超声检查和神经传导研究在诊断腕管综合征中的有效性：准确性的临床试验
Effectiveness of ultrasonography and nerve conduction studies in the diagnosing of carpal tunnel syndrome: clinical trial on accuracy.
作者信息
Pimentel Benedito Felipe Rabay, Faloppa Flávio, Tamaoki Marcel Jun Sugawara, Belloti João Carlos
机构信息
Division of Hand Surgery and Upper Limb, Discipline of Orthopaedics and Traumatology, Paraiba Valley Regional Hospital and Taubaté University Hospital, University of Taubaté, 239 Francisco de Barros, Taubaté, São Paulo, zip code 12020-230, Brazil.
Division of Hand Surgery and Upper Limb, Department of Orthopedics and Traumatology, Federal University of São Paulo, Paulista School of Medicine, 786 Borges Lagoa, São Paulo, São Paulo, zip code 04038-030, Brazil.
出版信息
BMC Musculoskelet Disord. 2018 Apr 12;19(1):115. doi: 10.1186/s12891-018-2036-4.
BACKGROUND
The aim of this study was to evaluate the effectiveness of two diagnostic tests routinely used for diagnosing carpal tunnel syndrome (CTS)-ultrasonography (US) and nerve conduction studies (NCS)-by comparing their accuracy based on surgical results, with the remission of paresthesia as the reference standard.
METHODS
We enrolled 115 patients, all of the female gender with a high probability of a clinical diagnosis of CTS. All patients underwent US and NCS for a diagnosis and subsequent surgical treatment. As a primary outcome, the accuracy of the US and NCS diagnoses was measured by comparing their diagnoses compared with those determined by the surgical outcomes. Their accuracy was secondarily evaluated based on before and after scores of the Boston Carpal Tunnel Questionnaire (BCTQ).
RESULTS
Overall, 104 patients (90.4%) were diagnosed with CTS by the surgical reference standard, 97 (84.3%) by NCS, and 90 (78.3%) by US. The concordance of NCS and surgical treatment (p < 0.001; kappa = 0.648) was superior to that of US and surgical treatment (p < 0.001; kappa = 0.423). The sensitivity and specificity of US and NCS were similar (p = 1.000 and p = 0.152, respectively: McNemar's test). The BCTQ scores were lower after surgery in patients diagnosed by both US and NCS (p < 0.001and p < 0.001, respectively: analysis of variance).
CONCLUSIONS
US and NCS effectively diagnosed CTS with good sensitivity but were not effective enough to rule out a suspicion of CTS.
TRIAL REGISTRATION
This study was registered at September, 10 th, 2015, and the registration number was NCT02553811 .
背景
本研究旨在通过比较超声检查（US）和神经传导研究（NCS）这两种常用于诊断腕管综合征（CTS）的诊断测试基于手术结果的准确性，并以感觉异常的缓解作为参考标准，来评估其有效性。
方法
我们纳入了115例患者，均为临床诊断CTS可能性较高的女性。所有患者均接受了US和NCS检查以进行诊断及后续手术治疗。作为主要结局指标，通过将US和NCS的诊断结果与手术结果确定的诊断进行比较，来衡量它们诊断的准确性。其次，根据波士顿腕管问卷（BCTQ）的术前和术后评分来评估其准确性。
结果
总体而言，根据手术参考标准，104例患者（90.4%）被诊断为CTS，NCS诊断出97例（84.3%），US诊断出90例（78.3%）。NCS与手术治疗的一致性（p < 0.001；kappa = 0.648）优于US与手术治疗的一致性（p < 0.001；kappa = 0.423）。US和NCS的敏感性和特异性相似（分别为p = 1.000和p = 0.152：McNemar检验）。通过US和NCS诊断的患者术后BCTQ评分均较低（分别为p < 0.001和p < 0.001：方差分析）。
结论
US和NCS能有效诊断CTS，敏感性良好，但排除CTS怀疑的效果不够理想。
试验注册
本研究于2015年9月10日注册，注册号为NCT02553811。
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