency.

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Sommario Sono stati esaminati 56 pazienti con Sindrome Tunnel Carpale (CTS), per un totale di 84 mani. Ciascun paziente è stato valutato clinicamente ed elettromiograficamente. L'esame clinico mirava ad evidenziare la presenza di deficit sensitivi e motori e rilevare la presenza di altre patologie. Lo scopo del nostro studio è stato quello di valutare l'esistenza di una correlazione tra sintomi e/o segni clinici e dati elettromiografici. È stata rilevata una correlazione particolarmente significantiva tra deficit sensitivo (ipoestesia tattile e/o dolorifica) e ampiezza del SAP e inoltre tra la comparsa di deficit motori (ipostenia) e/o atrofia e la latenza distale motoria.

     

134例腕管综合征的回顾性分析

目的探讨腕管综合征的发生原因、临床特点、电生理检查、治疗效果,提高对本病的认识,预防本病的发生.方法回顾性分析134例腕管综合征患者的发病原因、临床表现、电生理检查结果及疗效.结果本组134例患者均具有手部疼痛表现,其中29例具有典型正中神经分布区域感觉障碍,36例出现大鱼际肌的不同程度肌肉萎缩,其中90例患者存在肯定或可能的诱因.134例患者肌电图提示正中神经在腕管处传导速度减慢或阻滞,经外科手术或保守治疗可以有不同程度缓解.结论多种因素可导致腕管综合征,手部正中神经分布区的感觉异常,夜间加重的临床表现结合肌电图提示正中神经神经性受损（腕部）可以确诊,预后良好,早期诊断及有效预防是必要的.     

Nocturnal prolactin secretion in carpal tunnel syndrome

The correlation between plasma PRL levels and CTS was investigated in 21 patients in whom a specific causal agent of CTS could not be identified. No correlation between plasma PRL levels and other clinical and neurophysiological data was detected

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Sommario Il rapporto fra concentrazione plasmatica della PRL e sindrome del tunnel carpale è stata studiata in 21 pazienti con la forma idiopatica di tale sindrome. Non è stata trovata una correlazione fra i livelli di PRL e i dati clinici e neurofisiologici in questi pazienti.

     

Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands

Following the AAEM electrodiagnostic guidelines, we developed a neurophysiological classification of carpal tunnel syndrome (CTS). Sixhundred hands with clinical CTS (mean age 51.4 yr., female/male ratio 5.5/1, right/left ratio 1.8/1) were prospectively evaluated and divided into six classes of severity only on the basis of median nerve electrodiagnostic findings: extreme CTS (EXT — absence of thenar motor responses), severe CTS (SEV — absence of sensory response and abnormal distal motor latency — DML), moderate CTS (MOD — abnormal digit-wrist conduction and abnormal DML), mild CTS (MILD — abnormal digit-wrist conduction and normal DML), minimal CTS (MIN — exclusive abnormal segmental and/or comparative study), and negative CTS (NEG — normal findings at all tests) Using this neurophysiological classification, the CTS groups appeared normally distributed (EXT 3% of cases, SEV 14%, MOD 36%, MILD 24%, MIN 21%, NEG 3%), and the age of patients and clinical findings appeared to be related to neurophysiological abnormalities. Significant differences in median neurophysiological parameters not included in the classification (such as palm-wrist sensory conduction velocity) were observed in the different CTS groups. The analysis of the groups showed that: 1) the majority of advanced cases (SEV and EXT) occurred in older patients (60–80 years), 2) most of the milder cases (MIN and MILD) occurred in young female patients. The aim of this study was to standardise the neurophysiological evaluation of CTS.This study was presented in part at the meeting Giornata Neurofisiologica Romana — Sindrome del tunnel carpale — Roma 27-Sept-96.     

腕管综合征患者正中神经区域外症状及其可能机制

腕管综合征(Carpal Tunnel Syndrome, CTS)是正中神经在腕部通过腕横韧带下方腕管处受压而出现的手部症状,是最常见的外周神经卡压神经疾病[1].一项欧洲流行病学调查显示,该病终生罹患风险为10%,在总体人群中患病率为2.7%[2].CTS的典型症状是手部正中神经分布区感觉异常、麻木、疼痛等,较大程度地影响患者的生活质量,在美国,其是工作日损失和员工赔偿金的主因之一[3].虽然CTS是正中神经损害导致的手部症状,但患者经常会有手部尺神经分布区不适以及其他正中神经区域外症状.为此,本文对CTS患者的临床表现特点,正中神经区域外症状特点,及其可能机制作一综述.     

腕管综合征病因的复杂性（242例回顾性分析）

本文总结了２４２例腕管综合征（ＣＴＳ）患者，其中女性２０１例，占８３％，平均年龄４７岁。约一半患者无特殊原因；另一半为某种情况或疾病伴发ＣＴＳ，包括颈椎病１０．３％），糖尿病（７．５％）、肢端肥大症（６．６％）、妊娠（２．９％）、类风湿关节炎（２．１％），长期反复使用手为主的职业者１２．０％，其它９．５％。本文对ＣＴＳ为何在中老年女性多发以及各种可能的因素作了回顾性分析并结合国内外文献进行了讨论。我们认为，引起ＣＴＳ的病因多种多样，在临床采集病史进行诊断时应予以注意，力求对病因或诱发因素作深入分析以便治疗和预防能全面地进行。     

Sonographic and electrophysiological detection in patients with carpal tunnel syndrome

Abstract

Objectives: To assess prospectively the significance of sonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome (CTS), to look for proper parameters and cutoff values for the sonographic diagnosis, and to correlate with the electrophysiological findings.

Materials and methods: This study involved 30 patients, who were clinically diagnosed as CTS merely based on their symptoms and signs; and 30 healthy volunteers were served as controls. Eligible subjects underwent sonographic and electromyographic detection.

Results: In the CTS patient group, the cross-sectional area (CSA) at the pisiform bone level (CSA2) and the diameter (D) of the median nerve increased. When the cutoff values of CSA2 and D were 0·105 cm² and 0·195 cm, the sensitivity, specificity and accuracy of the diagnosis were 91·5, 94·5, 94·1%, and 90·7, 80·4, 86·5%, respectively. Both CSA and D were negatively related to sensory conduction velocity, while CSA was positively related to distal motor latency.

Conclusion: There is a good association of sonographic with electrophysiologic detection for the diagnosis of CTS.     

环指感觉神经感觉传导速度在轻度腕管综合征诊断中的应用

目的 寻找诊断轻度腕管综合征(CTS)敏感的电生理检查方法。方法 临床症状、体征符合CTS,正中神经运动末端潜伏期正常的患者19例(29侧)和年龄性别相匹配的健康对照组23名(25侧),采用顺向性感觉神经传导速度(SCV)测定法分别测定环指(指4)正中神经和尺神经SCV,中指(指3)正中神经SCV。结果 环指尺神经SCV>45.2 m/s,正中神经SCV<44.1 m/s,和(或)尺神经SCV与正中神经SCV差值>8.1 m/s(x+σx),考虑符合CTS诊断。CTS组中指正中神经SCV测定异常率为66％,环指为76％,环指正中神经与尺神经SCV差值异常率为93％。环指刺激在8例(14侧)患者腕部正中神经处记录到双峰电位,但对照组均未见。结论 比较环指正中神经和尺神经SCV在鉴别轻度CTS方面是敏感的方法之一,在怀疑CTS时,该项检查可作为常规的电生理检查方法。