高频彩色多普勒超声对上肢神经疾病的诊断价值

目的:探讨高频彩色多普勒超声诊断上肢神经疾病的临床价值。方法:采用高频彩色多普勒超声对32例上肢神经疾病患者进行诊断检查,通过观察上肢神经的连续性、神经外膜、神经束和周围组织,以及与神经相关联的肿块及其相关性,确定神经疾病的类型和部位,分析其声像图特征,并与健侧进行对比。结果:神经鞘瘤患者14例,均为单发,图像特征以椭圆形低回声为主,界清,有包膜。神经纤维瘤患者6例,其中5例单发,为低回声,内部回声尚均,梭形为主,两端与神经相连;另1例多发,呈串珠状。尺神经炎患者3例,局部神经增粗,回声减低,横断面呈低回声,"筛网状"结构消失,CDFI血流信号较丰富。外伤患者9例,局部神经受压、形态失常,且其周围可见不规则异常回声区。结论:不同上肢神经疾病的声像图各有其特征性表现,高频彩色多普勒超声可为临床诊治提供依据。     

结节性筋膜炎的高频超声特征性表现及误诊分析

摘要： 目的：探讨结节性筋膜炎高频超声声像图特征性表现,分析超声误诊原因。方法：回顾性分析25例经手术和病理证实的结节性筋膜炎患者术前超声声像图表现,总结其临床表现及高频超声声像图特征。结果：25例结节性筋膜炎高频超声声像图特征性表现为单发圆形、椭圆形及梭形,部分可见浅分叶,均无明显包膜,边界尚清,活动度较好,与周围组织无粘连;21例病灶表现为低回声,部分内部可见中高回声,3例为中等回声,1例为高回声;19例病灶后方回声增强。CDFI：19例病灶内部及周边未探及明显血流信号;4例病灶内部或周边探及点状血流信号;2例病灶可见较丰富血流信号,呈低速高阻型,并且病灶体积相对较大。25例病灶中,14例病灶发生在皮下脂肪层,8例累及皮下筋膜层,3例累及肌肉层。超声诊断皮下异常回声15例,超声误诊10例,其中5例为脂肪瘤、2例血管瘤、1例神经源性肿瘤,1例血肿,1例软组织肿瘤。结论：结节性筋膜炎高频超声表现具有一定特征性,对结节性筋膜炎具有重要的诊断价值。     

超声诊断外周神经病变的临床价值

目的探讨高频超声在外周神经病变和损伤中的诊断价值。方法应用高频超声检查15例正常查体肢体外周神经、12例外周神经损伤及6例神经肿瘤，术前超声检查与术中探查结果作比较分析。结果正常神经纵切面声像图为多条线性的平行较强回声；横切面为圆形中等回声结构，中心为点状强回声。2例外周神经完全离断，显示连续性中断，近端形成神经瘤；7例外周神经部分损伤，显示连续性部分中断；3例卡压性损伤，神经水肿增粗，内部呈束状低回声不清晰。6例神经肿瘤与神经相连续。结论高频超声可作为外周神经病变和损伤首选的检查方法，值得临床推广应用。     

高频超声动态检测带状疱疹患者皮肤及皮神经的临床意义

目的了解带状疱疹患者病程各期皮肤、皮下组织及皮神经声像图表现,探讨高频超声动态检测带状疱疹皮肤各层和皮神经声像图变化的临床意义.方法分别于出疹前、出疹期、皮损消退和皮损消退后1个月,对22例患者的38个病变部位进行高频超声检测,同时分别取同一病例健侧的对应部位作为对照组.观察皮肤各层及皮神经的声像图特征、回声变化,以皮神经走行的纵断面进行皮肤、皮下组织厚度和皮神经直径的测量.结果高频超声显示患侧在出疹前22处病变皮肤和32处病变皮神经回声减低,与健侧比较皮肤增厚(P＜0.05),皮神经增粗较明显(P＜0.01).出疹期皮肤35处、皮下28处、皮神经36处病变回声均明显减低,皮肤、皮下组织增厚与健侧比较(P＜0.05),皮神经增粗较明显(P＜0.01).皮损消退和消退后1个月,仍有皮神经增粗.所有患者均无后遗神经痛发生.结论高频超声可检测皮肤、皮下组织和皮神经结构,是一种简便易行的方法.带状疱疹患者在出疹前便有声像图改变,动态检测可为临床医师诊治提供可靠依据,对早期诊断鉴别诊断、早期治疗、减少误诊,改善患者预后均有重要意义.     

肌肉系统病变的高频超声声像图分析

目的分析高频超声下肌肉系统病变超声声像图表现。方法应用彩色多普勒超声对76例患肌肉软组织病变进行检查，观察并记录病变的回声特性，大小，范围，边界，内部回声，结构等。结果高频超声对76例患的检查敏感性为100%，肌腱断裂，韧带状纤维瘤，肌肉损伤，肌肉肿瘤及炎性病变等在声像图上有特异性改变。结论高频超声能够清晰显示肌肉系统病变的物理性质，对该类病变有较高的诊断敏感性和特异性。     

神经内外囊肿致周围神经卡压的超声诊断

目的 探讨超声在诊断神经内、外囊肿致周围神经损伤的价值.方法 用高频超声检查和诊断8例肘部尺神经损伤伴囊肿和9例腓总神经损伤伴囊肿,观察其神经内、外囊肿致周围神经损伤声像图表现.结果 8例肘部尺神经损伤伴囊肿和9例腓总神经损伤伴囊肿,其中12例超声显示神经增粗水肿,内部束状回声消失或不连续,点线回声不清楚,神经周围局部呈无回声与周围软组织粘连;5例超声显示神经增粗水肿,外膜回声强,内部束状回声消失,呈瘤样低回声与神经相连续,其内有血流改变,部分束间有少量积液,神经周围无明显积液.12例术中探查所见与超声检查结果相吻合,5例不完全一致.结论 肘关节囊液和上胫腓关节液流注可形成肘部尺神经和腓总神经内、外囊肿,声像图表现均有不同,神经内囊肿较神经外囊肿致神经损伤较重.结合不同声像图特征进行鉴别,以便尽早发现与诊治有非常重要的意义.     

甲状腺微小癌高频彩色多普勒超声诊断分析

目的探讨甲状腺微小癌（TMC）的彩超声像图特点。方法回顾性分析38例TMC患者的临床资料作为观察组,全部病例术前均行超声检查,且均经手术及病理证实;另选同期35例具有相似超声声像图特征的甲状腺良性病变患者作为对照组。结果 38例TMC患者二维超声微小结节检出率为100%,声像图表现主要有甲状腺微小癌多为较低回声区,内部回声欠均匀,后方回声可见轻度的增强,13例结节内可见有微小钙化灶,大多无明显的血流信号,6例出现同侧淋巴结转移。观察组与对照组低回声、边界清楚、边缘光滑、微钙化灶的比例差异显著。结论高频彩超可根据肿块性质、形态和血供信息以鉴别肿块良恶性,对结节的定位、数目和大小的估计明显优于其他影像学检查,高频彩色多普勒超声是诊断TMC的首选检查方法。     

带状疱疹患者皮肤及皮神经高频超声表现

目的　了解带状疱疹患者局部皮肤及皮神经病理变化所致的声像图特点。方法　应用高频超声检测带状疱疹患者 3 7例 ,病变 77处 ;后遗神经痛患者 7例 ,病变 17处。均以同一患者健侧对应部位做对照 ,观察皮肤及皮下组织厚度、回声特征及皮神经的宽度、回声特征。结果　带状疱疹患者皮肤、皮下组织均增厚 (P <0 .0 1) ,回声减低 ;受累皮神经增粗 (P <0 .0 1) ,回声减低 ,线性结构模糊。后遗神经痛患者皮肤、皮下组织改变不明显 (P >0 .0 5 ) ;受累皮神经增粗 (P <0 .0 1) ,回声增强 ,线性结构模糊。结论高频超声可清楚显示带状疱疹患者皮肤、皮神经炎性改变声像图 ,为临床诊断提供客观依据     

高频彩超诊断外周神经源性良性肿瘤

目的:探讨高频彩超对外周神经源性良性肿瘤的临床诊断价值。方法:回顾分析12例经手术和病理证实的外周神经源性良性肿瘤特征性声像图表现。结果:在12例外周神经良性肿瘤中,神经鞘瘤9例,神经纤维瘤3例。声像图表现以纺锤形或椭圆形为主,界清,为实质低回声,多数有包膜,内部及周边均可见有动脉血流。特征性表现是多数病例肿瘤两端与神经干连接。结论:外周神经系统良性肿瘤具有一定的特征性声像图表现,而高频彩色超声可以清晰的观察到肿瘤与神经干的连接关系,使其成为该类肿瘤的首选检查方法。     

高频超声在跟腱断裂中的临床应用价值

目的 探讨高频超声在跟腱断裂中的诊断价值.方法 对91例跟腱断裂患者进行超声声像图特征的观察及总结并与手术结果对照,同时对跟腱断裂易于误诊的原因作了分析.结果 完全断裂者88例,声像图可见患侧跟腱较健侧明显增厚,腱回声中断,其间可见低或无回声区,断端为不规则的强回声团,部分断裂3例,声像图表现为跟腱内部出现部分纤维中断或局灶低回声区,超声诊断与手术结果全部符合.结论 超声检查可确定跟腱断裂的部位及程度,对临床治疗及追踪观察均具有重要的意义.     

The effect of low-frequency electrical stimulation on denervation atrophy in man

The effect of low frequency electrical stimulation (LES) on denervation atrophy and recovery of the muscles was examined in a group of 73 patients with a single or a combined total lesion of the median, ulnar or peroneal nerves. The differences between the patients were evaluated by means of clinical muscle force testing, EMG, dynamometry (ulnar and median nerve lesions), computer tomography (ulnar nerve lesions) and ultrasonography (median and peroneal nerve lesions). A beneficial effect of LES could not be shown.     

Functional capacity after peripheral nerve lesion: significance of pain syndromes

INTRODUCTION: The loss of functional capacity by peripheral nerve lesion is easy to be estimated: A certain neurologic dysfunction results in a characteristic reduction of the former individual capacity. In contrast, the effect of accompanying pain to every-day life and working ability is not known exactly. In this study, we compared the results of judgement in nerve lesions under the circumstances of additional pain syndromes. METHODS: From January 1994 until December 1998 we saw 57 patients with peripheral nerve lesions, part of them with an additional pain syndrome. Beside conventional neurological examination a detailed pain analysis has been done. RESULTS: Lesions of the median or ulnar nerves showed regularly disturbances in neurological functions (10/14 for the median nerve, 13/16 for the ulnar nerve). Astonishing is the fact, that serious pain after nerve lesion only occurs in cases of partial nerve lesion. We saw neuralgias in 6 patients with ulnar neuropathy, in three cases of median nerve lesions we could see severe neuralgia (causalgia we found in 3 cases of ulnar neuropathy, in 6 cases after Median Nerve lesion). Patients with a lesion of the central plexus brachialis showed in 10 of 11 cases an additional pain syndrome. Other nerves have been affected more rarely. For the judgement of the loss of earning capacity we saw an additional pain related diminuition of at least 10% compared to those patients without pain problems. CONCLUSIONS: The common grading scales for peripheral nerve lesions are not suitable in cases accompanied by an additional pain syndrome. Beside a functional deficit the effect of severe pain in these patients has to be estimated. On an average, patients with additional pain-problems get a 10% extended loss of earning capacity, even more in particular cases.     

超声诊断单侧尺神经病变：利用无症状侧尺神经横截面积作为参考值评估患侧病变的可靠性研究

目的：探讨利用无症状侧的尺神经横截面积作为参考值来评价患侧尺神经厚度变化的方法是否有 效。方法：收集单侧尺神经病变患者47 例为病变组,选取同期招募正常志愿者60 例为对照组,利用高频超 声测量尺神经横截面积,比较病变组无症状侧与对照组的差异性,病变组治愈后再次用超声复查无症状侧 尺神经横截面积,并与对照组比较差异性。结果：病变组无症状侧4 个位置的尺神经横截面积与对照组比 较差异存在统计学意义（P＜0.05）;治愈后,病变组无症状侧尺神经横截面积与对照组对比差异无统计学意 义（P＞0.05）。结论：单侧尺神经病变患者的无症状侧也可能存在一定程度的病变,使用无症状侧的尺神经 横截面积作为参考值来评估患侧的方法有限制。     

Ulnar conduction block at the wrist.

Two cases of ulnar nerve lesions at the wrist are reported. The lesions had an acute onset and exclusively impaired the ulnar motor deep branch. The coexistence of carpal tunnel syndrome in each case allowed an early diagnosis but was somewhat misleading. In both cases, the use of classic motor and sensory conduction studies did not provide clear abnormalities that would have precisely determined the site of the nerve lesion. In both cases, only palmar stimulation of the ulnar motor deep branch showed an important conduction block. This electrodiagnostic finding showed definitively the site of the ulnar nerve lesion at the wrist and excluded proximal ulnar nerve lesions or C8-T1 radiculopathy. In both cases recovery occurred without surgery.     

术中超声对颅脑深部占位病变的应用价值

目的 探讨术中超声在颅脑深部占位病变手术中的应用价值.方法 48例颅脑深部占位病变患者在手术切除前后及术中应用实时超声对病灶进行定位及定性诊断,指导临床医师选择合适的手术路径,评价肿瘤的切除程度.结果 32例颅脑深部恶性占位病变患者在边界不清晰、病变周围存在水肿带及病变内有血流信号等方面的检出率分别为53.2%、50.0%及37.5%,16例良性占位病变患者仅4例发现异常血流信号而被诊断,两组检出率比较差异均有统计学意义(P﹤0.05).16例良性病变患者均于术中超声引导下一次性成功切除,切除率为100%;32例恶性占位病变患者中,17例边界清晰的恶性占位病变均定位准确且完全切除;15例边界不清的恶性占位病变患者中,经术中超声判断存在残留5例,完全切除6例,无法判断4例.术中超声判断颅脑深部恶性占位病变完全切除率为87.5%(28/32).术后经MRI诊断及再次手术病理证实残留3例,术后半年内肿瘤再次复发者2例.术中超声定位引导下肿瘤总体完全切除率为91.6%(44/48).结论 术中超声对颅脑深部占位病变可进行初步定性诊断,并可对病灶准确定位,指导临床医师选择合适的手术方式,提高颅脑深部肿瘤的切除准确率.     

高频彩超诊断肛周脓肿和肛瘘的临床应用价值

目的探讨高频彩超检查肛周脓肿、肛瘘的声像图特点及术前定位的临床应用价值。方法对临床拟诊肛周脓肿或肛瘘的73例患者,应用高频探头进行肛门周围探测,观察声像图特征及血流分布情况,并进行术前定位。结果超声检查73例患者,共检出病灶79个,其中肛周脓肿38例、单纯性肛瘘29例、复杂性肛瘘4例、漏诊2例。肛周脓肿声像图表现为圆形、椭圆形或不规则低回声、无回声或混合回声区;肛瘘声像图表现为管道样低回声,病灶边缘区见丰富彩色血流信号。超声术前定位与手术结果一致。结论高频彩超能区分肛周脓肿及瘘管与周围组织的关系,为确定病灶部位、数目及瘘口位置提供更多的可靠信息,为临床治疗提供更确切的依据。     

超声诊断肢体上皮样肉瘤的临床价值

目的 探讨超声在肢体上皮样肉瘤诊断中的临床价值。方法 收集我院经手术病理证实为肢体上皮样肉瘤患者43例资料,分析其术前超声图像特征,并随访其短期复发情况。结果 43例肢体上皮样肉瘤超声均明确提示病变位置,定位准确率100%;声像图表现均呈团块状低回声,均无包膜,平均最大径（5.73±4.99）cm,为以实性为主（81.4%）,边界不清晰（55.8%）,形态不规则（88.4%）,内部回声不均匀（95.3%）,多为单发（72.1%）,血流分级Ⅲ级（53.5%）。超声明确提示软组织肿物42例,另有1例患者肿物感不明显,超声提示为神经病变,瘢痕粘连。术后随访3个月至8年,出现复发并再次手术者22例,超声均直接提示复发,声像图均表现为回声不均匀的实性低回声,边界不清晰（15/22）,形态不规则（16/22）,Alder血流分级均为Ⅰ级。结论 肢体上皮样肉瘤声像图表现多为单发不规则团块状实性低回声肿物,无包膜,边界不清晰,内部回声不均匀,血流较丰富。超声不仅可在术前明确病变范围及其周围组织受累情况,术后亦可动态随访,具有重要的临床价值。     

Color Doppler ultrasound of liver lesions: Signal enhancement after intravenous injection of the ultrasound contrast agent Levovist®

Patients with focal liver lesions (hemangioma, focal nodular hyperplasia, adenoma, hepatocellular carcinoma, metastatic lesions, focal fatty lesion) received the ultrasound contrast agent Levovist® (300 mg/mL and 400 mg/mL) intravenously. This ultrasound contrast agent (a suspension of micrometer-sized microparticles of galactose and microscopic gaseous bubbles) can pass through the lungs without impairment. After the administration of Levovist®, increased color flow signals were detected in the liver. Five of 6 patients with metastatic liver lesions showed previously undetected blood flow in the rim of the tumor. In 4 patients with hepatocellular carcinoma, enhanced signal intensity was observed in the vessels of the rim and in 3 of those patients in the center of the tumor. One patient with adenoma and one patient with focal nodular hyperplasia showed signal enhancement in the central area of the tumor. No signal enhancement was observed in hemangiomas, a focal fatty lesion, or in a carcinoid metastatic lesion. Levovist® increased the echointensity of normal and tumor vessels in liver lesions. This new ultrasound contrast agent led to the detection of tumor vessels previously not detectable by conventional color flow imaging. © 1996 John Wiley & Sons, Inc.     

Characterized dispersive wave-form of evoked compound muscle action potential in the localized ulnar nerve neuropathy

Disorder of the ulnar nerve with continuity around the elbow is known to be a neuropathy produced by long lasting compression, friction or traction. Forty-four patients with clinical diagnosis of ulnar nerve neuropathy were examined by means of motor nerve conduction study and induced electromyography. Compound muscle action potentials (CMAPs) from hand muscle were evoked by stimulating many points proximal and distal to the elbow and analysis of CMAP was performed. In mild grade of nerve lesion, dispersive wave-form with the extension of its duration was elicited by only stimulating proximal points to the elbow. It was also found that conduction velocity is delayed only over the short distance across the elbow. Thus an initial stage of nerve lesion has a tendency of dysfunctioning of conductivity restricted in only affected portion. CMAP patterns are classified into four groups in comparison with the progress of clinical signs of the disease. This classification can be utilized for the evaluation of the progress of ulnar nerve lesion.