掌刺激法在轻度腕管综合症检测中的应用

目的：探讨掌到腕正中神经感觉传导在早期腕管综合症（CTS）诊断中的应用.方法：对临床体征、症状符合腕管综合症（CTS）患者进行常规神经电生理检测.对符合神经电生理腕管诊断正常的患者（即正中神经末梢运动潜伏期DML≤4.5）加做环指刺激法、拇指刺激法、掌到腕正中神经感觉传导（掌刺激法）.结果：掌刺激法中的掌-腕SCV低于41.8m/s考虑诊断为轻度CTS.在三种诊断方法中,掌刺激法敏感度为67％（结合样本量大的相关专业文献中得出的统计数据为敏感度高达100％）,远高于环指刺激法55％和拇指刺激法36％.结论：CTS患者正中神经损害随着病情的进展,损伤由卡压处开始逐步向神经末梢发展,累及正中神经神经末梢,直至重度CTS,导致SNAP消失.腕-掌正中神经感觉神经传导在腕管早期诊断往往非常敏感,掌刺激法中的掌腕SCV低于41.8 m/s考虑诊断为轻度CTS,在患者出现CTS症状,但常规法无法鉴别时,可加做掌刺激法作为常规鉴别诊断.

THE APPLICATION OF METACARPAL STIMULATION IN DETECTING OF MILD CARPAL TUNNEL SYNDROME

To explore the application of palm-wrist segment median nerve sensory conduction velocity in diagnosis of mild carpal tunnel syndrome （CTS） , Methods： Routime electroneurophysiological detection was tested in patients who meet the clinical sign and symptgms. In patients whose detection shows normal （ the median nerve distal motor latency ~〈 4.5 ） , following methods ： ring finger stimulation, thumb stimulation, palm-wrist segment median nerve sensory conduction velocity （metacarpal stimulation ） were tested. Results： Sensory conduction velocity （SCV） ~〈 41.8 m/s of palm-wrist in metacarpal stimulation could be considered a diagnosis of mild carpal tunnel syndrome. In the three diagnosis methods, the sensitivity of ＂palm- wrist＂ was 67% （ the sensitivity in other speciality literature which has a large number of cases is 100% ） . The sensitivity of ring finger stimulation was 55% and the thumb stimulation was 36%. The front data was much higher than the other methods,Conclusion： With the development of the disease, the injure of patients with CTS progressed from the stressful position to median nerve end. As a result, it turns to serious CTS and SNAP disappear. The palm-wrist segment median nerve sensory conduction velocity in detecting mild CTS has a high sensitivity. When the patients have the CTS symptoms but we can＇t identify with normal methods, we can use palm-wrist stimulation as the conventional differential diagnosis.