The Use of Ultrasonography to Assess Outcomes and Prognostic Indicators in Carpal Tunnel Syndrome: A Study in Patients Treated with Night Splinting

超音波作為腕隧道症候群成效及預後因子：以夜間副木治療之研究

王琳毅(Lin-Yi Wang) ； 廖美雲(Mei-Yun Liaw) ； 黃郁琦(Yu-Chi Huang) ； 陳筱嵐(Hsiao-Lan Chen) ； 劉耀宗(Yiu-Chung Lau) ； 彭亞蘋(Ya-Ping Pong)

《台灣復健醫學雜誌》 44卷3期 (2016/09) Pp. 123-134

https://doi.org/10.6315/2016.44(3)01

摘要

Background: Controversy exists regarding the use of ultrasonography (US) to assess outcome variables and prognostic indicators of carpal tunnel syndrome (CTS). Objective: To investigate the value of US in evaluating outcomes and prognosis for CTS treated with night splinting. Methods: Fifty-eight hands with mild to moderate CTS were prospectively enrolled; 42 diseased hands completed the study. Satisfaction rating, symptom severity score (SSS), functional status score (FSS), nerve conduction study (NCS) data, and US data were evaluated as outcome variables before and after 3 and 6 months of night splinting. On an intent-to-treat basis, a binary logistic regression analysis was used to determine prognostic indicators of subjective satisfaction and receiver operating characteristic (ROC) curves were plotted. Results: After 6 months of splinting, 29 hands had good subjective outcomes and 13 had poor subjective outcomes. SSS, FSS, sensory conduction velocity (SCV) on NCS, and the cross-sectional area of the median nerve at the pisiform bone level (PCSA) on US improved significantly in hands with good satisfaction but not in hands with poor satisfaction. On an intent-to-treat basis, 29 hands were categorized as good or poor subjective outcomes respectively. According to regression model and the ROC curves, SCV and PCSA were independent prognostic indicators, and the optimal cut-off values of SCV and PCSA for good subjective outcome were ≥40m/s and ≤11.35 mm2 respectively. Conclusions: US is an appropriate tool for assessing outcome variables and a prognostic indicator of night splinting for CTS.

關鍵字

carpal tunnel syndrome ； ultrasonography ； nerve conduction study ； splint ； prognostic indicator

並列摘要

背景：超音波作為腕隧道症候群的預後因子仍有爭議。目的：針對輕度到中度腕隧道症候群夜間穿戴副木治療的個案，探討超音波是否能作為成效及預後的指標。方法：本研究納入58 隻輕度到中度腕隧道症候群的手，42隻手完成研究。在治療前、夜間副木治療三、六個月接受療效評量（主觀滿意度、症狀嚴重度評分symptom severity score （SSS）、功能狀態評量functional status score （FSS）、神經傳導檢查及超音波評估）。根據意向分析，使用二項回歸分析找出主觀滿意度的預後因子並畫出接受者操作特徵（receiver operating characteristic, ROC）曲線。結果：經過六個月副木治療，主觀滿意度好的有29 隻手，主觀滿意度差的有13 隻手。主觀滿意度好的其SSS, FSS, 感覺傳導速度, 及超音波上正中神經在豌豆骨旁的截面積（the cross-sectional area of themedian nerve at the pisiform bone level, PCSA）皆有顯著進步，但主觀滿意度差的都無進步。根據意向分析，各有29隻手分屬治療成功或失敗。依據回歸模式及ROC 曲線，感覺傳導速度與PCSA 是獨立預後因子；對於治療成功，其最佳切點值分別是≥40 m/s 及 ≤11.35 mm^2。結論：輕度到中度腕隧道症候群夜間穿戴副木的個案，超音波能作為成效及預後的指標。

並列關鍵字

腕隧道症候群(carpal tunnel syndrome) ； 超音波(ultrasonography) ； 神經傳導檢查(nerve conduction study) ； 副木(splint) ； 預後因子(prognostic indicator)

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