43例不典型腕管综合征的临床症状及神经肌电图分析

摘要

Objective To summarize and analyze the clinical symptoms,electromyogram (EMG) changes and treatment in atypical carpal tunnel syndrome (CTS) and accumulate experience for clinical diagnosis and treatment.Methods The clinical data of 43 patients with atypical CTS treated in our hospital from June,2009 to February,2014 were analyzed retrospectively.Results The most common symptoms of atypical CTS in 43 cases were numbness of one side in the upper limbs with or without upper limb pain,fatigue,thenar muscle atrophy,which could be easily misdiagnosed as cervical spondylosis and peripheral neuritis.The dominant hand was the commonest involved hand,but it often affected hands in bilateral sides.EMG showed that the sensitive fibres of the median nerve were commonly involved.Along with the progression of the disease,the motor nerves might be also injured.Conclusion Atypical CTS is easily misdiagnosed or underdiagnosed only based on clinical symptoms and signs.The EMG examination is the most common auxiliary examination.Early treatment can achieve a good prognosis.The conservative treatment is preferred first,then surgery if unsatisfactory.%目的 总结分析不典型腕管综合征的临床表现、神经肌电图改变及治疗方法,为临床诊治积累经验.方法 对2009年6月至2014年2月于本院诊治的43例不典型腕管综合征患者的临床资料进行回顾性分析.结果 43例不典型腕管综合征患者中,最常见的症状为一侧上肢麻木,还可出现上肢胀痛、乏力,大鱼际肌萎缩;易误诊为颈椎病、末梢神经炎等;以优势手发病多见,常可累及双侧;神经肌电图检查显示正中神经感觉纤维最常受累,随着病情进展,可出现运动纤维损害.结论 不典型腕管综合征仅依靠临床症状和体征,往往造成误诊、漏诊,神经肌电图检查是诊断腕管综合征的最常用辅助检查,该病早期治疗效果较好,首选保守治疗,效果不理想可考虑手术治疗.