中潜伏期体感诱发电位在重度腕管综合征诊断中的价值.DOCVIP

临床医学论文-中潜伏期体感诱发电位在重度腕管综合征诊断中的价值 【摘要】? 目的? 探讨临床上重度腕管综合征时，正中神经体感诱发电位中潜伏期波N60在诊断中的价值。方法? 15例17腕复合肌肉动作电位未能引出的重度腕管综合征患者，刺激部位一点在掌远侧横纹近端2cm向远端间隔2cm和4cm，另一点在中指。诱发电位中枢记录点在刺激对侧，参考电极在双耳。结果? 在正常对照组，通过N60峰间差测得的从远端掌横纹到中指间的传导速度范围是45.1～89.2m/s，平均（67.4±13.0）m/s。而在12腕患肢中，从中指刺激的结果是由8腕N60明显延长，4腕完全未测出，其测得的传导速度为9.3～21.2m/s，平均（15.6±4.2）m/s。结论? 正中神经体感诱发电位的N60波在运动和感觉电位均不能记录的重度腕管综合征患者的诊断中可作为判断传导异常的客观指标之一。 ??? 【关键词】? 腕管综合征；神经传导速度；体感诱发电位 ???? The value of somatosensory evoked potentials in the diagnosis of carpal tunnel syndrome ??? 【Abstract】? Objective? To evaluate the use of median nerve somatosensory evoked potentials (SEP) wave N60 in the diagnosis of severe carpal tunnel syndrome(CTS).Methods? 17 hands of 15 patients with severe carpal tunnel syndrome whose compound muscle action potential (CMAP) were not recordable.The stimuli site one was 2cm proximal to the distal crease of the wrist and the second site was the middle finger.The SEP were recorded contralateraly in a central electrode to the side of stimulation and referenced to the bilateral ear.Results?In normal subjets,the conduction velocities between the distal ctease and the middle finger measured from the N60 latency difference were 45.1 to 89.2m/sec with a mean velocity of 67.4?3.0m/sec.In 12 CTS hands had a significant delayed N60(8 hands) or no response(4 hands).The conduction velocityranged from 9.3 to 21.2m/sec with a mean was 15.6?.2m/sec.Conclusion?The N60 of median nerve SEP was a useful for objectively identifying conduction abnormalities in severe CTS when motor and sensory action potentials can not be recorded. ??? 【Key words】? carpal tunnel syndrome;nerve conduction velocity;somatosensory evoked potential ??? 近年来随着神经电生理学在腕管综合征的诊治中的广泛使用，临床上对本病诊断和鉴别诊断的依据也越来越多。本文通过对15例17腕重度腕管综合征患者术前患肢正中神经体感诱发电位检查，发现中潜伏期N60波在诊断中有一定的参考意义，现报告如下。 ??? 1? 资料与方法 ??? 1.1? 病例选择? 经复合肌肉动作电位(CMAP)和感觉神经动作电位(SNAP)检查不出或波幅太小无法判断的重度腕管综合征的患者15例17腕，其中男4例，女11例，年龄46～69岁，平均57.4岁，患者均行手术治疗。大鱼际萎缩程度双侧手对比无萎缩者3腕，不明显者4腕，明显者7腕，高度萎缩者3腕。 ??? 1.2? 方法? 通过中潜伏期诱发电位测定