Ginanneschi F, Milani P, Rossi A
Department of Neurological and Behavioural Sciences, Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100 Siena, Italy.
Muscle Nerve. 2008 Sep;38(3):1155-60. doi: 10.1002/mus.21070.
Impairment of ulnar sensory fibers at the wrist has recently been documented in moderate/severe carpal tunnel syndrome (CTS). This has been interpreted as a consequence of compressive forces transmitted to Guyon's canal by high pressure in the carpal tunnel or comorbidity between ulnar neuropathy and CTS. The main aim of the present study was to identify any ulnar nerve conduction impairment in the early stages of CTS. The relation between ulnar and median nerve conduction in all CTS severity stages was also assessed. Ulnar nerve sensory conduction at the wrist was investigated in 580 hands with CTS. Significant changes in ulnar nerve conduction were present even in the early stages of CTS. A significant, positive correlation was also found between CTS severity and conduction abnormalities of ulnar sensory fibers. These findings make the hypothesis of comorbidity weak. Based on the above results and on reports of high pressure in Guyon's canal in CTS, ulnar nerve conduction abnormalities may be caused in part by compressive forces progressively transmitted to the canal by increasing pressure in the carpal tunnel with increasing CTS severity. This does not exclude other causative factors such as subclinical traumatic damage acting on median and ulnar fibers.
近期研究表明，在中度/重度腕管综合征（CTS）中，腕部尺侧感觉纤维存在损伤。这被解释为腕管内高压传递至Guyon管的压力所致，或尺神经病变与CTS合并存在的结果。本研究的主要目的是确定CTS早期是否存在尺神经传导损伤。同时还评估了所有CTS严重程度阶段尺神经与正中神经传导之间的关系。对580例患有CTS的手部进行了腕部尺神经感觉传导研究。即使在CTS早期，尺神经传导也出现了显著变化。CTS严重程度与尺侧感觉纤维传导异常之间也存在显著的正相关。这些发现使得合并存在的假说难以成立。基于上述结果以及CTS患者Guyon管内高压的报道，尺神经传导异常可能部分是由于随着CTS严重程度增加，腕管内压力升高，压力逐渐传递至Guyon管所致。这并不排除其他致病因素，如作用于正中神经和尺神经纤维的亚临床创伤性损伤。
