Li C J, Wang T Y, Cao J Y, Huang A L, Wang J F, Ren C G, Chen S P, Wu L J
Institute of Digitized Medicine, Wenzhou Medical University, Zhejiang 325035, China.
Zhonghua Yi Xue Za Zhi. 2018 Nov 20;98(43):3490-3495. doi: 10.3760/cma.j.issn.0376-2491.2018.43.006.
To analyze the influence of simulation mouse use motion under different wrist forcing postures on median nerve, tendons and ligaments in the carpal tunnel. From June to November in 2017, a total of 49 healthy volunteers [aged from 18 to 27 years, 24 males (48 cases of hands) and 25 females (50 cases of hands)] were selected in the Institute of Digitized Medicine and First Affiliated Hospital of Wenzhou Medical University.Three hand postures of the volunteers were simultaneously and continuously measured by using LOGIQ E9 ultrasonic diagnostic apparatus and Zebris foot pressure distribution measurement system.Seventeen parameters of nerves, tendons and ligaments in carpal tunnel were observed under natural (0 N), and two forced (25 and 50 N) states.Double factor variance analysis was performed with generalized estimating equation (GEE). With increasing pressure (0, 25 and 50 N) of hand postures, the distance between median nerve and transverse carpal ligament were all less than 0.2 cm.The differences in both the distance between median nerve and flexor pollicis longus under the hand pressure changes or under the hand posture changes and the top angle of a triangle composed of median nerve, flexor pollicis longus and flexor digitorum superficialis group under the hand pressure changes or under the hand posture changes were all significant under the GEE analysis (all <0.01). There were no significant changes in all other structural parameters in the carpal tunnel with the increasing of hand pressure (all >0.05). The influence of the transverse carpal ligament to the median nerve belongs to the mechanism of pressure-induced irritation damage.The influence of flexor pollicis longus to median nerve belongs to the mechanism of tension-induced irritation damage.The influence of flexor digitorum superficialis to median nerve belongs to the mechanism of mixed shear irritation damage.
分析不同手腕用力姿势下模拟鼠标使用动作对腕管内正中神经、肌腱和韧带的影响。2017年6月至11月,在温州医科大学数字医学研究所和第一附属医院选取了49名健康志愿者(年龄18至27岁,男性24名,手部48例;女性25名,手部50例)。使用LOGIQ E9超声诊断仪和Zebris足底压力分布测量系统同时连续测量志愿者的三种手部姿势。在自然状态(0 N)以及两种用力状态(25 N和50 N)下观察腕管内神经、肌腱和韧带的17项参数。采用广义估计方程(GEE)进行双因素方差分析。随着手部姿势压力(0、25和50 N)增加,正中神经与腕横韧带之间的距离均小于0.2 cm。在GEE分析下,手部压力变化或手部姿势变化时,正中神经与拇长屈肌之间的距离以及由正中神经、拇长屈肌和指浅屈肌组构成的三角形顶角的差异均具有显著性(均<0.01)。随着手部压力增加,腕管内其他所有结构参数均无显著变化(均>0.05)。腕横韧带对正中神经的影响属于压力诱导刺激损伤机制。拇长屈肌对正中神经的影响属于张力诱导刺激损伤机制。指浅屈肌对正中神经的影响属于混合剪切刺激损伤机制。