85例中重度肘管综合征患者术前手部神经运动传导速度和握力对预后的影响

高星; 孟玉凤; 张桐桐; 王伟

doi:10.16766/j.cnki.issn.1674-4152.003713

85例中重度肘管综合征患者术前手部神经运动传导速度和握力对预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.003713

河北省中西医结合骨关节病研究重点实验室(筹)/河北省沧州中西医结合医院手显微外二科，河北沧州 061001

基金项目:

河北省中医药管理局科研计划项目 2021299

详细信息

通讯作者:
高星, E-mail: gaoxing1109@yeah.net

中图分类号: R337.3
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出版历程
- 收稿日期: 2024-03-14
- 网络出版日期: 2024-12-28

The effect of preoperative hand motor nerve conduction velocity and grip strength on prognosis in 85 patients with moderate to severe cubital tunnel syndrome

Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing)/Department of Hand Microsurgery, Cangzhou Integrated Chinese and Western medicine hospital, Cangzhou, Hebei 061001, China

摘要

摘要: 目的探讨85例中重度肘管综合征患者术前手部神经运动传导速度(MNCV)、握力对预后的影响，为其预后的评估提供指导。方法收集2021年7月—2023年7月于河北省沧州中西医结合医院治疗的85例中重度肘管综合征患者的病例资料，比较不同肘管综合征分级、不同预后患者的手部MNCV、握力水平，并评估上述指标预测预后不良的价值。结果 (1) 手术前，重度组患者不同状态下的手部MNCV及握力均较中度组低(P < 0.05)；手术后，2组患者上述指标均升高，且中度组较重度组高(P < 0.05)；(2)手术后，手部MNCV及握力比较：功能恢复优组>功能恢复良组>功能恢复可组>功能恢复差组，差异有统计学意义(P < 0.05)；(3)81例完整随访数据中功能恢复可及差的患者20例(预后不良组)，余61例为预后良好组，预后不良组患者不同状态下的手部MNCV及握力均较预后良好组低(P < 0.05)；(4)中重度肘管综合征患者不同状态下的手部MNCV及握力预测患者预后不良的效能较高；(5)预后不良组患者年龄≥50岁、病程≥10个月、长期屈肘工作及肌肉萎缩的占比较预后良好组高(P < 0.05)；(6)长期屈肘工作及肌肉萎缩是中重度肘管综合征患者预后不良的危险因素(P=0.008、0.001)。结论接受治疗后的中重度肘管综合征患者，在不同状态下的手部MNCV及握力均提高，且中度肘管综合征患者上述指标提升更明显，均可作为预测中重度肘管综合征预后的有效指标。
- 中重度肘管综合征 /
- 手部神经运动传导速度 /
- 握力 /
- 预后
Abstract: Objective To investigate the influence of hand motor nerve conduction velocity (MNCV) and grip strength on prognosis in 85 patients with moderate to severe cubital tunnel syndrome, and to provide guidance for prognosis evaluation. Methods Data of 85 patients with moderate to severe cubital tunnel syndrome treated in Cangzhou Hospital of Integrated Chinese and Western Medicine, Hebei Province from July 2021 to July 2023 were collected. Different cubital tunnel syndrome grades, different prognosis, and grip strength levels were compared, and the value of these indicators in predicting poor prognosis was evaluated. Results (1) Before the operation, the hand MNCV and grip strength in the severe group were lower than those in the moderate group (P < 0.05); After the operation, the above indexes increased in the two groups, and the moderate group was higher (P < 0.05); (2) After the surgery, comparison of hand MNCV and grip strength as follows: Excellent functional recovery group > good functional recovery group > fair functional recovery group > poor functional recovery group, with statistically significant difference (P < 0.05); (3) Among the 81 patients with complete follow-up data, 20 patients had poor functional recovery (poor prognosis group), and the remaining 61 patients were considered as the good prognosis group. The hand MNCV and grip strength in the poor prognosis group were lower under different conditions (P < 0.05); (4) Hand MNCV and grip strength under different conditions of moderate and severe cubital tunnel syndrome were more effective in predicting the poor prognosis of patients. (5) The proportion of patients aged ≥50 years, duration ≥10 months, long-term elbow bending and muscle atrophy in the poor prognosis group was higher than that in the good prognosis group (P < 0.05); (6) Long-term elbow bending and muscle atrophy were risk factors for poor prognosis in patients with moderate to severe cubital tunnel syndrome (P=0.008, 0.001). Conclusion After treatment, the cubital length hand MNCV and grip strength of patients with moderate and severe cubital tunnel syndrome are improved in different states, and the above indexes were improved more significantly in patients with moderate cubital tunnel syndrome, which could be used as effective indicators to predict the prognosis.
- Moderate to severe cubital tunnel syndrome /
- Hand motor nerve conduction velocity /
- Grip strength /
- Prognosis

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图 1 中重度肘管综合征患者不同状态下的手部MNCV及握力预测中重度肘管综合征预后不良的ROC曲线

Figure 1. ROC curve for predicting poor prognosis in patients with moderate to severe cubital tunnel syndrome based on hand MNCV and grip strength in different states

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表 1 不同肘管综合征分级患者手术前后不同状态下的手部MNCV及握力比较(x ±s)

Table 1. Comparison of hand MNCV and grip strength in patients with different grades of cubital tunnel syndrome before and after surgery(x±s)

组别	例数	V1(m/s)		V2(m/s)		V3(m/s)		V4(m/s)		握力(N)
组别	例数	手术前	手术后	手术前	手术后	手术前	手术后	手术前	手术后	手术前	手术后
中度组	59	34.52±2.33	42.39±3.42^b	33.27±2.16	41.44±2.61^b	32.46±2.53	40.62±3.21^b	31.76±2.85	40.89±2.82^b	23.15±2.76	28.68±2.07^b
重度组	26	32.08±2.47	39.76±3.54^b	30.38±2.23	38.52±2.78^b	29.71±2.64	37.81±3.43^b	28.43±2.94	37.97±3.04^b	20.08±2.83	24.33±2.34^b
统计量		4.368^a	3.232^c	5.628^a	4.659^c	4.557^a	3.642^c	4.916^a	4.295^c	4.689^a	8.576^c
P值		< 0.001	0.002	< 0.001	< 0.001	< 0.001	0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：^a为t值，^c为F值；与同组手术前比较，^bP < 0.05。

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表 2 手术后不同功能恢复程度肘管综合征患者手部MNCV及握力比较(x±s)

Table 2. Comparison of hand MNCV and grip strength in patients with different functional recovery levels after surgery(x±s)

功能恢复情况	例数	V1(m/s)	V2(m/s)	V3(m/s)	V4(m/s)	握力(N)
优	37	43.75±3.11^ab	42.52±2.45^abc	41.33±3.02^ab	41.19±2.77^ab	29.37±2.01^abc
良	25	42.13±3.49	40.27±2.62	39.86±3.38	40.63±2.84	27.82±2.18
可	16	38.08±3.74	38.35±2.88	37.52±3.46	37.96±2.93	24.43±2.24
差	7	36.21±4.52	36.13±3.43	36.23±3.85	36.08±3.58	21.66±2.61
F值		16.090	16.870	8.027	9.452	37.340
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：与功能恢复可组比较，^aP < 0.05；与功能恢复差组比较，^bP < 0.05；与功能恢复良组比较，^cP < 0.05。

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表 3 预后良好组及预后不良组患者不同状态下的手部MNCV及握力比较(x ±s)

Table 3. Comparison of hand MNCV and grip strength in patients with good prognosis and poor prognosis under different conditions(x±s)

组别	例数	V1(m/s)	V2(m/s)	V3(m/s)	V4(m/s)	握力(N)
预后良好组	61	42.46±3.43	41.62±3.51	41.09±3.79	40.74±3.83	28.94±3.34
预后不良组	20	38.52±3.74	37.75±3.78	37.42±3.94	36.48±4.02	23.41±3.52
t值		3.360	4.199	3.722	4.265	6.342
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

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表 4 中重度肘管综合征患者不同状态下的手部MNCV及握力预测中重度肘管综合征预后不良的ROC曲线

Table 4. ROC curve for predicting poor prognosis in patients with moderate to severe cubital tunnel syndrome based on hand MNCV and grip strength in different states

项目	AUC	95% CI	P值	cut-off值	Youden指数	灵敏度(%)	特异度(%)
V1	0.747	0.638~0.837	< 0.001	≤40.78 m/s	0.406	75.00	65.57
V2	0.848	0.751~0.918	< 0.001	≤37.25 m/s	0.668	75.00	91.80
V3	0.776	0.670~0.861	< 0.001	≤39.97 m/s	0.439	80.00	63.93
V4	0.757	0.649~0.845	< 0.001	≤37.40 m/s	0.487	70.00	78.69
握力	0.671	0.558~0.771	0.034	≤25.78 N	0.437	65.00	78.69

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表 5 预后良好组与预后不良组一般资料比较[例(%)]

Table 5. Comparison of general data between the good prognosis group and the poor prognosis group[cases (%)]

项目	例数	预后良好组(n=61)	预后不良组(n=20)	χ²值	P值
年龄(岁)				5.139	0.023
≥50	35	22(36.07)	13(65.00)
＜50	46	39(63.93)	7(35.00)
性别				0.200	0.655
男性	48	37(60.66)	11(55.00)
女性	33	24(39.34)	9(45.00)
病程(月)				11.148	0.001
≥10	47	29(47.54)	18(90.00)
＜10	34	32(52.46)	2(10.00)
BMI				0.105	0.745
≤24	39	30(49.18)	9(45.00)
＞24	42	31(50.82)	11(55.00)
长期屈肘工作				6.972	0.008
是	40	25(40.98)	15(75.00)
否	41	36(59.02)	5(25.00)
肘部外伤史				0.218	0.641
有	15	12(19.67)	3(15.00)
无	66	49(80.33)	17(85.00)
肌肉萎缩				5.039	0.025
是	62	43(70.49)	19(95.00)
否	19	18(29.51)	1(5.00)
振幅(mV)				0.389	0.533
≥5.0	52	38(62.30)	14(70.00)
＜5.0	29	23(37.70)	6(30.00)
潜伏期(ms)				0.033	0.855
≥9.0	54	41(67.21)	13(65.00)
＜9.0	27	20(32.79)	7(35.00)

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表 6 变量赋值情况

Table 6. Assignment of argument variables

变量	赋值方法
年龄	＜50岁=0，≥50岁=1
病程	＜10个月=0，≥10个月=1
长期屈肘工作	无=0，有=1
肌肉萎缩	否=0，是=1

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表 7 中重度肘管综合征患者预后不良的多因素logistic回归分析

Table 7. Multivariate logistic regression analysis of poor prognosis in patients with moderate to severe cubital tunnel syndrome

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.739	0.421	3.081	0.080	2.094	0.917~4.779
病程	0.812	0.518	2.457	0.118	2.252	0.816~6.217
长期屈肘工作	0.683	0.257	7.063	0.008	1.980	1.196~3.276
肌肉萎缩	0.727	0.223	10.628	0.001	2.069	1.336~3.203

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