改良正中神经运动传导速度检查法在提高腕管综合征检出率及早期诊断中的价值分析

发布时间：2019-01-29 20:24

【摘要】：目的:研究分析改良后的正中神经运动传导速度检查法在提高腕管综合征检出率及早期诊断中的价值。方法:收集2015年1月-2016年1月,在我院确诊为CTS的患者80例为观察对象。其中,71例患者临床症状及体征符合CTS,肌电图检查显示了明确的正中神经远端传导异常;9例患者临床症状及体征符合CTS,肌电图检查未能显示异常或肌电图检查指标接近临界值,后经随访或手术证实为CTS,也入组分析。入组的80例患者均在我院肌电图室行肌电图检查,有完整的肌电图检查数据。入组患者的MCV检查均采用改良组及传统组两种方法进行检测,分析比较两种检查方法在提高腕管综合征检出率及早期诊断上的差异。入组患者的SCV检查均采用常规的感觉神经顺向检查法,SCV检查结果关系到轻度CTS患者的诊断及入组,但不作为分析改良组与传统组检查方法差异性的指标。另外,选择47例(共52只腕)确诊为CTS,NCS显示为轻度,即正中神经DML(腕部刺激,拇短展肌记录)≤4.5ms[6]的患者为轻度CTS组;选择同期年龄相匹配的25例(共31只腕)健康人为正常对照组;分析正中神经DML、肘-腕MCV、腕-掌MCV等指标在轻度CTS及正常人中的差异并确定本实验室的正常值(±2.5s)。应用SPSS13.0统计软件包对收集的数据进行处理,对计数资料率的比较行χ2检验(本实验应用的是配对设计四格表资料的假设检验);对计量资料数据用±s表示,两组均数的比较用t检验。P0.05认为有统计学差异,P0.01认为有显著统计学差异。结果:1轻度CTS组及正常对照组的正中神经MCV检测结果1.1正中神经DML、腕-掌MCV,此两项指标在两组之间比较有显著统计学差异(P0.01),即轻度CTS组正中神经末端运动潜伏期延长、腕-掌MCV减慢。1.2正中神经肘-腕MCV,该指标在两组之间比较无显著统计学差异(P0.01),即轻度CTS组正中神经肘-腕MCV未见明显减慢。(Table 1)2本实验室正中神经MCV的正常值以正常对照组±2.5s为临界值,得出DML4.00ms、腕-掌MCV39.00m/s、肘-腕MCV46.00m/s为所对应指标的异常标准。结合其他文献[18]以及实际操作中的体会,最终以肘-腕MCV43.00m/s为该指标的异常标准。3 80例观察对象的正中神经SCV检查结果正中神经SCV检查异常62例,正常18例,阳性率77.50%。CTS检出率77.50%。(Table 2)4 80例观察对象的正中神经MCV检查结果4.1传统组MCV检查结果正中神经DML异常57例,阳性率71.25%,正中神经肘-腕MCV正常80例。CTS检出率71.25%。(Table 3)4.2改良组MCV检查结果正中神经腕-掌MCV减慢69例,阳性率86.25%,CTS检出率86.25%。正中神经肘-腕MCV正常80例(这项指标的检查方法及所获数据与传统组正中神经肘-腕MCV完全相同)。(Table 3)4.3改良组与传统组正中神经MCV检查CTS检出率不同。将两组CTS检出率行χ2检验,统计结果为P=0.008。P0.01,认为两组CTS检出率有显著统计学差异。(Table 4)结论:改良组与传统组正中神经MCV检查CTS检出率不同,改良组检出率较高,传统组较低,两组比较有显著统计学差异(P0.01)。正中神经腕-掌MCV检查在CTS早期诊断中具有重要意义。对于临床症状及体征符合CTS,肌电图检查未能显示异常或肌电图检查指标接近临界值时,改良后的检查方法能够进一步明确正中神经运动支在腕部是否传导减慢,能够做到早期诊断。总之,改良后的正中神经运动传导速度检查法在提高腕管综合征检出率及早期诊断中具有重大的实用价值,为临床诊断及治疗方式的选择提供了重要的依据。
[Abstract]:Objective: To study the positive rate of median nerve movement and its value in early diagnosis of carpal tunnel syndrome. Methods: From January 2015 to January 2016, 80 patients with CTS were observed in our hospital. Among them, the clinical symptoms and signs of 71 patients were in accordance with the CTS, and the electromyogram examination showed a definite central nerve far-end conduction abnormality; in 9 patients, the clinical symptoms and signs were in accordance with the CTS, the electromyogram examination did not show the abnormality or the electromyogram examination index was close to the critical value, The following follow-up or procedure was confirmed as CTS and also in group analysis. All the 80 patients in the enrolled group were examined by electromyography in the electromyogram room of our hospital. The MCV examination of the patients in the group was tested by two methods in the modified group and the traditional group, and the differences of the two methods of examination on the detection rate of the carpal tunnel syndrome and the early diagnosis were compared. The SCV of the patients in the group was examined by the routine sensory nerve method, and the results of the SCV examination were related to the diagnosis and enrollment of the patients with mild CTS, but not as an indicator of the difference between the modified group and the traditional group. In addition, 47 (total of 52 wrists) were selected to be CTS, and the NCS showed mild, that is, the median nerve DML (wrist-stimulated, short-to-short) and 4. 5ms[6] was a mild CTS group, and 25 (total 31 wrist) healthy controls matched with the same age were selected as the normal control group; The differences of median nerve DML, elbow-wrist MCV and wrist-palm MCV were analyzed in mild CTS and normal subjects and the normal value of the laboratory was determined (% 2.5s). The collected data is processed by the SPSS 13.0 statistical software package, and the comparison line of the counting data rate is checked by the second test (the hypothesis testing of the four-cell table data of the paired design is applied to the experiment), and the comparison of the two groups is t-checked for the data of the measurement data. There was a statistically significant difference between P0.05 and P0.01, and there was a significant statistical difference between the two groups. Results: The median nerve MCV in the first mild CTS group and the normal control group was 1. 1. The median nerve DML and the wrist-palm MCV were significantly different between the two groups (P 0.01), that is, the latency of the median nerve end of the mild CTS group was prolonged. The wrist-palm MCV was slowed down. 1. 2 median nerve elbow-wrist MCV, and there was no significant difference between the two groups (P 0.01), that is, the median nerve elbow-wrist MCV in the mild CTS group was not seen to be significantly reduced. (Table 1) The normal value of the median nerve MCV in the laboratory was in the normal control group, and the normal control group was the critical value. The DML4. 00ms, the wrist-palm MCV39.00m/ s and the elbow-wrist MCV460.00m/ s were the abnormal criteria of the corresponding index. According to the other literature[18] and the experience in actual operation, the abnormal standard of the index was finally determined by the elbow-wrist MCV4.3. 00m/ s. In the median nerve SCV of 80 cases, the median nerve SCV was abnormal in 62 cases, the normal 18 cases, the positive rate was 77. 50%. The detection rate of CTS was 70.50%. (Table 2) The results of the MCV examination of the median nerve (MCV) in the 4 (80) cases showed that the median nerve DML was abnormal in 57 cases, the positive rate was 71.25%, and the median nerve elbow-wrist MCV was normal in 80 cases. The detection rate of CTS was 71.25%. (Table 3) The results of MCV in the modified group showed that the median nerve-metacarpal MCV was down in 69 cases, the positive rate was 82.25%, and the detection rate of CTS was 82.25%. The median nerve elbow-wrist MCV was normal in 80 cases (the test method of this index and the obtained data were the same as the median nerve elbow-wrist MCV in the traditional group). (Table 3) The detection of CTS was different between the modified group and the median nerve MCV in the traditional group. In the two groups, the detection rate of CTS was determined by 2, and the statistical results were P = 0.0008. P0.01, and it was considered that there was a significant difference in the detection rate of CTS in the two groups. (Table 4) Conclusion: The detection rate of CTS in the modified group and the median nerve MCV in the traditional group is different, the detection rate of the modified group is higher, the traditional group is lower, and the difference between the two groups is significant (P0.01). The median nerve wrist-palm MCV examination is of great significance in the early diagnosis of CTS. When the clinical symptoms and signs are in accordance with the CTS and the electromyogram examination fails to display the abnormality or the electromyogram examination index is close to the critical value, the improved inspection method can further clarify whether the median nerve motion branch is slow in the wrist or not, and the early diagnosis can be achieved. In conclusion, the modified median nerve motion conduction velocity method has great practical value in improving the detection rate of carpal tunnel syndrome and early diagnosis, and provides an important basis for the selection of clinical diagnosis and treatment mode.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R688

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