腕隧道症候群之臨床症狀與神經電學診斷之相關性研究

Relationships between Clinical Symptoms and Electrodiagnosis in Carpal Tunnel Syndrome

趙珮瑛(Pei-Ying Chao) ； 林慧玲(Hui-Lin Lin) ； 潘信良(Shin-Liang Pan) ； 張權維(Chein-Wei Chang)

《台灣復健醫學雜誌》 32卷3期 (2004/09) Pp. 117-124

https://doi.org/10.6315/2004.32(3)02

摘要

腕隧道症候群是最常見的周邊神經病變之一。腕隧道症候群患者的自覺症狀表現十分多樣化，包括不同程度的麻木、疼痛、夜間症狀、無力……等。由於腕隧道症候群患者的自覺症狀之多樣性及不易量化，因此不容易將患者自覺症狀的嚴重程度與神經電學檢查的結果建立關聯性。本研究旨在探討原發性腕隧道症候群患者的臨床症狀嚴重程度與神經電學檢查結果的關聯性，並進一步評估自覺症狀對於病情嚴重度之代表性。
我們以問卷的方式將腕隧道症候群患者的自覺症狀嚴重程度量化，並嘗試由因素分析將自覺症狀歸類為手部麻木針刺、疼痛、無力三大症狀指標。將此三大症狀與電學診斷結果進行相關性分析後，我們發現麻木針刺感覺與電學檢查指標的相關性較高，分別與神經綜合分級呈正相關，與感覺神經傳導速率呈負相關。手部疼痛及無力指標與神經電學指標的相關性則未達統計上的意義。由此得知，不同的手部症狀所代表的臨床意義並不相同，尤其麻木針刺感覺是較有意義的指標。因此我們認為，臨床上評估腕隧道症候群患者時，應仔細區分出不同的症狀成分，尤其是患者麻木針刺感覺的嚴重程度，才能對患者的病情嚴重程度有較客觀的判斷。

關鍵字

腕隧道症候群 ； 神經電學診斷 ； 手部症狀

並列摘要

Carpal tunnel syndrome is one of the most common peripheral entrapment neuropathies. Patients with carpal tunnel syndrome experience numbness, pain, and/or weakness in the hands over the median nerve distribution area. In current practice, diagnosis of carpal tunnel syndrome is based on subjective symptoms and objective findings from physical examinations and electrodiagnosis. We examined 40 hands with carpal tunnel syndrome in 24 patients and evaluated the relation between symptom severity and electrodiagnosis. Subjective hand symptoms were obtained by self-administered questionnaire and were categorized as numbness, pain, or motor function according to factor analysis methods. Numbness symptoms were significantly related to electrodiagnosis findings of neurophysiological grading and sensory conduction velocity. The severity of numbness symptoms correlated with the abnormality of the electrodiagnosis results. Pain and motor function symptoms were not significantly associated with electrodiagnosis results. However, a nonsignificant inverse relation existed between pain severity and abnormality of electrodiagnosis results.
Our findings suggest a need to identify different components of hand symptoms in the diagnosis of carpal tunnel syndrome. Based on electrodiagnosis and symptom component analysis, a more accurate clinical estimate of disease severity can be obtained in patients with carpal tunnel syndrome.

並列關鍵字

carpal tunnel syndrome ； electrodiagnosis ； hand symptoms