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Carpal Tunnel Syndrome in Long-Term Hemodialysis Patients
長期血液透析病人發生腕道症候群的案例分析
摘要
在一般族群中，腕道症候群的發生，多與某些特殊行業或一些系統性疾病有關。但是對長期接受血液透析的病人而言，主要有三個因素可能造成透析相關的腕道症候群：包括動靜脈廔管造成局部水腫，靜脈壓升高或缺血性傷害；潛藏的多發性週邊神經病變；以及β2微球蛋白所造成的類澱粉沉積。本研究分析42位首次診斷有腕道症候群的長期血液透析病患（共70例患肢）以瞭解可能因素對此疾病的影響。結果顯示42位病患中有23位（54.76%）為男性，19位（45.24%）為女性，年齡分佈由32.33至73.58歲（平均55.31±10.46歲）。接受血液透析時間，除一位為1.33年外，其餘在5.17至16.33年間（平均10.41±3.66年，中間數8.83年）。42位病患中有4位（9.52%）有糖尿病，28位（66.67%）為雙側性腕道症候群，12位（28.57%）有多發性週邊神經病變。而70例腕道症候群患肢中，有36例（51.43%）患肢上有動靜脈廔管。結論：有接近一半的腕道症候群患肢上並沒有動靜脈瘻管，且只有不到三分之一的患者同時有多發性週邊神經病變，所以其他可能因子（如β2微球蛋白類澱粉沉積），仍是造成腕道症候群的重要因素。對於長期需要接受血液透析的病患，尤其是透析時間超過5年以上者，如有手部的相關症狀，應特別留意是否有腕道症候群的發生。
並列摘要
Systemic diseases such as rheumatoid arthritis, hypothyroidism, peripheral neuropathy and diabetes mellitus can contribute to carpal tunnel syndrome (CTS). However, three factors are considered important for CTS in hemodialysis patients, including local effect of arteriovenous fistula (AVF) wit hedema, venous hypertension or steal syndrome; polyneuropathy because of uremia or diabetes mellitus (DM); and amyloidosis due to β2-microglobulin (β2M) deposition. This study aimed to evaluate possible factors for CTS in long-term hemodialysis patients. The study examined 42 chronic hemodialysis with 70 CTS hands that were first diagnosed and treated with plastic surgery between Jan 1987 and Aug 2000. Of the 42 patients, 23 (54.76%) were male and 19 (45.24%) were female. The ages of the patients ranged from 32.33 to 73.58 years, with an average of 55.31±10.46 years. The duration of dialysis ranged from 5.17 to 16.33 years (with one exceptional case of 1.33 years), with an average of 10.41±3.66 years and a median of 8.83 years. Only 4 patients (9.52%) had DM. Bilateral CTS was found in 28 patients (66.67%), and 12 patients (28.57%) were found to have peripheral polyneuropathy. Of the 70 hands with CTS, only 36 hands (51.43%) had AVF on them. Conclusion: approximately one-half of the nads with CTS had no AVF, and less than one-third of CTS patients hand peripheral polyneuropathy. That is, other factors (includingβ2M amyloid deposition) were important for CTS. CTS should be suspected in chronic dialysis patients with any related clinical symptoms or signs, particularly when the dialysis duration exceeds 5 years.