【摘要】：目的:研究分析改良后的正中神經(jīng)運動傳導速度檢查法在提高腕管綜合征檢出率及早期診斷中的價值。方法:收集2015年1月-2016年1月,在我院確診為CTS的患者80例為觀察對象。其中,71例患者臨床癥狀及體征符合CTS,肌電圖檢查顯示了明確的正中神經(jīng)遠端傳導異常;9例患者臨床癥狀及體征符合CTS,肌電圖檢查未能顯示異�；蚣‰妶D檢查指標接近臨界值,后經(jīng)隨訪或手術證實為CTS,也入組分析。入組的80例患者均在我院肌電圖室行肌電圖檢查,有完整的肌電圖檢查數(shù)據(jù)。入組患者的MCV檢查均采用改良組及傳統(tǒng)組兩種方法進行檢測,分析比較兩種檢查方法在提高腕管綜合征檢出率及早期診斷上的差異。入組患者的SCV檢查均采用常規(guī)的感覺神經(jīng)順向檢查法,SCV檢查結(jié)果關系到輕度CTS患者的診斷及入組,但不作為分析改良組與傳統(tǒng)組檢查方法差異性的指標。另外,選擇47例(共52只腕)確診為CTS,NCS顯示為輕度,即正中神經(jīng)DML(腕部刺激,拇短展肌記錄)≤4.5ms[6]的患者為輕度CTS組;選擇同期年齡相匹配的25例(共31只腕)健康人為正常對照組;分析正中神經(jīng)DML、肘-腕MCV、腕-掌MCV等指標在輕度CTS及正常人中的差異并確定本實驗室的正常值(±2.5s)。應用SPSS13.0統(tǒng)計軟件包對收集的數(shù)據(jù)進行處理,對計數(shù)資料率的比較行χ2檢驗(本實驗應用的是配對設計四格表資料的假設檢驗);對計量資料數(shù)據(jù)用±s表示,兩組均數(shù)的比較用t檢驗。P0.05認為有統(tǒng)計學差異,P0.01認為有顯著統(tǒng)計學差異。結(jié)果:1輕度CTS組及正常對照組的正中神經(jīng)MCV檢測結(jié)果1.1正中神經(jīng)DML、腕-掌MCV,此兩項指標在兩組之間比較有顯著統(tǒng)計學差異(P0.01),即輕度CTS組正中神經(jīng)末端運動潛伏期延長、腕-掌MCV減慢。1.2正中神經(jīng)肘-腕MCV,該指標在兩組之間比較無顯著統(tǒng)計學差異(P0.01),即輕度CTS組正中神經(jīng)肘-腕MCV未見明顯減慢。(Table 1)2本實驗室正中神經(jīng)MCV的正常值以正常對照組±2.5s為臨界值,得出DML4.00ms、腕-掌MCV39.00m/s、肘-腕MCV46.00m/s為所對應指標的異常標準。結(jié)合其他文獻[18]以及實際操作中的體會,最終以肘-腕MCV43.00m/s為該指標的異常標準。3 80例觀察對象的正中神經(jīng)SCV檢查結(jié)果正中神經(jīng)SCV檢查異常62例,正常18例,陽性率77.50%。CTS檢出率77.50%。(Table 2)4 80例觀察對象的正中神經(jīng)MCV檢查結(jié)果4.1傳統(tǒng)組MCV檢查結(jié)果正中神經(jīng)DML異常57例,陽性率71.25%,正中神經(jīng)肘-腕MCV正常80例。CTS檢出率71.25%。(Table 3)4.2改良組MCV檢查結(jié)果正中神經(jīng)腕-掌MCV減慢69例,陽性率86.25%,CTS檢出率86.25%。正中神經(jīng)肘-腕MCV正常80例(這項指標的檢查方法及所獲數(shù)據(jù)與傳統(tǒng)組正中神經(jīng)肘-腕MCV完全相同)。(Table 3)4.3改良組與傳統(tǒng)組正中神經(jīng)MCV檢查CTS檢出率不同。將兩組CTS檢出率行χ2檢驗,統(tǒng)計結(jié)果為P=0.008。P0.01,認為兩組CTS檢出率有顯著統(tǒng)計學差異。(Table 4)結(jié)論:改良組與傳統(tǒng)組正中神經(jīng)MCV檢查CTS檢出率不同,改良組檢出率較高,傳統(tǒng)組較低,兩組比較有顯著統(tǒng)計學差異(P0.01)。正中神經(jīng)腕-掌MCV檢查在CTS早期診斷中具有重要意義。對于臨床癥狀及體征符合CTS,肌電圖檢查未能顯示異�；蚣‰妶D檢查指標接近臨界值時,改良后的檢查方法能夠進一步明確正中神經(jīng)運動支在腕部是否傳導減慢,能夠做到早期診斷�？傊�,改良后的正中神經(jīng)運動傳導速度檢查法在提高腕管綜合征檢出率及早期診斷中具有重大的實用價值,為臨床診斷及治療方式的選擇提供了重要的依據(jù)。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R688

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