|
|
神经传导速度测定技术对腕管综合征预后评价的研究
|
Abstract:
目的：探讨神经传导速度测定技术对中、重度腕管综合征患者预后的评价作用。方法：收集2020年12月至2024年3月在我院经手术治疗的腕管综合征患者77例(单侧53例，双侧24例，共101例手术)，根据临床分型标准分为中度和重度。于术前、术后3个月及术后1年分别测定并记录患者患侧正中神经传导速度检查(nerve conduction study, NCS)各参数值和波士顿腕管量表(Boston carpal tunnel questionnaire, BCTQ)评分。结果：根据腕管综合征临床分型标准中度腕管综合征组患者55例，重度腕管综合征组患者46例；通过对正中神经传导速度检查各参数值及波士顿腕管量评分分析得出的数据表明，中度和重度患者在手术治疗后均得到显著改善(P < 0.05)，在术后随访各时间点2组正中神经传导各参数值及波士顿腕管量表评分均好转，但仅中度组感觉神经电位波幅、感觉传导速度在术后3个月与术后1年比较时差异有统计学意义(P < 0.05)；中度组正中神经传导各参数值及波士顿腕管量表评分基线比较时均好于重度组(P < 0.05)；但在术后随访各时间点，虽然中度组正中神经传导各参数值及波士顿腕管量表评分仍然好于重度组，但在术后3个月随访时感觉传导末端感觉潜伏期、感觉传导速度及波士顿腕管量评分2组比较时差异无统计学意义(P > 0.05)，术后1年随访时感觉传导末端感觉潜伏期(distal sensory latency, DSL)及波士顿腕管量评分2组比较时差异无统计学意义(P > 0.05)。结论：腕管松解术可显著改善腕管综合征神经功能，中度好于重度，术后早期恢复至关重要。感觉传导末端潜伏期(DSL)可以作为评估CTS患者术后恢复的客观指标。
Objective: To investigate the prognostic value of nerve conduction velocity measurement in patients with moderate to severe carpal tunnel syndrome. Methods: From December 2020 to March 2024, 77 patients with carpal tunnel syndrome (53 unilateral cases, 24 bilateral cases, a total of 101 operations) who underwent surgical treatment in our hospital were collected and divided into moderate and severe according to the clinical classification criteria. The parameters of nerve conduction study (NCS) and the score of Boston carpal tunnel questionnaire (BCTQ) were measured and recorded before operation, 3 months and 1 year after operation. Results: According to the clinical classification criteria of carpal tunnel syndrome, there were 55 patients in the moderate carpal tunnel syndrome group and 46 patients in the severe carpal tunnel syndrome group; the data obtained from the analysis of the parameters of median nerve conduction velocity examination and BCTQ score showed that the moderate and severe patients were significantly improved after surgical treatment (P < 0.05). At each time point of postoperative follow-up, the parameters of median nerve conduction and the score of BCTQ in the two groups were improved, but only the amplitude of sensory nerve potential and sensory conduction velocity in the moderate group were significantly different from those in the first year after surgery (P < 0.05); the median nerve conduction parameters and BCTQ scores in the moderate group were better than those in the severe group at baseline (P < 0.05); however, at each time point of postoperative follow-up, although the parameters of median nerve conduction and BCTQ score in the moderate
| [1] | Padua, L., Coraci, D., Erra, C., Pazzaglia, C., Paolasso, I., Loreti, C., et al. (2016) Carpal Tunnel Syndrome: Clinical Features, Diagnosis, and Management. The Lancet Neurology, 15, 1273-1284. https://doi.org/10.1016/s1474-4422(16)30231-9 |
| [2] | Currie, K.B., Tadisina, K.K. and Mackinnon, S.E. (2022) Common Hand Conditions: A Review. JAMA, 327, 2434-2445. https://doi.org/10.1001/jama.2022.8481 |
| [3] | Westenberg, R.F., Oflazoglu, K., de Planque, C.A., Jupiter, J.B., Eberlin, K.R. and Chen, N.C. (2020) Revision Carpal Tunnel Release: Risk Factors and Rate of Secondary Surgery. Plastic & Reconstructive Surgery, 145, 1204-1214. https://doi.org/10.1097/prs.0000000000006742 |
| [4] | Wessel, L.E., Gu, A., Asadourian, P.A., Stepan, J.G., Fufa, D.T. and Osei, D.A. (2021) The Epidemiology of Carpal Tunnel Revision over a 1-Year Follow-Up Period. The Journal of Hand Surgery, 46, 758-764. https://doi.org/10.1016/j.jhsa.2021.04.003 |
| [5] | Sasaki, Y., Terao, T., Saito, E., Ohara, K., Michishita, S., Kato, N., et al. (2020) Clinical Predictors of Surgical Outcomes of Severe Carpal Tunnel Syndrome Patients: Utility of Palmar Stimulation in a Nerve Conduction Study. BMC Musculoskeletal Disorders, 21, Article No. 725. https://doi.org/10.1186/s12891-020-03750-z |
| [6] | Ise, M., Saito, T., Katayama, Y., Nakahara, R., Shimamura, Y., Hamada, M., et al. (2021) Relationship between Clinical Outcomes and Nerve Conduction Studies before and after Surgery in Patients with Carpal Tunnel Syndrome. BMC Musculoskeletal Disorders, 22, Article No. 882. https://doi.org/10.1186/s12891-021-04771-y |
| [7] | 顾玉东. 腕管综合征与肘管综合征的临床分型现状与建议[J]. 中华骨科杂志, 2011, 31(7): 818-819. |
| [8] | Witt, J.C., Hentz, J.G. and Stevens, J.C. (2004) Carpal Tunnel Syndrome with Normal Nerve Conduction Studies. Muscle & Nerve, 29, 515-522. https://doi.org/10.1002/mus.20019 |
| [9] | Levine, D.W., Simmons, B.P., Koris, M.J., Daltroy, L.H., Hohl, G.G., Fossel, A.H., et al. (1993) A Self-Administered Questionnaire for the Assessment of Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome. The Journal of Bone & Joint Surgery, 75, 1585-1592. https://doi.org/10.2106/00004623-199311000-00002 |
| [10] | Lei, W., Qian, X. and Sun, X. (2016) Study of the Reliability and Validity of Chinese Version of the Boston Carpal Tunnel Questionnaire. Nursing Journal of Chinese People’s Liberation Army, 33, 39-42. |
| [11] | Erickson, M., Lawrence, M., Jansen, C.W.S., Coker, D., Amadio, P. and Cleary, C. (2019) Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome. Journal of Orthopaedic & Sports Physical Therapy, 49, CPG1-CPG85. https://doi.org/10.2519/jospt.2019.0301 |
| [12] | Dy, C.J., Colorado, B.S., Landau, A.J. and Brogan, D.M. (2021) Interpretation of Electrodiagnostic Studies: How to Apply It to the Practice of Orthopaedic Surgery. Journal of the American Academy of Orthopaedic Surgeons, 29, e646-e654. https://doi.org/10.5435/jaaos-d-20-00322 |
| [13] | Heybeli, N., Kutluhan, S., Demirci, S., Kerman, M. and Mumcu, E.F. (2002) Assessment of Outcome of Carpal Tunnel Syndrome: A Comparison of Electrophysiological Findings and a Self-Administered Boston Questionnaire. Journal of Hand Surgery, 27, 259-264. https://doi.org/10.1054/jhsb.2002.0762 |
| [14] | Billig, J.I., Kotsis, S.V., Chung, K.C., Adkinson, J., Fowler, J., Gaston, R.G., et al. (2021) Variation in Use of Electrodiagnostic Testing: Analysis from the Michigan Collaborative Hand Initiative for Quality in Surgery. The Journal of Hand Surgery, 46, 169-177. https://doi.org/10.1016/j.jhsa.2020.11.017 |
| [15] | Lee, H.J., Kwon, H.K., Kim, D.H. and Pyun, S.B. (2013) Nerve Conduction Studies of Median Motor Nerve and Median Sensory Branches According to the Severity of Carpal Tunnel Syndrome. Annals of Rehabilitation Medicine, 37, 254-262. https://doi.org/10.5535/arm.2013.37.2.254 |
| [16] | Dagtas, M.Z. and Unal, O.K. (2022) Long-Term Outcome of Electrodiagnostic Values and Symptom Improvement after Carpal Tunnel Release: A Retrospective Cohort Study. The Journal of Hand Surgery, 47, 727-735. https://doi.org/10.1016/j.jhsa.2022.04.003 |
| [17] | Osiak, K., Elnazir, P., Walocha, J.A. and Pasternak, A. (2022) Carpal Tunnel Syndrome: State-of-the-Art Review. Folia Morphologica, 81, 851-862. https://doi.org/10.5603/fm.a2021.0121 |
| [18] | Kasius, K.M., Claes, F., Verhagen, W.I.M. and Meulstee, J. (2019) Motor Nerve Conduction Tests in Carpal Tunnel Syndrome. Frontiers in Neurology, 10, Article 149. https://doi.org/10.3389/fneur.2019.00149 |
| [19] | Kim, J.Y., Yoon, J.S., Kim, S.J., Won, S.J. and Jeong, J.S. (2012) Carpal Tunnel Syndrome: Clinical, Electrophysiological, and Ultrasonographic Ratio after Surgery. Muscle & Nerve, 45, 183-188. https://doi.org/10.1002/mus.22264 |
| [20] | Werner, R.A. and Andary, M. (2011) Electrodiagnostic Evaluation of Carpal Tunnel Syndrome. Muscle & Nerve, 44, 597-607. https://doi.org/10.1002/mus.22208 |
| [21] | Aksekili, M.A., Biçici, V., Isık, Ç., et al. (2015) Comparison of Early Postoperative Period Electrophysiological and Clinical Findings Following Carpal Tunnel Syndrome: Is EMG Necessary? International Journal of Clinical and Experimental Medicine, 8, 6267-6271. |
| [22] | Yilmaz, E. and Toluk, Ö. (2022) Comparison of Clinical Findings and Electromyography Results in Patients with Preliminary Diagnosis of Carpal Tunnel Syndrome. Journal of Electromyography and Kinesiology, 65, Article 102688. https://doi.org/10.1016/j.jelekin.2022.102688 |
| [23] | Kasius, K.M., Claes, F., Verhagen, W.I.M. and Meulstee, J. (2019) Motor Nerve Conduction Tests in Carpal Tunnel Syndrome. Frontiers in Neurology, 10, Article 149. https://doi.org/10.3389/fneur.2019.00149 |
| [24] | Orhurhu, V., Orman, S., Peck, J., Urits, I., Orhurhu, M.S., Jones, M.R., et al. (2020) Carpal Tunnel Release Surgery—A Systematic Review of Open and Endoscopic Approaches. Anesthesiology and Pain Medicine, 10, e112291. https://doi.org/10.5812/aapm.112291 |
| [25] | Peters, S., Page, M.J., Coppieters, M.W., Ross, M. and Johnston, V. (2016) Rehabilitation Following Carpal Tunnel Release. Cochrane Database of Systematic Reviews, No. 6, CD004158. https://doi.org/10.1002/14651858.cd004158.pub3 |
| [26] | Lee, J., Yoon, B., Cho, J.W., Ryu, H. and Han, S. (2020) Carpal Tunnel Release Despite Normal Nerve Conduction Studies in Carpal Tunnel Syndrome Patients. Annals of Plastic Surgery, 86, 52-57. https://doi.org/10.1097/sap.0000000000002570 |
