正中神经压迫试验对腕管综合征神经传导速度的影响

【】　目的　比较正中神经压迫试验对腕管综合征（carpaltunnelsyndrome，CTS）患者正中神经传导速度的影响。　方法　设置CTS组和对照组两个组别，共29例受试者纳入研究。CTS组为14例CTS患者，对照组为15例健康受试者。神经传导速度测定包括正中神经和尺神经的感觉传导末端潜伏期（distalsensorylatency，DSL）、感觉神经动作电位（sensorynerveactionpotential，SNAP）、跨腕关节感觉传导速度（sensoryconductionvelocity，SCV）、运动传导末端潜伏期（distalmotorlatency，DML）及复合肌肉动作电位（compoundmuscleactionpotential，CMAP）。先测感觉传导，再测运动传导。正中神经压迫试验5min后再次测量上述指标。　结果　正中神经压迫试验前后电生理检查考虑诊断CTS分别为22侧和24侧。压迫正中神经后，CTS组正中神经DSL较压迫前显著延长（P0.05）。与对照组相比，在压迫试验前后CTS组的正中神经DSL和DML均明显延长（P0.05）。　结论　正中神经压迫试验5min能使CTS患者正中神经的感觉传导末端潜伏时明显延长，有助于提高神经传导测定对早期CTS的诊断率。【Abstract】　Objective　Todeterminetheeffectofmediannervecompressiononmediannerveconductionspeedinpatientswithcarpaltunnelsyndrome(CTS).　Methods　Inthiscase-controlstudy,29subjectswereenrolled.CTSgroupincluded14patients(22hands)withCTSconfirmedbyelectrodiagnosticstudies,whilethecontrolgroupincluded15healthysubjects(30hands).Theacrosswristnerveconductionofmedianandulnarnervewasmeasuredwhenthewristwasinneutralposition.Measuredparametersincludeddistalsensorylatency(DSL),sensorynerveactionpotential(SNAP),sensoryconductionvelocity(SCV),distalmotorlatency(DML)andcompoundmuscleactionpotential(CMAP).Sensorynerveconductionsweretestedfirst,andthenthemotornerveconduction.Thepatientswereaskedtoperformthemediannervecompressiontestbyflexingelbows,pronatingforearmandpushingthedorsalsurfacesofbothhandstogetherintomaximumwristflexionfor5minutes.Thentheaboveparametersweremeasuredagain.　Results　Byelectrodiagnosticstudies,22handsand24bandswerediagnosedwithCTSbeforeandafterthemediannervecompressiontest,respectively.Afterthecompressiontest,themediannerveDSLweresignificantlyprolongedinCTSgroup(P0.05).TheparametersofulnarnerveingroupCTSandmediannerveandulnarnerveincontrolgroupfailedtoshowanysignificantchange(P>0.05).TheCTSgrouphadlongermediannerveDSLandDMLthanthecontrolgroups(P<0.05),butthedifferencesinulnarnerveDSLandDMLwerenotsignificantlybetweenthetwogroups.　Conclusion　A5-minutemediannervecompressiontestmaymakethemediannerveDSLprolongedandmaybeahelpfuldiagnosisofearlyCTS.