高频超声对臂丛神经显像和定位的价值

目的评价高频超声对臂丛神经显像和定位的价值。方法采用高频超声对30例志愿者行臂丛神经检查，主要在肌间沟、锁骨上、锁骨下及腋下4个部位。11例志愿者臂丛分布的4个部位上，在实时超声引导下进针及定位神经，然后在电神经器刺激下确认是否为神经。所有臂丛神经声像图特征、解剖的变化、进针和神经定位均被动态记录。结果臂丛神经在横断面上表现为圆形或椭圆形的低回声结构，内部由点状回声组成，肌间沟、锁骨上及腋下臂丛神经显示率均为100％，锁骨下臂丛神经显示率为97％。11例志愿者臂丛声像图上低回声结构在超声引导下行电刺激均被证实为神经组织。结论高频超声能提供高质量的臂丛神经声像图。超声引导下穿刺对臂丛神经阻滞麻醉有潜在应用价值。     

臂丛神经的超声解剖学研究

目的 应用超声研究臂丛神经解剖学特点,为超声引导臂丛神经阻滞提供解剖学依据.方法 应用高频超声研究24例健康人臂丛神经在腋路和肌间沟的解剖分布特点.结果 24例健康人臂丛神经完全显示.臂丛神经在腋路主要沿腋动脉走行;在肌间沟水平,臂丛神经分布于前、中斜角肌组成的肌间沟内.结论 超声能清晰显示臂丛神经各个主要分支.     

Sonographic evaluation of primary peripheral nerve repair.

OBJECTIVE. This feasibility study was undertaken to define the potential of sonography for the follow-up evaluation of patients with surgical repair after nerve transection and persistent impairment of nerve function. METHODS. Nineteen patients with primary repair of a transected peripheral nerve because of direct trauma or complex fractures were evaluated with sonography. All patients had persistent clinical symptoms and neurologic signs of impaired nerve function. In 11 patients who underwent second operations, the intraoperative findings were correlated with those of sonography. RESULTS. Reliable identification of repaired nerves with sonography was feasible in all patients. However, in some cases, sufficient visualization of the site of nerve coaptation was problematic because of extensive scarring. Sonographic findings included the appearance of partial discontinuity of nerve fascicles, detection of neuromas, and compression of nerves by overlying scars. Surgical correlation with sonographic findings was excellent for neuroma detection; however, definition of nerve continuity on sonography was sometimes impaired by scarring. CONCLUSIONS: Sonography has a high potential for follow-up examinations of peripheral nerves in relation to previous nerve repair in patients with persistent neurologic signs and symptoms of nerve impairment. Sonography may help in decisions for follow-up surgery by identifying lesions such as neuromas in continuity or discontinuous nerve elements--lesions that will possibly benefit from a second look.     

周围神经术前肌电图结果与术中所见的比较研究及误诊原因分析

目的 探讨肌电图(EMG)检查对周围神经损伤的诊断意义，分析误诊的原因。方法 收集2000年1月至2003年4月行手术治疗的周围神经损伤患者63例(69条神经)，按神经损伤特点分为开放性周围神经损伤组、闭合性周围神经损害组、臂丛损伤组和神经修复后再生组，各组患者均于术前进行肌电图检测，并将检测结果与术中所见进行比较、分析。结果 开放性周围神经损伤组术前EMG对神经完全损伤的诊断符合率为73.08％，与术中所见结果比较，差异有统计学意义。闭合性周围神经损害组对受损神经的定性、定位诊断，均在术中得到证实。臂丛损伤组的大体定位正确率达96．30％，完全符合率达70．37％；对臂丛完全根性损伤的检出率为68．52％，与磁共振的检出率(55．56％)相比，差异无统计学意义。神经修复后再生组5条神经，EMG结果与术中所见3条符合，2条不符合。69条神经中，EMG检查完全符合率为71.01％，基本符合率为85．51％，完全不符率为13．04％；假阳性率为4．49％，假阴性率为22．73％。结论 EMG检查对损伤神经的定位、定性诊断及神经修复后再生状况的评价在临床诊治中具有重要的指导意义，但可出现假阳性及假阴性结果，且以运动诱发电位的假阴性为多。术前EMG与磁共振检查相结合，可提高对臂丛神经完全根性损伤的检出率。     

High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease.

OBJECTIVE: The value of sonography for the diagnosis of diseases of the peripheral nervous system is only little known. This image presentation is intended to raise the awareness of sonographers and clinicians of the potential of sonography by giving an anatomic-sonographic correlation of lower extremity peripheral nerves and an overview of commonly encountered diseases. METHODS: On 2 lower extremity cadaver specimens, peripheral nerves were imaged in typical locations such as the tarsal tunnel. During sonography the nerve was injected with blue dye, and thin-slice anatomic sections were obtained at the scan level with a chain saw. In addition, sonographic images of patients with typical diseases are shown. RESULTS: An excellent anatomic-sonographic correlation was obtained, which underlines the feasibility of sonography for imaging of lower extremity peripheral nerves. Reliable results may be obtained with sonography of typical disease processes of lower extremity peripheral nerves. CONCLUSIONS: Recent developments in sonographic technology such as the introduction of high-frequency linear array transducers, compound imaging, and extended field-of-view imaging strongly improve the applicability of transcutaneous sonography for the examination of peripheral nerve disease.     

Sonography of Common Peripheral Nerve Disorders With Clinical Correlation

Sonography is now considered an effective method to evaluate peripheral nerves. Low cost, high resolution, the ability to image an entire limb in a short time, and dynamic assessment are several of the positive attributes of sonography. This article will review the normal appearance of peripheral nerves as shown with sonography. In addition, the most common applications for sonography of the peripheral nerves will be reviewed, which include entrapment neuropathies, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Clinical information related to nerve disorders is also included, as it provides valuable information that can be obtained during sonographic examinations, increasing diagnostic accuracy.     

The use of train of four monitoring for clinical evaluation of the axillary brachial plexus block

The axillary approach of brachial plexus anesthesia is the most commonly used technique for forearm and hand surgery. Dynamometer is known as objective test for the clinical assessment of motor block of the nerves in brachial plexus block. However, the use of this device may not always be practical in operating room. The train-of-four (TOF) test is a non-invasive peripheral nerve stimulator that shows the level of motor block of muscle relaxants. The aim of the study is to investigate the use of TOF testing as a peripheral nerve stimulator for objective clinical evaluation of motor block at axillary brachial plexus block. 44 patients were randomized according to the development of partial or complete motor in the axillary brachial plexus block. The nerves were selectively localized by nerve stimulation and ultrasound guidance. After obtaining an appropriate peripheral motor response, predetermined volumes of bupivacaine were selectively injected to the 4 nerves. Sensory, motor block levels and TOF values were measured at 10th, 20th, 30th minutes immediately after the axillary brachial plexus block. TOF values were gradually decreased and significant difference was observed between the development of a complete and partial motor block at 30th minute. TOF values were also significantly less in patients of complete sensory block than the patients of partial sensory block at 30th minute. The use of TOF monitoring may be beneficial to assess the objective clinical effect of motor block in the patients with axillary brachial plexus nerve block.     

臂丛神经损伤MRI表现特征及诊断价值

目的探讨臂丛神经损伤的MRI征象及其诊断价值。方法收集2011年1月-2013年4月经手术证实臂丛神经损伤21例患者的MRI影像学资料,并与手术所见的相关内容进行回顾性研究。结果按臂丛神经损伤分类,臂丛神经节前段损伤13例（23条神经）,MRI表现主要有神经根离断或消失11条,神经根增粗或者纡曲9条,其中伴神经根袖形态异常3条,脊膜囊肿9个,硬脊膜增厚6例,脊髓肿胀、变形或移位3例;臂丛神经节后段损伤8例（24条神经）,MRI表现主要有神经干增粗8条,中断12条、走行僵直4条,其中邻近结构紊乱、肿胀或萎缩6例。手术所见,臂丛神经节前段损伤27条,神经节后段损伤29条。将臂丛神经节前段、节后段损伤MRI表现分别与手术所见对照,MRI诊断臂丛节前神经损伤的灵敏度为81.5%,特异度为80.0%,准确率为81.3%;诊断节后神经损伤灵敏度为79.3%,特异度为85.7%,准确率为80.6%。结论 MRI可优良地揭示臂丛神经的节前段及节后段损伤,对损伤诊断的准确性高,是临床诊治的一种无创性首选影像学方法。     

Sonography of peripheral nerves: technique,anatomy, and pathology

Sonography provides a unique method for evaluating peripheral nerves because of its high spatial resolution, its ability to follow structures over long distances in a limb, and its dynamic nature that allows movement of patient and transducer. When combined with the wide availability and relatively low cost, sonography is an excellent modality for peripheral nerve assessment. The authors review the techniques used in assessment of peripheral nerves, the relevant anatomy, and common pathologic processes.     

Pictorial essay: Ultrasound of tumours and tumour-like lesions of peripheral nerves

High-resolution ultrasound is an excellent diagnostic modality for visualising peripheral nerves and differentiate tumours of the peripheral nerve. With high-frequency transducers (5-15 MHz), peripheral nerves can be visualised, the hypoechoic nerve fascicles, the surrounding tissue and tumourous lesions including the relation to their nerve of origin can be evaluated. By using colour Doppler sonography (CDS), it is possible to detect and assess vascularisation of tumours of the nerve. We present sonographic features of common and uncommon benign and malignant tumours of the peripheral nerve.     

DiI的特性及在周围神经示踪中的应用

目的摸索DiI在周围神经示踪中的应用技巧，探讨其物理和生物学特性。方法应用不同示踪、操作方法，行周围神经干双向DiI示踪，测量其在神经干中的扩散速度，观察评价示踪效果。结果用DiI乙醇溶液示踪、冰冻切片、低光强下直接观察效果较好；在神经干内顺行、逆行扩散速度相同，不同时间组扩散速度有差异，DiI在神经干内的扩散具有轴突特异性。结论（1）DiI在周围神经示踪中的应用方法不同于在中枢神经；（2）DiI是一种良好的荧光类双向神经示踪剂，具有轴突特异性，可以用于活体神经束路的示踪研究。     

超声引导下小儿肌间沟臂丛神经阻滞的应用研究

目的 探讨小儿肌间沟臂丛神经的超声解剖学特点及超声引导下小儿肌间沟臂丛神经阻滞的可行性和安全性.方法 36例拟行肱骨髁部骨折切开复位内固定术患儿,超声检查肌间沟内臂丛神经的分布,观察臂丛神经的声像图特点,测量神经干的直径与皮肤的距离,在超声引导下行肌间沟臂丛阻滞.结果 超声检查36例小儿肌间沟内臂丛神经均清晰显示,超声引导下以0.25%布比卡因行肌间沟臂丛阻滞麻醉有效率达100%.结论 臂丛神经超声解剖结构清晰,超声引导下小儿肌间沟臂丛神经阻滞安全可行.     

High‐resolution sonography detects extraforaminal nerve pathology in patients initially diagnosed with cervical disc disease: A case series

In patients presenting with neck and upper limb complaints, MRI changes suggestive of cervical disc disease do not exclude concomitant extraforaminal pathology, as shown in the series of three cases presented here. High‐resolution ultrasound of the brachial plexus and peripheral nerves may be useful in identifying an extraforaminal pathology when (1) symptoms and signs are disproportionate to MRI findings of cervical disc disease; (2) there is obvious discordance between MRI and nerve conduction findings; (3) an entrapment neuropathy is suspected but the site of nerve lesion is unidentifiable on the basis of available investigations and clinical findings. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound 2013     

The sonographic “coffee bean” sign helps distinguish an axillary neurofibroma from a lymphadenopathy

Axillary masses may represent various soft tissue tumors or lymphadenopathy. Neurofibromas are benign peripheral nerve sheath tumors and, while they are very uncommon, it is important to remember that neurogenic tumors arising from brachial plexus can develop in the axilla. We describe an axillary neurofibroma arising from the brachial plexus that presented with a “coffee bean sign” on sonography that distinguished it from axillary lymphadenopathy. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :33–37, 2014     

婴幼儿臂丛神经损伤的MRI表现及其诊断价值

目的探讨婴幼儿臂丛神经损伤的磁共振成像(magnetic resonance imaging,MRI)征象及其诊断价值。材料与方法收集临床诊断臂丛神经损伤的15例患儿的MRI和肌电图资料进行回顾性分析,并用Kappa检验判断两者结果间的一致程度,P0.05为差异有统计学意义。结果 15例患儿中,双侧臂丛神经损伤者8例,单侧者7例,共91条神经受损。单纯节前损伤28例,单纯节后损伤51例,同时累及节前节后损伤12例。节前损伤主要表现为神经根消失或离断、神经根增粗、神经根袖扩张和脊膜囊肿。节后损伤主要表现为神经干增粗、神经干鞘膜不规则增宽、神经干走形僵直、神经干连续性中断并脑脊液胸膜瘘和神经干邻近结构水肿。臂丛损伤MRI与肌电图累及范围一致性好(κ=0.718,P0.05)。结论婴幼儿MRI臂丛神经成像可早期发现病变,并可作为婴幼儿早期臂丛神经损伤筛查及复查的重要依据。     

Injury to the brachial plexus

Trauma to the brachial plexus may have unfortunate physical, psychological, and social effects. Because this nerve network provides motor and sensory innervation to the arm and hand, an injury may result in functional impairment with concomitant loss in confidence and self-image. It is important for nurses to understand the properties of peripheral nerves and to appreciate the ramifications of injuries to these nerves.     

Deferoxamine-induced dysplasia of the knee: sonographic features and diagnostic performance compared with magnetic resonance imaging.

OBJECTIVE: To evaluate the features and diagnostic performance of sonography in the assessment of deferoxamine-induced dysplasia of the knee. METHODS: The left knees of 32 patients with thalassemia who were receiving regular blood transfusions and chelation therapy were studied with sonography for signs of deferoxamine-induced bone dysplasia. Abnormal physeal and metaphyseal changes detected on sonography included notching at the metaphyseal corner, a blurred or irregular peripheral juxtaphyseal metaphyseal contour, and widening of the peripheral juxtaphyseal metaphyseal echogenic interface. The accuracy of sonography in diagnosing dysplasia was evaluated by using magnetic resonance imaging as the standard of reference. RESULTS: There were 14 true-positive findings, 10 true-negative findings, 7 false-negative findings, and 1 false-positive sonographic diagnosis of dysplasia, giving 67% sensitivity, 91% specificity, a 93% positive predictive value, and a 59% negative predictive value. CONCLUSION: Sonography was specific but only moderately sensitive in the diagnosis of deferoxamine-induced dysplasia at the knee when compared with magnetic resonance imaging.     

Continuous wave Doppler ultrasound for evaluation of vasomotor tone of the radial artery.

OBJECTIVE: At present, the sympathetic skin response (SSR) is the only routinely employed technique for evaluating the autonomic function of peripheral nerves. The present study was conducted in order to compare SSR to continuous wave Doppler (CWD) of the radial artery in both healthy control subjects and patients with lower brachial plexus lesions. METHODS: Both methods were performed in 50 healthy volunteers (aged 23 to 70 years; mean age and standard deviation, 39.6+/-14.3 years) and six patients presenting with severe lesions of the lower brachial plexus (aged 22 to 60 years; mean age, 37.6+/-16.0 years). RESULTS: In each control subject, a SSR could be evoked with a mean latency of 1.2+/-0.2 s and a mean amplitude of 2.9+/-1.5 mV. In 45 healthy subjects, CWD revealed both a reduction of systolic, diastolic, and mean peak blood flow velocity after electrical (ES) and acoustic (AS) stimulation as well as after inspiratory cough (IC). The mean latencies to the decrease in flow velocity decrease amounted to 1.8+/-0.7, 2.0+/-0.7, and 1. 4+/-0.4 s, respectively. The resistance (Pourcelot) index increased significantly. CWD failed to show changes of blood flow velocity in five healthy subjects due to high sympathetic tone (no baseline diastolic blood flow) or instability of blood flow caused by respiration. In patients with lower brachial plexus lesions, SSR was diminished and changes in blood flow could not be observed on the affected side. CONCLUSION: CWD sonography allows easy quantitative assessment of arteriolar tone in healthy subjects and patients with autonomic nerve lesions of the limbs.     

创伤性臂丛神经损伤的磁共振成像3D-FIESTA-C、IDEAL序列特征及诊断价值

目的：探讨创伤性臂丛神经损伤的磁共振成像（MRI）三维循环相位稳态采集快速成像（three-dimensional fast imaging employing steady state acquisition with cycled phases,3D-FIESTA-C）序列和三点法非对称回波水脂分离成像（iterative decomposition of water and fat with echo asymmetry and least squares estimation,IDEAL）序列特征及诊断价值。方法：对32例创伤性臂丛神经损伤患者进行术前MRI 3D-FIESTA-C及IDEAL序列检查后,再行图像后处理及诊断,总结臂丛神经损伤的MRI特征,将诊断结果与手术探查结果进行比较,评价术前MRI 3D-FIESTA-C联合IDEAL序列检查在诊断臂丛神经损伤中的作用。结果：12例患者术后证实共有39条节前神经损伤,3D-FIESTA-C序列显示出38条,其中31条神经根影像提示消失或离断,7条神经根丝减少、迂曲,无法连续追踪至椎间孔,同时可伴有神经根袖变钝、脊膜囊肿形成、硬脊膜增厚及脊髓形态信号异常改变。术前MRI 3D-FIESTA-C序列诊断臂丛神经节前损伤的灵敏度为97.5%,特异度为100%,准确率达98.3%。31例120条节后损伤中共12例45条节后神经断裂,其中7条伴纤维瘤形成,IDEAL序列显示42条节后神经根断裂,其他损伤表现为神经增粗,扭曲,走行僵直,周围结构水肿紊乱等。术前IDEAL序列诊断臂丛节后损伤的灵敏度为96.7%,特异度为100%,准确率为97.1%。结论：MRI 3D-FIESTA-C联合IDEAL序列检查可清晰显示节前及节后臂丛神经损伤情况,对臂丛神经损伤的诊断符合率较高,可作为临床首选的无创性影像学方法。