Gousheh Jamal, Iranpour Afshin
Division of Reconstructive and Microsurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Plast Reconstr Surg. 2005 Aug;116(2):508-13. doi: 10.1097/01.prs.0000172893.59458.8a.
Carpal tunnel syndrome is more common in hemodialysis patients than in the general population. In addition to uremic neuropathy, arteriovenous fistula has been identified as one of the possible causes for the development of carpal tunnel syndrome.
Wrists of 279 hemodialysis patients who had arteriovenous fistula for at least 6 months served as the case group and the other intact wrists of the same patients served as the control group. Carpal tunnel syndrome was diagnosed clinically; however, 116 random patients underwent electrodiagnostic studies the day after hemodialysis.
Clinically, carpal tunnel syndrome was diagnosed less frequently in the contralateral wrist than in the wrist with arteriovenous fistula (12.2 percent versus 30.5 percent, p < 0.0001). Meanwhile, the authors found a positive correlation between the duration of fistula and the development of carpal tunnel syndrome (p < 0.028). The site of fistula (snuffbox, radiocephalic) used, however, had no effect on the rate of development of carpal tunnel syndrome (p > 0.2). Contrary to the clinical assessment, electrodiagnostic studies did not indicate any significant association between the frequency of carpal tunnel syndrome and arteriovenous fistula or its duration. With the nerve conduction velocity abnormalities observed in patients with uremic polyneuropathy, the authors believe that clinical diagnosis of carpal tunnel syndrome is more indicative of the development of the condition than the electrodiagnostic results.
The authors' clinical results have revealed that hemodialysis patients are at considerable risk of developing carpal tunnel syndrome in the wrist with an arteriovenous fistula. These patients should be under close observation and receive routine checkup.
腕管综合征在血液透析患者中比在普通人群中更常见。除了尿毒症性神经病变外，动静脉内瘘已被确定为腕管综合征发生的可能原因之一。
将279例动静脉内瘘使用至少6个月的血液透析患者的手腕作为病例组，将同一患者的另一只未使用内瘘的手腕作为对照组。通过临床诊断腕管综合征；然而，116例随机患者在血液透析后第二天接受了电诊断研究。
临床上，对侧手腕诊断出腕管综合征的频率低于有动静脉内瘘的手腕（12.2%对30.5%，p<0.0001）。同时，作者发现内瘘使用时间与腕管综合征的发生之间存在正相关（p<0.028）。然而，所使用的内瘘部位（鼻烟窝、桡动脉头静脉）对腕管综合征的发生率没有影响（p>0.2）。与临床评估相反，电诊断研究未表明腕管综合征的频率与动静脉内瘘及其使用时间之间存在任何显著关联。鉴于在尿毒症性多发性神经病变患者中观察到神经传导速度异常，作者认为腕管综合征的临床诊断比电诊断结果更能表明该病的发生情况。
作者的临床结果表明，血液透析患者在有动静脉内瘘的手腕发生腕管综合征的风险相当高。这些患者应密切观察并接受常规检查。
