拇指感觉神经传导速度对轻度腕管综合征的诊断作用

感觉神经传导速度(sensoly conduction velocity，SCV)的测定对轻度腕管综合征有一定的诊断价值。为了提高对轻度腕管综合征的诊断率，2001年1月～2002年8月，我们对23例轻度腕管综合征患者和23例(46手)志愿者，测定了腕部正中神经和桡神经的感觉神经传导速度，并进行了对比研究。结果证实只要桡神经的SCV正常，正中神经的SCV延迟，即可诊断为轻度腕管综征。     

环指感觉神经动作电位潜伏期诊断轻度腕管综合征的作用

目的　寻找诊断轻度腕管综合征 (carpaltunnelsydrome ,CTS)电生理的敏感诊断指标。方法　将临床症状、体征符合CTS ,而正中神经末端运动动作电位潜伏期正常的患者 3 8例为CTS组 ,取年龄、性别相匹配的健康人 46名为对照组。采用顺向法分别测定 2组指 4(环指 )正中神经和尺神经感觉动作电位的潜伏期 (Lat) ,并比较其差值。结果　环指正中神经和尺神经感觉动作电位潜伏期差值的异常率为91% (≥ 0 4ms)。刺激环指后 16例患者腕部正中神经处记录到双峰电位 ,对照组则未见。结论　环指正中神经和尺神经感觉动作电位潜伏期之差≥ 0 4ms ,即可诊断为轻度CTS。在怀疑轻度CTS时 ,该法最敏感 ,可作为常规的电生理检查方法。     

108例腕管综合征正中神经传导测定结果分析

分析１０８例腕管综合征正中神经传导测定结果，以求最敏感的电诊断指标。比较１０８例正中神经复合肌肉动作电位，肘至腕的运动传导速度测定及指至腕部的感觉神经动作电位三项。指标异常检测率，表明拇指至腕段的感觉传导速度减慢是最敏感的电诊断参量。１０８例中伴有前臂段运动传导速度减慢的占１０．５％。同组病例无症状上肢出现电生理异常者为２０％，指示有亚临床的腕管部神经卡压存在的可能。     

探讨腕管综合征电生理分期的定量指标

目的　探讨并制定腕管综合征早、中、晚 3期电生理的分期定量指标 ,为临床分期提供电生理依据。方法　对临床诊断为腕管综合征患者的 74例 12 0侧 ,测定拇短展肌的肌电图 (EMG) ,正中神经远端运动电位的潜伏期 (distalmotorlatency ,DML) ,1～ 3指的感觉电位 (SNAP) ,以及环指在正中、尺神经上SNAP潜伏期的差值及感觉神经传导速度 ,并对其结果进行分析。结果　早期 :EMG( -)。DML <4 5ms。感觉电位 :正中、尺神经环指感觉电位潜伏期差值异常 (≥ 0 4ms) ,1～ 3指中至少有 1指的波幅较健侧下降超过 1/2。中期 :EMG(± )。DML≥ 4 5ms。感觉电位 :1～ 3指的感觉电位可引出 ,但传导速度减慢 ( <40 0ms)。晚期 :EMG( )。DML明显延长或消长。感觉电位 :1～ 4指中至少有 1指的感觉电位消失。结论　早期和中期腕管综合征的分期指标为DML ,而中期和晚期腕管综合征的分期指标为运动或感觉电位的存在与否。     

腕管综合征术前、后感觉神经动作电位与复合肌肉动作电位检测结果的比较

目的　比较腕管综合征术前和正中神经松解术后 (术中 )两者感觉神经动作电位 (sensorynerveactionpotential ,SNAP)与复合肌肉动作电位 (compoundmuscleactionpotential,CMAP)检测结果的差异。方法　对 2 0例腕管综合征患者 ,术中在切开屈肌支持带及正中神经松解术后 ,分别测定 (1)拇短展肌的CMAP ;(2 )刺激示、中指 ,于腕部记录正中神经的SNAP ;(3 )刺激环指 ,于腕部分别记录正中神经和尺神经的SNAP。将三者结果与术前的相应数据行统计学分析。结果　 (1)术前拇短展肌CMAP的潜伏期小于4 3ms ,术后其潜伏期、波幅与术前相比差异无统计学意义 (P >0 0 5 )。 (2 )术后 2～ 4指SNAP的潜伏期比术前平均缩短 5 %、波幅增加 13 %左右 ,两者相比差异均有统计学意义 (P <0 0 1)。结论　腕管综合征手术中 ,在正中神经松解术后行SNAP检测较CMAP检测的结果更为敏感和准确。     

腕部三神经阻滞在断指再植术的应用

断指再植术 ,以往常规选择臂丛神经阻滞麻醉或高位硬膜外麻醉。我们改行腕部三神经 (桡神经、正中神经、尺神经 )阻滞麻醉 ,取得良好的效果。资料与方法腕部三神经阻滞麻醉 ,用于断指再植手术 2 2例 ,ＡＳＡⅠ级 ,男 19例 ,女 3例 ,年龄 17～ 5 6岁。结合手部感觉神经的分布 ,分别为拇、食、中指选用正中神经加桡神经浅支 ;环指选用正中神经加尺神经 ,小指选用尺神经。在腕部 ,正中神经处于前臂深筋膜之下 ,在桡侧腕屈肌腱与掌长肌腱之间。尺神经表浅 ,位于腕部第二条横线 ,即近侧掌横纹 ,与尺侧屈腕肌肌腱桡侧缘的交点处或腕部尺神经管内。…     

正中神经传导功能恢复过程和影响预后的因素

腕管综合征临床很常见,在经过成功的减压治疗后,正中神经传导功能常能得到一定改善。手术医生有必要了解预计的恢复过程及可能达到的恢复程度。传统的神经传导试验(NCSs)可用于记录正中神经通过腕部时传导的异常。但在一小部分有正中神经压迫症状患者,NCSs可能无法测到神经传导的异常。相反,相当一部分患者正中神经传导异常却无临床症状。相比NCSs,自动神经传导     

感觉定量检测在慢性肾脏病患者周围神经病变筛查中的应用

目的通过对80例处于慢性肾脏病（CKD）不同阶段的患者感觉定量检测（QST）及感觉神经传导速度（SCV）的观察分析,探讨QST在慢性肾脏病患者周神经病变诊断方面的应用。方法依据估算肾小球滤过率（eGFR）分别收集了CKD2期,CKD3期,CKD4期,CKD5期各20例CKD的患者和20例正常人,进行QST和SCV测定,然后进行分析。结果1．QST四个温度觉（TT）及振动觉（VT）阈值比较：CKD3期,CKD4期,CKD5期的患者分别较CKD2期患者、正常人闽值显著增大（P〈0．05）,且前三组患者各阈值两两比较均有显著差异性（P〈O．05）。2．正中神经、胫神经、腓总神经传导速度比较：CKD4期,CKD5期患者分别较CKD2期,CKD3期,正常人感觉神经传导速度显著减慢（P〈0．05）;前两组患者传导速度比较也有显著差异性（P〈0．05）;3．SCV与QST异常率比较：在CKD4期,CKD5期的患者SCV异常率为55．O％,QST异常率高达80％;在CKD3期SCV异常率为15.0％,而QST异常率为55．0％,两者异常率在这三组患者的比较均有统计学意义（P（0．05）。结论QST在诊断早期慢性肾脏病周围神经病变方面较敏感,CKD患者的周围神经病变最先累及小神经纤维。     

正中神经腕部断裂晚期修复一例

患者　女 ,10岁 ,1995年 10月 6日右腕被刺伤 ,来院诊断为右腕正中神经损伤 ,于 2 0 0 1年 2月 12日入院。检查 :右腕横行瘢痕 ,局部隆起压痛 ,拇外展中度受限 ,大鱼际萎缩 (+ + + ) ,拇指、示指、中指、环指桡侧半感觉障碍。肌电图检查显示右拇短展肌正尖波 + + +、纤颤波 + + + ,最大用力时募集反应为单纯相 ;神经传导速度测定 (ＭＮＣＶ) :右正中神经自腕部及肘部刺激于大鱼际记录 ,远端潜伏期 (Ｌａｔ)延长 ,传导速度 (ＮＣＶ)减慢 ,波幅(ＮＡＰ)衰减明显 ;感觉传导速度测定 (ＳＮＣＶ) :右腕部至拇指 :潜伏期 (Ｌａｔ)及波幅 (ＮＡＰ)…     

掌部小切口减压治疗腕管综合征

目的:介绍掌部小切口横断腕横韧带治疗腕管综合征的方法,并评价其疗效及安全性。方法:自2006年1月至2007年9月,采用掌部纵形小切口,切断腕横韧带治疗腕管综合征15例(18侧),男2例,女13例;年龄34～69岁,平均48岁;单侧12例,双侧3例;病程8～26个月,平均18个月。主要临床表现为:桡侧3个半指麻木或疼痛,腕部疼痛,并向前臂放射,夜间麻醒史,大鱼际肌肉萎缩,Tinel征阳性,Phalen征阳性。电生理检查均有正中神经感觉神经传导速度(SCV)减慢、感觉神经动作电位(SNAP)波幅下降或缺失,严重者拇短展肌可有自发电位。术后随访时采用GSS评分(Global symptom score),分别从疼痛、麻木感、感觉异常、肌力减退和夜醒等5个方面进行评价。结果:术后所有患者伤口均甲级愈合,无并发症发生。15例患者均获随访,时间20～28个月,平均24个月。除1例患者未完全缓解外,其余患者症状消失,拇短展肌肌力增强,GSS评分较术前有明显改善(P<0.05)。结论:小切口减压治疗腕管综合征具有安全性高、手术时间短、创伤小、瘢痕小等优点,直视下切断腕横韧带,可彻底松解正中神经,是安全、有效的手术入路。     

Selective measurement of digital nerve conduction velocity

We developed a new method to measure the nerve conduction velocity of a single digital nerve. In 27 volunteers (27 hands), we separately stimulated each digital nerve on the radial and ulnar sides of the middle and ring fingers. A double-peaked potential was recorded above the median nerve at the wrist joint when either the radial-side nerve or the ulnar-side nerve of the middle finger was stimulated. The first peak of this potential had disappeared after the digital nerve was blocked under the stimulating electrodes, and the peak appeared again coinciding with the decrease of anesthesia. Shifting the stimulating electrodes on the digital nerve resulted in no significant difference in the peak conduction velocity. It is possible that each peak of the potential was attributable to conduction of an action potential along one of the two digital nerves. This new method allows the assessment of a single digital nerve, and may be clinically useful for assessing the rupture of a digital nerve and the sensory nerve action potentials in carpal tunnel syndrome. Received: June 30, 2000 / Accepted: November 20, 2000     

Relative slowing of the median antidromic sensory nerve conduction velocity to the ring finger in screening for carpal tunnel syndrome

PURPOSE: This study analyzed the accuracy of the relative slowing of the antidromic sensory conduction velocity of the median nerve in comparison with the ulnar nerve, from the wrist to the ring finger, in the diagnosis of carpal tunnel syndrome (CTS). METHODS: Eighty-two patients had been referred consecutively to our department to confirm or exclude CTS. The antidromic sensory conduction velocities of the median nerve and the ulnar nerve from the wrist to the ring finger were determined. The difference between the 2 values was calculated to express the relative slowing of the median nerve compared with the ulnar nerve. Carpal tunnel syndrome was diagnosed when the patient had clinical symptoms compatible with CTS confirmed by an established electrophysiologic investigation. The accuracy of a relative slowing of 5 m/s, 10 m/s, and 15 m/s of the median antidromic sensory conduction velocity to the ring finger was determined to diagnose CTS. RESULTS: At a cut-off value of 5 m/s the sensitivity was 95%, the specificity was 63%, and the efficiency was 79%. At a cut-off value of 10 m/s the sensitivity was 90%, the specificity was 85%, and the efficiency was 88%. At a cut-off value of 15 m/s the sensitivity decreased to 83%, the specificity increased to 93%, and the efficiency was 88%. CONCLUSIONS: A high accuracy is achieved in the diagnosis of CTS by determining the relative slowing of the median antidromic sensory nerve conduction velocity from the wrist to the ring finger.     

Carpal tunnel syndrome: Neurographical parameters in different stages of median nerve compression

In a series of 47 cases and 55 hands operated upon for carpal tunnel syndrome, the pre-operative electrodiagnostic findings have been compared retrospectively with the morphological findings within the carpal tunnel during operation. As a main result there was no significant correlation between the degree of electrophysiological changes and the degree of median nerve compression. Only the lack of any motor or sensory response seems to indicate a more severe median nerve compression. In about 20% of cases with operatively proven marked median nerve compression, both distal motor latency and motor nerve conduction velocity were well within normal limits and would not have led to the diagnosis of a carpal tunnel syndrome in these cases. The diagnosis, therefore, cannot be made on the basis of electrodiagnostic pathological values only of distal motor latency and motor nerve conduction velocity, but has to take into account as well the sensory nerve conduction velocity as well as the clinical picture and neurological findings.     

Prevalence of anatomic variations encountered in elective carpal tunnel release

PURPOSE: To determine the prevalence of aberrant or unexpected anatomic structures within one surgeon's elective experience of carpal tunnel releases and their association with pathologic compression. METHODS: A total of 31 anomalies of median nerve, muscle, and tendon, median artery persistence, and ulnar nerve were documented in 30 hands during the course of 526 elective carpal tunnel releases in one surgeon's practice. The data collected were reviewed retrospectively. All carpal tunnel releases were performed open, exposing the median nerve from the palmar arch to the proximal wrist crease. Anomalies were categorized into those involving the median nerve and its motor and sensory branches, the ulnar nerve, a persistent median artery, and anomalies of muscle/tendon units traversing the carpal tunnel area. RESULTS: Seven hands were noted to have aberrant muscle/tendon variations within the carpal tunnel region (1.3%). Anomalies of the median nerve or its palmar cutaneous or motor branches were observed in 5 hands (1.0%). An anomaly of the ulnar nerve with an aberrant branch crossing the carpal tunnel incision occurred in one hand. A persistent median artery (>or=1 mm) was noted in 18 hands (3.4%). One hand had 2 anomalies present. One anomaly was high bifurcation of the median nerve and the second anomaly was an anomalous muscle to the long finger superficialis. CONCLUSIONS: The specific anatomic variations described may be anticipated and more readily recognized by hand surgeons during such open surgery, thus increasing the efficacy and safety of this common procedure.     

Carpal tunnel syndrome secondary to wrist and finger flexor spasticity

Ten patients with spastic wrist flexion deformities secondary to traumatic brain injury were evaluated for carpal tunnel syndrome. The angle of wrist flexion deformity averaged 75 degrees (range, 58 to 115 degrees). Nerve conduction studies demonstrated prolonged median motor and/or sensory latencies in all patients. Preoperative wick catheter measurements of carpal tunnel pressures in eight patients averaged 11 mm Hg in the resting position, 21 mm Hg in maximal wrist flexion, and 15 mm Hg in maximal extension. Each patient had carpal tunnel release with simultaneous wrist and finger flexor tendon releases or lengthenings. At surgery nine of the median nerves were constricted at the proximal edge of the transverse carpal ligament. The presence of normal carpal tunnel pressures and impingement of the median nerve at the proximal edge of the transverse carpal ligament indicates that the chronically flexed posture of the wrist resulted in median nerve compression, and this condition may be aggravated by underlying pressure from the spastic finger flexors.     

On Resection of the Knee

In 16 patients, where the diagnosis carpal tunnel syndrome was electrophysiologi-cally confirmed, the pressure between the median nerve and the carpal ligament was measured peroperatively.

At rest the pressure was 18-64 mmHg, mean 31 mmHg. Passive volar and dorsal wrist flexion increased the pressure about three times. Isometric or isotonic maximal contractions of wrist and finger muscles, elicited by tetanic nerve stimulation increased the pressure to three to six times the resting value. These high pressures may be one of the causes of the nerve lesion in the carpal tunnel syndrome.     

Diagnostic utility of waveform analysis of compound muscle action potentials for carpal tunnel syndrome

PURPOSE: To determine the diagnostic utility of waveform analysis of compound muscle action potentials (CMAP) for carpal tunnel syndrome (CTS). METHODS: A total of 131 hands in 71 patients diagnosed with CTS (grouped according to severity) and 80 hands in 44 normal subjects were evaluated using nerve conduction test through the carpal tunnel combined with waveform analysis of CMAP. RESULTS: Compared to normal subjects, the sensory nerve conduction velocity and mean frequency of the CMAP waveform were significantly reduced in patients with CTS. Compared with distal motor latency and sensory nerve conduction velocity, the mean frequency of the CMAP decreased significantly with increasing clinical severity. CONCLUSION: This study suggests that waveform analysis of CMAP is of diagnostic value in CTS, and is also of value in objective evaluation of postoperative recovery of carpal median nerve dysfunction.