ارزیابی ارزش تشخیصی سونوگرافی در مقابل روش‌های الکترودیاگنوستیک در تشخیص سندرم Carpal Tunnel

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دستیار، گروه نورولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استادیار، گروه نورولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: نوروپاتی عصب Median به علت تحت فشار قرار گرفتن عصب در ناحیه‌ی مچ یا همان سندرم Carpal tunnel (Carpal tunnel syndrome یا CTS)، شایع‌ترین نوروپاتی ناشی از گیر افتادن عصب می‌باشد. CTS شیوع بالایی دارد و عدد تقریبی آن 6/280 در هر 100000 بیمار در سال تخمین زده شده است. تشخیص دقیق این سندرم، به عنوان راهنمای درمان و پیش‌گیری از عوارض و ناتوانی‌های ناشی از آن ضروری است.روش‌ها: مطالعه‌ی حاضر از دی ماه 1392 تا فروردین ماه 1393 بر روی 64 بیماری که با علایم بالینی CTS به طور سرپایی به درمانگاه مرکز آموزشی- درمانی الزهرای (س) اصفهان مراجعه کردند، انجام شد. 54 نفر از این بیماران زن و 10 نفر مرد بودند. تمام بیماران تحت ارزیابی سونوگرافی و بررسی هدایت عصبی قرار گرفتند. مقادیر مختلف سطح مقطع عصب Median و نسبت سطح مقطع در مچ به بازو اندازه‌گیری شد و Cut of point مطلوب برای Wrist to forearm ratio (WFR) جهت تشخیص CTS تعیین شد.یافته‌ها: Cut of point به دست آمده از طریق منحنی Receiver operating characteristic (ROC) برای WFR که حساسیت (Sensitivity) و ویژگی (Specificity) مقبولی داشته باشد، 07/2 بود و سطح زیر منحنی ROC برابر با 8/0 و با انتخاب این Cut of point حساسیت 76 درصد و ویژگی 83 درصد برای تشخیص CTS از طریق سونوگرافی مطرح می‌شود. همچنین، مطالعه‌ی حاضر نشان داد که با انتخاب Cut of point برابر با 07/2 برای WFR در عصب Median ارزش اخباری مثبت (Positive predictive value یا PPV) 95 درصد و ارزش اخباری منفی (Negative predictive value یا NPV)، 45 درصد بود.نتیجه‌گیری: بر طبق سایر مطالعات انجام شده و بررسی مقالات موجود بر این نکته که نسبت سطح مقطع عصب در مچ به بازو شاخص دقیق‌تری است در اغلب موارد اتفاق نظر وجود دارد و این تکنیک زمان قابل توجهی را به روش تشخیصی اضافه نمی‌کند و با توجه به احتمال تفاوت‌های فردی، نژادی و آناتومیک، انتخاب این شاخص به جای سطح مقطع تنها در مچ، منطقی به نظر می‌رسد و با انجام این کار شاخص دقیق‌تری با قرار دادن هر فرد به عنوان شاهد خود به دست خواهد آمد. نتایج اولیه‌ی این مطالعه، حساسیت بالایی برای این شاخص به عنوان شاخص تشخیصی CTS مطرح کرده است. یافته‌های اولیه‌ی این مطالعه، حساسیت بالایی برای WFR نشان داده است، اما مطالعه‌ی بزرگ‌تری با حجم نمونه‌ی بیشتر جهت تأیید این موضوع لازم است.

کلیدواژه‌ها

عنوان مقاله [English]

Comparing the Diagnostic Value of Ultrasonography with Electrodiagnostic Tests in Carpal Tunnel Syndrome

نویسندگان [English]

  • Mohammad Reza Mohaghegh 1
  • Majid Ghasemi 2
  • Keivan Basiri 2
  • Ali Asghar Okhovat 2
  • Bagher Zaki 1
1 Resident, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Median neuropathy due to nerve compression in the wrist, or carpal tunnel syndrome (CTS), is the most common entrapment neuropathy. Incidence of CTS is high at an estimated value of 280.6 per 100,000 patients per year. Accurate diagnosis of CTS is essential for treatment and preventing disability and morbidity.Methods: 64 patients with clinical diagnosis of CTS from the out-patient clinic of Alzahra Hospital, Isfahan, Iran were evaluated between January and March 2013. All the patients (54 women and 10 men) underwent nerve conduction study (NCS) and ultrasonography. The cross sectional area of the median nerve at the level of pisiform bone and 12cm proximal to that in elbow was estimated via ultrasonography which were used to calculate wrist/forearm ratio(WFR). The cut-off point value for WFR of median nerve was assessed and sensitivity and specificity of ultrasonography for CTS diagnosis was also determined.Findings: The optimal diagnostic cut-off values of CTS that we obtained by ROC curve was 2.07 and the areas under the ROC curve, was 0.8. This cut-off value had a sensitivity of 76%, specificity of 83%, positive predictive value (PPV) of 95% and negative predictive value (NPV) of 45%.Conclusion: The WFR is a new option in the ultra-sonographic diagnosis of CTS. This technique does not add significant time to routine ultra-sonographic examination .The use of a ratio also helps to omit the variability between populations and anatomic variation. Our initial findings suggest a high sensitivity for this method, but study of a larger population is needed for confirmation.

کلیدواژه‌ها [English]

  • Carpal tunnel syndrome
  • Ultrasonography
  • Cross sectional area

مراجع

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مجله دانشکده پزشکی اصفهان
دوره 34، شماره 370 - شماره پیاپی 370
فروردین و اردیبهشت 1395
صفحه 41-48

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سابقه مقاله

  • تاریخ دریافت: 28 مهر 1394
  • تاریخ بازنگری: 31 فروردین 1403
  • تاریخ پذیرش: 17 فروردین 1401

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