正中和尺掌-腕混合神经潜伏期差在腕管综合征诊断中的应用

目的:评估正中和尺掌-腕混合神经潜伏期差在腕管综合征(CTS)诊断中的应用价值。方法:选取2019年1月至2019年12月在常熟市中医院门诊诊断为CTS的患者47例(77只手掌)作为研究组,同时收集同时段在体检中心健康检查的志愿者46名(69只手掌)作为对照组,分别记录正中神经腕-拇短展肌的远端运动潜伏期(DML)、腕-中指的感觉神经传导速度(SCV)、感觉神经动作电位(SNAP)波幅及正中和尺掌-腕混合神经潜伏期差(ΔDSL)。结果:研究组与对照组比较,腕-拇短展肌DML延长(4.49±0.97)ms比(3.16±0.42)ms],腕-中指SCV减慢(42.62±7.35)m/s比(60.65±6.70)m/s],SNAP波幅下降(11.89±8.05)μV比(22.07±7.22)μV],正中和尺掌-腕混合神经ΔDSL延长(0.84±0.34)ms比(0.23±0.10)ms],差异均具有统计学意义(P<0.05)。腕-拇短展肌DML、腕-中指SCV、正中和尺掌-腕混合神经ΔDSL诊断特异度分别为97.1%、100%、98.6%(P>0.05),诊断敏感度分别为66.2%、59.2%、90.1%(P<0.05)。结论:正中和尺掌-腕混合神经ΔDSL用于诊断CTS是比较敏感的,尤其可以提高早期CTS的阳性检出率。

Application of distal sensory latency difference between median and ulnar palmar-wrist mixed nerves in the diagnosis of carpal tunnel syndrome

Objective:To evaluate the value of distal sensory latency difference(ΔDSL)between median and ulnar palmar-wrist mixed nerves in the diagnosis of carpal tunnel syndrome(CTS).Methods:A total of 47 patients(77 palms)diagnosed as CTS in the outpatient department of Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to December 2019 were enrolled as the study group,and 46 volunteers(69 palms)in the physical examination center during the same period were enrolled as the control group.The distal motor latency(DML)of median nerve wrist-abductor pollicis brevis,sensory nerve conduction velocity(SCV)of wrist-middle finger,amplitude of sensory nerve action potential(SNAP)andΔDSL between median nerve and abductor pollicis brevis were recorded.Results:In the study group,the DML of wrist-abductor pollicis brevis was prolonged(4.49±0.97)ms vs.(3.16±0.42)ms],the SCV of wrist-middle finger was lowered(42.62±7.35)m/s vs.(60.65±6.70)m/s],the amplitude of SNAP was decreased(11.89±8.05)μV vs.(22.07±7.22)μV],andΔDSL of median and ulnar palmar-wrist mixed nerves was prolonged(0.84±0.34)ms vs.(0.23±0.10)ms],with statistically significant difference(P<0.05).The diagnostic specificity of the DML of wrist-abductor pollicis brevis,the SCV of wrist-middle finger andΔDSL of median and ulnar palmar-wrist mixed nerves was 97.1%,100%,98.6%respectively(P>0.05),and the diagnostic sensitivity was 66.2%,59.2%,90.1%respectively(P<0.05).Conclusion:ΔDSL of median and ulnar palmar-wrist mixed nerves was relatively sensitive in the diagnosis of CTS,especially for early CTS detection,it may improve the positive detection rate.