腕管综合征患者手术前后临床结果与神经传导研究的关系。
Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome.
机构信息
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan.
出版信息
BMC Musculoskelet Disord. 2021 Oct 16;22(1):882. doi: 10.1186/s12891-021-04771-y.
BACKGROUND
Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS.
METHOD
Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months postoperatively. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement.
RESULTS
The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6-12 months, r = 0.67; 0-12 months, r = 0.60) and DASH (0-12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6-12 months, r = - 0.33; 0-12 months, r = - 0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below.
CONCLUSION
NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS.
背景
神经传导研究（NCS）是评估腕管综合征（CTS）的客观评估的唯一有用的测试。但是，术前和术后 NCS 与临床结果之间的关系尚不清楚。本研究旨在确定 CTS 患者的术前和术后（术后 6 个月）NCS 是否可以预测患者为导向的和运动结果（术后 6 和 12 个月）。
方法
在 2011 年 3 月至 2020 年 3 月期间，对 85 例 CTS 患者中的 107 只手进行了分析。所有患者均接受开放式腕管松解术，并在术前和术后 6 个月和 12 个月使用手臂，肩部和手部残疾问卷（DASH）和握力（GS）进行检查。此外，术前和术后 6 个月进行 NCS 检查。NCS 使用远端运动潜伏期（DML）和感觉传导速度（SCV）作为参数。计算 NCS 和 DASH 或 GS 之间的相关系数。使用接收者操作特征曲线确定 NCS 阈值以预测 DASH 和 GS 的改善。
结果
术前和术后 6 个月和 12 个月的 GS 平均评分分别为 21.3、22.3 和 22.8，而术前和术后 6 个月和 12 个月的 DASH 平均评分分别为 28.8、18.3 和 12.2。术前/术后 6 个月的平均 NCS 评分（DML 和 SCV）分别为 7.3/5.4 和 27.8/36.7。术前 NCS 与 DASH 和 GS 均无相关性。术后 SCV 与握力变化相关（6-12 个月，r = 0.67；0-12 个月，r = 0.60）和 DASH（0-12 个月，r = 0.77）。此外，术后 DML 与 DASH 的变化相关（6-12 个月，r = -0.33；0-12 个月，r = -0.59）。SCV 截断值为 38.5/45.0 或更高时，GS/DASH 改善的预测敏感性为 50.0%/66.7%，特异性为 100%/100%。当 DML 截断值为 4.4/4.4 或更低时，GS/DASH 改善的预测敏感性为 83.3%/66.7%，特异性为 100%/66.7%。
结论
术后 6 个月的 NCS 可用于预测 CTS 患者术后 6 个月后临床结果的改善。
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