正中神经超声检查在老年腕管综合征患者中的诊断准确性：敏感性和特异性评估。
The diagnostic accuracy of median nerve ultrasonography in elderly patients with carpal tunnel syndrome: sensitivity and specificity assessment.
机构信息
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden,
Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
Clin Interv Aging. 2018 Oct 11;13:1953-1962. doi: 10.2147/CIA.S177307. eCollection 2018.
BACKGROUND
Accurate diagnosis of carpal tunnel syndrome (CTS), the most common entrapment neuropathy, and its differentiation from other diseases are essential, especially in older individuals with advanced symptoms and modified electrophysiological abnormalities. The current study was conducted to evaluate the diagnostic accuracy of ultrasonography (US), regarding sensitivity and specificity in the diagnosis of CTS in elderly patients.
METHODS
Individuals with upper limb complaints and reference subjects were recruited from the Rofaydeh Hospital, Tehran, Iran, from June 2013 to October 2014 - (15 months). We evaluate case and control subjects for health status, demographics, clinical characteristics of CTS, median nerve physiology by electrodiagnostic tests, and anatomy by US. Median nerve cross-sectional area (CSA) at precanal, tunnel inlet, midcanal, tunnel outlet, and antecubital levels was measured applying US examination.
RESULTS
Of the 723 complaining patients, we assessed 380 patients with CTS symptoms. Electrodiagnostic studies (EDX) confirmed the CTS diagnosis in 203 of these clinically diseased patients. A total of 103 patients (of the 113 reference subjects) had normal EDX in the reference group. Comparisons of wrists between the afflicted and reference subjects demonstrated the CSA at precanal, tunnel inlet, midcanal, and tunnel outlet levels being significantly more abundant in the diseased hands than in the nondiseased hands. CSA at the tunnel inlet and the inlet-to-antecubital CSA ratio with a threshold of 8.5 mm and 0.65 gave the best diagnostic accuracy with a sensitivity and specificity of 96.9 and 93.6% for the inlet CSA and 99 and 28% for the CSA ratio, respectively.
CONCLUSION
The US as a noninvasive diagnostic method may serve for the investigation of CTS in elderly patients with excellent sensitivity and specificity.
背景
准确诊断腕管综合征（CTS），这是最常见的嵌压性神经病，以及与其他疾病的区分，尤其是在有晚期症状和改良电生理异常的老年患者中，这是非常重要的。本研究旨在评估超声（US）在诊断老年患者 CTS 中的诊断准确性，包括敏感性和特异性。
方法
我们从 2013 年 6 月至 2014 年 10 月（15 个月）在伊朗德黑兰的 Rofaydeh 医院招募了上肢有症状的患者和参考对象。我们评估了病例组和对照组的健康状况、人口统计学特征、CTS 的临床特征、电诊断测试中的正中神经生理学以及 US 下的解剖结构。在预管、管入口、中管、管出口和肘前水平测量正中神经横截面积（CSA）。
结果
在 723 名有症状的患者中，我们评估了 380 名有 CTS 症状的患者。电诊断研究（EDX）在这些有临床疾病的患者中确认了 203 例 CTS 诊断。在参考组中，共有 103 名（113 名参考对象中的）参考对象的 EDX 正常。比较患病手和正常手的手腕，发现患病手中的预管、管入口、中管和管出口水平的 CSA 明显更为丰富。管入口处的 CSA 和入口到肘前的 CSA 比值，阈值为 8.5mm 和 0.65，其诊断准确性最高，入口 CSA 的敏感性和特异性分别为 96.9%和 93.6%，CSA 比值分别为 99%和 28%。
结论
作为一种非侵入性诊断方法，US 可用于老年 CTS 患者的调查，具有极好的敏感性和特异性。
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