Oyer David S, Saxon David, Shah Ajul
Department of Clinical Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Endocr Pract. 2007 Jan-Feb;13(1):5-10. doi: 10.4158/EP.13.1.5.
To describe the clanging tuning fork (CTF) test, a novel method for using the C 128-Hz tuning fork to test for diabetic peripheral neuropathy (DPN), to evaluate the accuracy and reproducibility of this technique, and to compare it with the 5.07 (10 g) Semmes-Weinstein monofilament test.
To determine the mean and standard deviation for the CTF test, repeated measurements were taken on one toe of 12 patients with diabetes during one visit. After these tests, 30 randomly selected patients were tested on both feet, with right and left scores compared for reproducibility of the results. The scores of the CTF test were compared with the monofilament scores in 45 patients with diabetes. Presence of foot ulcers in 81 patients was correlated with both test scores.
The mean duration of vibration sensation was 10.2 seconds, with a standard deviation of +/-1.3 seconds. The Pearson correlation coefficient comparing the right and the left foot scores for the same patient was 0.947 (P<0.05). Among patients with 8 seconds or less of vibration perception, results of monofilament testing were abnormal only in those whose vibration perception was less than or equal to 4 seconds. Of 32 patients with vibration perception of 4 seconds or less, 50% had normal monofilament test scores, including 29% of 17 patients with absent vibratory sensation.
The CTF test is reproducible and accurate. It provides a quantitative assessment of DPN and can document severe neuropathy, even in the presence of a normal result with the 10-g monofilament test. The risk of foot ulcers, which is associated with diminished vibratory sensation, can therefore be detected earlier and more accurately with the CTF test. The CTF test should replace the 10-g monofilament test as the recommended technique for detection of DPN.
描述叮当音叉（CTF）测试，这是一种使用128赫兹音叉检测糖尿病周围神经病变（DPN）的新方法，评估该技术的准确性和可重复性，并将其与5.07（10克）Semmes-Weinstein单丝测试进行比较。
为确定CTF测试的均值和标准差，在一次就诊期间对12例糖尿病患者的一个脚趾进行重复测量。这些测试后，对30例随机选择的患者双脚进行测试，比较左右脚得分以评估结果的可重复性。将45例糖尿病患者的CTF测试得分与单丝测试得分进行比较。81例患者足部溃疡的存在情况与两种测试得分相关。
振动感觉的平均持续时间为10.2秒，标准差为±1.3秒。同一患者左右脚得分的Pearson相关系数为0.947（P<0.05）。在振动感知时间为8秒或更短的患者中，单丝测试结果仅在振动感知时间小于或等于4秒的患者中异常。在32例振动感知时间为4秒或更短的患者中，50%的患者单丝测试得分正常，包括17例无振动感觉患者中的29%。
CTF测试具有可重复性和准确性。它提供了对DPN的定量评估，即使在10克单丝测试结果正常的情况下也能记录严重的神经病变。因此，通过CTF测试可以更早、更准确地检测出与振动感觉减退相关的足部溃疡风险。CTF测试应取代10克单丝测试，作为检测DPN的推荐技术。
