| Abstract: | 研究背景
腕隧道症候的產生，有許多的相關因素，而懷孕即是其中之一【1-10】。又最近有些研究報告指出個人的體質因素，如肥胖、腕徑比例及身體質量指數，對於腕隧道症候的產生，有更密切的關係【9-17】。
懷孕期間的婦女發生此症之比率(2~25%)，較一般群眾(0.1~1.55%)為高【1-5，10, 17-35】，而且在懷孕時孕婦身體會產生明顯的變化，即包括水腫、體重增加、身體質量指數的增加等【7,10,17-18,21】，因此觀察孕婦腕隧道症的產生;患者的腕徑比例與身體質量指數及其正中神經電氣生理之變化，來檢視研究造成孕婦腕隧道症候的可能致病原因。
材料與方法
本研究共收集34位在懷孕期間產生手部不適臨床症狀的孕婦，和30位在懷孕期間沒有手部臨床症狀的孕婦為控制組；這些病人的來源，主要由本院婦產科及開業婦產科醫師轉介而來。64位懷孕婦女，於產前都接受問卷、臨床症狀、腕徑比例與身體質量指數的評估；有臨床症狀的34位孕婦都於產前接受神經電氣生理的檢查；然而只有其中18位，於生產後三個月後再次接受腕徑比例與身體質量指數的測量，與神經傳導電氣生理的檢查。
研究結果
本研究中有手部不適臨床症狀的34位孕婦，和在懷孕期間沒有手部臨床症狀的30位孕婦，在體重增加量、身體質量指數（BMI）增加量、腕徑比例、或腕徑比例大小，確實有明顯的身體結構上的差異；但是否有水腫，在這兩組中則無差異。
有臨床症狀的34位孕婦，以神經電氣生理的檢查，診斷出有24位為腕隧道症候群患者，其中以夜間睡眠時會手部麻木、平時之手部麻木症狀、和Tinel’s sign與Phalen’s sign的有無，與檢出率較有相關；但與身體結構的變化上則無差異。
又這34位孕婦中，只有18位願意於產後三個月後再次接受檢查，其中：仍有7位為腕隧道症候群患者，而11位沒有為腕隧道症候群。這些產後的婦女，其體重、身體質量指數（BMI）、腕徑比例等的變化，和是否仍有腕隧道症候群無關。但是她們的神經電氣生理檢查中，發現其運動和感覺神經傳導速度（NCV）、與感覺神經的遠端潛時（distal latency）確實有明顯的變化。
結 論
孕婦是否產生手部不適之症狀（包括腕隧道症候群），和腕徑比例大小、身體質量指數的高低或變化應有關係；雖然孕婦的神經傳導速率於產前、產後雖有明顯的變化；但目前本研究仍缺乏直接的證據，來證實孕婦是否會發生腕隧道症，與其懷孕期間腕徑比例大小、身體質量指數的變化有關。又於產後仍有腕隧道症者，是否仍有其他因素的影響，則需更進一步的觀察和探討。
Background：
Many factors are contributable to Carpal Tunnel Syndrome（CTS） 【1-10】. Pregnancy, as well as other physical characteristics, is attributable to CTS such as obesity, wrist ratio and body mass index (BMI). Some of these factors begin to develop with pregnancy and last throughout the whole gestation period or ever after delivery【9-17】.
The prevalence rate of CTS in the pregnant women has been reported between 2% and 25%, higher than that in the general population (0.1-1.55%)【1-5,10, 17-35】. Women have a series of physiological changes such as edema, weight gain, and BMI in pregnancy【7,10,17-18,21】. Hence, changes in wrist ratio, BMI and median nerve electrophysiologic findings in the pregnant with CTS can provide important information for evaluating the possible pathogenesis in the CTS of the pregnancy women.
Materials and Methods：
This study enrolled 34 pregnant women with hand discomfort, and other 30 controls. These patients were referred mainly from the obstetric department and a few private practice obstetricians. We performed a questionnaires interview, clinical examination, as well as assessment of wrist ratio and BMI of these 64 cases. All the 34 women with clinical manifestations received a complete nerve conduction study on the hands, but only 18 of them received a follow-up evaluation 3 months after delivery.
All statistical analyses were performed using the SPSS software package. A two-tailed P value of <0.05 was considered statistically significant.
Result ：
Weight gain, BMI increase and increased wrist ratio were significantly more prominent in the pregnant women with hand syndrome than those with no clinical manifestation of hand discomfort.
Twenty-four out of the 34 cases with clinical hand symptom, had electro-physiological evidence of Carpal Tunnel Syndrome.
In the follow-up nerve conduction study after delivery, 7 of them still had electro-physiological evidence of Carpal Tunnel Syndrome. The remaining 11 women were free of Carpal Tunnel Syndrome. Changes in the body weight, BMI, wrist ratio did not differ significant between these 2 groups. However, improvement of electro-physiology finding was clearly demonstrated in the follow-up nerve conduction study.
Conclusion：
The hand discomfort in pregnancy seems related to the changes of wrist ratio and BMI. Although findings in the nerve conduction velocity change significantly after pregnancy, these women not necessarily have clinical manifestations of CTS. For those postpartum women who still had Carpal Tunnel Syndrome, we need further evaluation in the future. |
