| 高频超声在腕管综合征病因学评价中的应用 |
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| 引用本文： | 权赫磊,罗渝昆,王月香,朱亚琼,姜波. 高频超声在腕管综合征病因学评价中的应用[J]. 中华医学超声杂志(电子版), 2022, 19(5): 454-458. DOI: 10.3877/cma.j.issn.1672-6448.2022.05.011 |
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| 作者姓名： | 权赫磊 罗渝昆 王月香 朱亚琼 姜波 |
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| 作者单位： | 1. 100853 北京，解放军医学院；100853 北京，解放军总医院第一医学中心超声诊断科；570311 海口，武警海南总队医院2. 100853 北京，解放军医学院 |
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| 摘 要： | 目的探讨高频超声在评价腕管综合征病因中的作用。 方法选取2015年3月至2019年12月在解放军总医院经电生理检查诊断或手术证实腕管综合征的患者，首先对腕管进行灰阶超声检查，观察腕管内正中神经的位置、走向，神经受压情况、神经束结构、神经外膜回声以及神经周围结构的异常，横切面扫查腕管及正中神经时观察正中神经横截面情况、测量豌豆骨平面正中神经的横截面积以及观察神经周围结构的异常；应用能量多普勒超声以观察正中神经及腕管内其他结构的血流情况。采用独立样本t检验比较患侧腕和无症状侧腕豌豆骨平面正中神经横截面面积的差异。利用受试者操作特征（ROC）曲线分析豌豆骨平面正中神经的横截面面积的诊断价值并找出最佳的诊断界值。 结果腕管综合征患者63例，共95侧腕。腕管综合征患者高频超声表现为腕管内正中神经的卡压近端肿胀、增粗，神经束结构模糊，神经外膜增厚。能量多普勒超声显示正中神经内血流信号增加。患侧腕与无症状侧腕的豌豆骨平面正中神经横截面面积比较［（15.91±5.95）mm2 vs（8.71±1.62）mm2］，差异具有统计学意义（t=-2.51，P＜0.001），ROC曲线下面积为0.946，截断值为10.5 mm2时，敏感度为89.5%，特异度为83.9%。高频超声诊断为特发性腕管综合征者73侧腕（76.8%，73/95），可明确诊断病因的共22侧腕（23.2%，22/95），其中13侧腕（13.7%，13/95）为腕管内屈肌腱腱鞘炎，1侧腕（1.1%，1/95）为腕管内屈肌腱腱鞘积液，2侧腕（2.1%，2/95）为腕管内腱鞘囊肿，1侧腕（1.1%，1/95）为腕管内实性肿块，2侧腕（2.1%，2/95）为腕管内指浅屈肌肌腹过低，2侧腕（2.1%，2/95）为正中神经高位分叉伴永存正中动脉，1侧腕（1.1%，1/95）为桡骨远端术后瘢痕压迫正中神经。 结论高频超声可作为评估腕管综合征病因的一种手段。
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| 关 键 词： | 腕管综合征 超声 正中神经 |
| 收稿时间： | 2020-09-16 |
Value of high-resolution ultrasound in etiological evaluation of carpal tunnel syndrome |
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| Helei Quan,Yukun Luo,Yuexiang Wang,Yaqiong Zhu,Bo Jiang. Value of high-resolution ultrasound in etiological evaluation of carpal tunnel syndrome[J]. Chinese Journal of Medical Ultrasound, 2022, 19(5): 454-458. DOI: 10.3877/cma.j.issn.1672-6448.2022.05.011 |
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| Authors: | Helei Quan Yukun Luo Yuexiang Wang Yaqiong Zhu Bo Jiang |
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| Affiliation: | 1. PLA Medical College, Beijing 100853, China; Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Armed Police Hainan Corps Hospital, Haikou 570311, China2. Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China |
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| Abstract: | ObjectiveTo assess the value of high-resolution ultrasound in the etiological assessment of carpal tunnel syndrome (CTS). MethodsSixty-three patients (95 wrists) with CTS diagnosed by electrophysiological ?ndings or surgical operation were examined by ultrasonography from March 2015 to December 2019 at the Chinese PLA General Hospital. Ultrasound examinations were performed to assess the position, site of compression, fascicles, epineurium, and the surrounding structures of the median nerve. The cross section of the median nerve at the level of the pisiform bone was measured. Intraneural power Doppler signals were also evaluated. The t-test of independent samples was used to compare the difference of the cross section area between the symptomatic and contralateral asymptomatic wrists. Using the receiver operating characteristic (ROC) curve, the diagnostic value of the cross-sectional area of the median nerve at the pea bone plane was analyzed, and the best diagnostic boundary value was identified. ResultsHigh-resolution ultrasound showed increased cross-sectional area, blurry structure of nerve bundles, and thickening of the epineurium of the median nerve in patients with CTS. Power Doppler ultrasound showed increased intraneural signals of the median nerve. There were significant differences in the cross section area of the median nerve at the level of the pisiform bone between the affected and asymptomatic wrists [(15.91±5.95) mm2 vs (8.71±1.62) mm2; t=-2.51, P＜0.001]. The area under the ROC curve was 0.946. A cut-off point of 10.5 mm2 resulted in a sensitivity of 89.5% and specificity of 83.9%. The high frequency ultrasound diagnosed idiopathic carpal tunnel syndrome in 73 sides (76.8%, 73/95). A total of 22 wrists (23.2%, 22/95) could be clearly diagnosed, which included 13 cases (13.7%, 73/95) of flexor tendon tenosynovitis in the carpal tunnel, 1 case (1.1%, 1/95) of flexor tendon sheath effusion in the carpal tunnel, 2 cases (2.1%, 2/95) of carpal canal ganglion cyst, 1 case (1.1%, 1/95) of carpal canal solid mass, 2 cases (2.1%, 2/95) of superficial flexors of the fingers in the carpal tunnel, 2 cases (2.1%, 2/95) of upper bifurcation of the median nerve with persistent median artery, and 1 case (1.1%, 1/95) of distal radius postoperative scar compressing the median nerve. ConclusionHigh-resolution ultrasound is useful for assessing the etiology of CTS. |
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| Keywords: | Carpal tunnel syndrome Ultrasonography Median nerve |
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