Ohno Katsunori, Fujino Keitaro, Fujiwara Kenta, Yokota Atsushi, Neo Masashi
Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Department of Orthopedic Surgery, Hokusetsu General Hospital, 6-24 Kitayanagawa-cho, Takatsuki, Osaka, 569-8686, Japan.
J Med Ultrason (2001). 2022 Apr;49(2):279-287. doi: 10.1007/s10396-022-01195-6. Epub 2022 Mar 3.
This study aimed to examine the associations between sonographic measurements of the abductor pollicis brevis (APB), grip and pinch strength, and distal motor latency (DML) in patients with carpal tunnel syndrome (CTS) before and after surgery.
We prospectively studied patients (46 hands) who underwent 1 year of postoperative follow-up after endoscopic carpal tunnel release. The patients underwent ultrasound (US) scans, grip and pinch strength assessment, a nerve conduction study, and patient-reported outcome measures (Carpal Tunnel Syndrome Instrument and Michigan Hand Outcomes Questionnaire) before and 1 year after surgery. The standardized response mean was calculated to compare the sensitivity of clinical changes in these measurements.
US measurements (thickness of the APB and the cross-sectional area of the APB) and muscle strength (grip strength, key pinch, and tip pinch) were greater, and DML was reduced after surgery compared with those before surgery (all P < 0.05). Patient-reported outcome measures also showed clinical improvement 1 year after surgery (P < 0.05). US measurements of the APB were significantly correlated with grip and pinch strength (all P < 0.05), but not with DML, before surgery and 1 year after surgery. The standardized response mean showed a large responsiveness for US measurements of the APB and patient-reported outcome measures.
US evaluation of the APB after CTS can complement the evaluation of grip and pinch strength in the clinical setting. Postoperative recovery of the APB leads to improved motor dysfunction in CTS. Therefore, US measurement of the APB could be a useful tool for evaluating motor function.
本研究旨在探讨腕管综合征（CTS）患者手术前后拇短展肌（APB）的超声测量值、握力和捏力以及远端运动潜伏期（DML）之间的关联。
我们对46只手的患者进行了前瞻性研究，这些患者在内镜下腕管松解术后接受了1年的术后随访。患者在手术前和手术后1年接受了超声（US）扫描、握力和捏力评估、神经传导研究以及患者报告的结局指标（腕管综合征量表和密歇根手功能结局问卷）。计算标准化反应均值以比较这些测量中临床变化的敏感性。
与手术前相比，手术后US测量值（APB厚度和APB横截面积）和肌肉力量（握力、关键捏力和指尖捏力）更大，DML降低（所有P<0.05）。患者报告的结局指标在手术后1年也显示出临床改善（P<0.05）。手术前和手术后1年，APB的US测量值与握力和捏力显著相关（所有P<0.05），但与DML无关。标准化反应均值显示APB的US测量值和患者报告的结局指标具有较大的反应性。
CTS后对APB进行超声评估可在临床环境中补充握力和捏力评估。CTS患者APB的术后恢复导致运动功能障碍改善。因此，APB的US测量可能是评估运动功能的有用工具。
