To Evaluate The Value Of Electromvography Combined With Ultrasound In The Early Diagnosis And Prognosis Of Caral Tunnel Syndrome

ObjectiveTo evaluate the value of electromyography combined with ultrasound in the early diagnosis and prognosis of 117 carpal tunnel syndrome(CTS)patients within three months.Subjects And Methods117 CTS cases(169 affected upper limbs)within three months were randomly enrolled in this study as case group,and 69 age and gender matched healthy volunteers served as control group during December 2018 to December 2019,Nerve conduction and needle electromyography were performed in all the cases.The measured parameters included:motor latency(DML),motor conduction velocity(MCV),sensory conduction velocity(SCV),complex muscle action potential(CMAP)and sensory nerve Action potential,snap),and observe the shape and timing of motor unit potential(MUP)during small force contraction,and the type of muscle recruitment during large force contraction.The length of median nerve in the carpal canal was explored by longitudinal scanning of the carpal canal and its internal structure.The cross sectional area(CSA)of median nerve in the pea bone plane was recorded,and The hardness and elasticity of the median nerve was investigated by real-time shear wave elastic imaging.The shear wave velocity(SWV)was also measured.After the examination,all patients filled in the Boston carpal tunnel questionaire(bctq)score as B1,and received conservative treatment(brace brake,taking Mecobalamin capsule and calcium hydroxybenzoate dispersible tablet).After 3 months of treatment,the questionnaire score was evaluated as B2,and the relative score change value A was calculated as follows,A=B1-B2/B1 The higher the value A is,the better the treatment effect is.When A≥0.46,the symptoms are obviously improved.Finally,the data were analyzed by spss21.0.When p<0.05,the results were considered as statistically significant.ResultsThere were 169 affected hands in 117 patients,including 27 left hands,38 right hands and 52 bilateral hands.The age of the patients was 24-77 years old,with an average of 52.96±11.45 years old,including 33 male and 84 female patients.The course of disease ranged from 2 weeks to 3 months,with an average of 1.52 ± 0.89 months.The positive results of nerve conduction examination were 148(87.57%)affected hands,48 of which were bilateral,21 of which were left and 31 of which were right.The positive rate of nerve conduction test was 87.57%,including DML prolongation in 105 hands(62.13%),CMAP decrease in 53 hands(31.36%),MCV decrease in 26 hands(15.38%),SNAP decrease in 90 hands(53.25%),SCV decrease in 129 hands(76.33%).There were significant differences in five parameters of nerve conduction test between the case group and the control group(P<0.05).39 hands(23.08%)had abnormal spontaneous potential,strong contractive phase or small contractive MUP.The positive rate of needle electromyography combined with nerve conduction examination was still 87.57%,which meant the former didn’t increase the positive rate on the basis of nerve conduction examinationThe positive results of ultrasonography were 120(71.01%)affected hands,31 bilateral,24 left,34 right,including 88 cases with increased CSA(52.07%)and 98 cases with increased SWV(57.9%).There were significant differences in CSA and SWV between the case group and the control group(P<0.05).The positive rate of EMG combined with ultrasonography was 97.04%,which was higher than that of EMG(87.57%)or ultrasonography(70.4I%).DML of median nerve was positively correlated with CSA(r=0.640,P<0.05);DML of median nerve was positively correlated with SWV(r=0.498,P<0.05)CMAP of median nerve was negatively correlated with CSA(r=-0.440,P<0.05);CMAP of median nerve was negatively correlated with SWV(r=-0.372,P<0.05)MCV of median nerve was negatively correlated with CSA(r=-0.346,P<0.05);MCV of median nerve was negatively correlated with SWV(r=-0.246,P<0.05)There was a negative correlation between snap and CSA(r=-0.401,P<0.05);there was a negative correlation between snap and SWV(r=-0.361,P<0.05)In the case group,the BCTQ score B1 of 169 affected hands was 2.60±0.45 at baseline.After conservative treatment,the BCTQ score of B2 was 1.65 ± 0.56,and the relative score change value A was 0.38± 0.12.After treatment,the score improved in 153 cases,not changed in 15 cases and deteriorated in 1 case.Among them,62 cases(36.69%)were significantly effective(A≥0.46),91 cases(53.85%)were effective(0<A<0.46),16 cases(9.47%)were ineffective(A≤0).The correlation analysis was performed between the rank data of theraputic effect and the parameters of electromyography or ultrasound respectively:DML,CMAP,MCV,snap,SCV,CSA and SWV of median nerve were all correlated with the treatment effect(P<0.05),DML was negatively correlated with the treatment effect(r=-0.360,P<0.05);CMAP was positively correlated with it(r=0.642,P<0.05);MCV was positively correlated with the treatment effect(r=0.281,P<0.05);snap was negatively correlated with the treatment effect(r=-0.360,P<0.05);SCV was positively correlated with curative effect(r=0.371,P<0.05);CSA was negatively correlated with curative effect(r=-0.370,P<0.05);SWV was negatively correlated with curative effect(r=-0.398,P<0.05).The order of relevance was as follows:CMAP>snap>SWV>SCV>CSA>DML>MCV,and the correlation between CMAP and efficacy was highest(r=0.642).The higher the CMAP,the better the short-term effect.MCV,DML,snap,SCV,CSA,SWV were weakly correlated with the efficacy(|r|<0.5)Conclusions1.Electromyography and ultrasonography have a better diagnostic value for early CTS,and the combination of them significantly reduces the false negative rate.For patients without abnormal nerve conduction,needling electromyography can assist in identifying different diagnosis;for patients with prolonged terminal latency but normal nerve conduction amplitude,needling electromyography can provide evidence of muscle denervation.2.There is a correlation between the parameters of them.The electrophysiological information of EMG and the morphological information of ultrasound complement each other,which reveals the early development of the disease.3.The parameters of EMG and ultrasonography have a certain correlation with the short-term prognosis of conservative treatment,among which CMAP has strong correlation with the prognosis(r=0.642).The lower the amplitude of motor conduction wave,the more serious the damage degree of median nerve,and the worse the short-term prognosis.So it can guide clinical operation to release as soon as possible.