高频超声在诊断腕管综合征中的应用

腕管综合征（carpal tunnel syndrome，CTS）是正中神经在腕管内受压而表现出支配区功能障碍的一组症状和体征，也是最常见的周围神经嵌压综合征之一，通常根据其特征性临床和电生理所见即可做出诊断。虽然目前电生理检查被认为是诊断CTS的金标准，但它不能显示正中神经周围的毗邻结构，不能为进一步明确病因和手术提供更多的信息。现将近年来关于超声诊断CTS的应用进行综述。     

高频超声在腕管综合征诊断中的应用探讨

【目的】探讨高频超声在诊断腕管综合征（CTS）中的应用价值,并进一步分析神经增粗与神经传导速度及病程的相关性,并证实高频超声在诊断CTS中的临床价值。【方法】对100例健康志愿者及63例经临床和电生理检查确诊的CST进行高频超声腕管内正中神经的检查,并记录神经的横截面积（CSA）,并作CSA与神经电生理及病程的相关性分析。【结果】对照组腕管内正中神经的CSA为（8．60±2．25）mm^2,CST组CSA为（15．61±4．60）mm^2,两组相比较有显著差异（P〈0．01）。CST组CSA与神经电生理（感觉传导速速）的相关系数为-0．74（P〈0．01）,与CTS病程的相关系数为0．79（P〈0．01）。【结论】高频超声在CTS的诊断有重要应用价值,其可作为CTS及周围神经检查新的形态学诊断方法。     

腕管综合征高频超声表现

腕管综合征系腕管内正中神经受到压迫引起的手指麻木等神经症状,是周围神经中最常见的卡压症之一.以往以电生理检查及临床表现为诊断依据,但电生理检查不能提供神经压迫所致形态学改变的信息[1],高频超声可发现外周神经形态学改变,是一种非常有效的检查方法[2].     

高频超声联合剪切波弹性成像对腕管综合征的诊断价值

目的：研究高频超声联合剪切波弹性成像（SWE）对腕管综合征的诊断价值。方法：选取2020年4月—2022年10月我院收治的98例腕管综合征患者,筛选同期在本院体检的健康人50例为对照组。对研究对象行高频超声与SWE检查,比较两组高频超声参数值（包括豌豆骨水平和腕横纹上部两处正中神经直径,分别记D1、D2,横截面积分别记CSA1、CSA2）,SWE参数值（豌豆骨水平与腕横纹上部正中神经弹性模量均值,分别记W、F,同义感兴趣区正中神经与指浅屈肌弹性模量均值比,记为FRatio）;绘制受试者工作特征（ROC）曲线,分析高频超声与SWE参数单独与联合检查对腕管综合征的诊断效能。结果：腕管综合征组D1、CSA1值大于对照组,差异有统计学意义（P<0.05）;两组D2、CSA2值无统计学意义（P>0.05）。腕管综合征组W、F、FRatio值大于对照组,差异有统计学意义（P<0.05）。ROC曲线显示,D1、CSA1、W、F、FRatio检查对腕管综合征诊断的AUC分别为0.698、0.772、0.773、0.719、0.702,联合检查的AUC为0.864,联合检查的灵敏度与特...     

高频超声在腕管综合征病因学评价中的应用

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。     

超声检查在腕管综合征诊治中的研究进展

<正>腕管综合征(CTS)是周围神经卡压中最常见的一种疾病。1854年James Paget首次通过一个Colles骨折的患者描述了CTS的表现。1913年Maris和Foix对大鱼际肌萎缩的尸体进行解剖,发现腕横韧带(TL)近端有神经瘤形成,从而首次提出切断腕横韧带以松解正中神经的建议。1933年James R.Learmonth进行了首例正中神经减     

高频超声诊断腕管综合征的应用价值

腕管综合征（Carpal Tunnel Syndrome）又称腕管狭窄症,是正中神经在腕管内受压而表现出的一组症状和体征,是周围神经卡压性疾患。多种原因可引起腕管内压力增加,引起正中神经受压水肿并逐渐发生纤维化。法国学者Marie和Foix医生早在1913年,首次报道了低位正中神经卡压症状患者的神经病理检查结果,并提出如果早期能够做出明确诊断并切开腕横韧带,或许可以避免其神经病变的出现。     

肌腱滑膜炎致急性腕管综合征超声表现二例

腕管综合征是正中神经在腕管内被卡压而产生正中神经感觉或运动功能障碍的一组症状与体征,分急性与慢性.急性腕管综合征多由创伤和急性炎症造成,慢性腕管综合征病因不明,可能与内分泌等因素有关.现将应用高频超声诊断肌腱滑膜炎所致急性腕管综合征2例,报道如下.     

高频超声诊断腕管综合征的敏感性及特异性分析

目的观察高频超声诊断腕管综合征（CTS）的敏感性及特异性。 方法将36例已确诊为CTS的患者纳入实验组,并同期选取32例健康体检者纳入对照组。对入选对象进行腕部高频超声扫查,分别测量被检者在腕部肌肉等长收缩前、后其正中神经（豌豆骨水平）前后径厚度(D)、横断面积（CSA）以及腕部肌肉等长收缩前、后上述指标差值,并进行组间对比。采用ROC曲线对2组对象正中神经相关指标进行敏感性及特异性分析。 结果通过对比2组对象数据,发现正中神经厚度在腕部肌肉等长收缩前、等长收缩后及等长收缩前、后的判别敏感度分别为85.00%、86.67%和91.67%,判别特异度分别为55.88%、61.76%和76.47%;正中神经CSA在腕部肌肉等长收缩前、等长收缩后及等长收缩前、后的判别敏感度分别为75.00%、76.67%和95.00%,判别特异度分别为72.06%、80.88%和80.88%。提示腕部肌肉等长收缩前、后正中神经厚度和CSA在诊断CTS时具有良好的特异性及敏感性,并且以腕部肌肉等长收缩前、后CSA差值的诊断价值尤为显著。 结论采用高频超声测量腕部肌肉等长收缩前、后CSA差值对诊断CTS具有良好的敏感性及特异性,可作为临床诊断CTS的可靠方法之一。     

Idiopathic Carpal Tunnel Syndrome: Evaluation of the Depth of the Carpal Tunnel by Ultrasonography

The objective of the work described here was to evaluate the depth of the carpal tunnel (DCT) in patients with idiopathic carpal tunnel syndrome (CTS) and healthy volunteers by ultrasonography (US), through measurement of the distance from the flexor retinaculum to the surface of the capitate bone at the carpal tunnel outlet, and compare it with other ultrasonographic and electrophysiologic parameters in CTS. The study was conducted in 60 non-diabetic patients with idiopathic carpal tunnel syndrome (unilateral n = 37, bilateral n = 23) evidenced by electrophysiologic diagnosis according to the criteria of the American Association of Electrodiagnostic Medicine (AAEM). Furthermore, 40 hands from 20 healthy volunteers were examined. Median nerve cross-sectional area (CSA); flattening ratio (FR), the ratio of the length to the width of the median nerve; and DCT at the canal outlet were measured for all participants. The mean age was 35.6 ± 9.48 y. The female-to-male ratio was 47:13 in the CTS patients. The sensitivity and specificity were 82% and 95% for CSA, 75% and 60% for FR and 75% and 87.5% for DCT, respectively. Differences between patients and healthy controls were significant for all three parameters, greatest for DCT, followed by CSA and then FR. We conclude that DCT increased in CTS and this new parameter is comparable in sensitivity and specificity to CSA and FR. DCT increased independently of the cause of the CTS (decrease in size of canal or increase in contents).     

健康人腕管内正中神经的超声显像

目的 :研究正常健康人腕管内正中神经的超声回声表现。方法 :对 118例正常健康人腕管行高频超声检查 ,观察正中神经的形态、大小、解剖关系及回声表现 ;且在桡骨远端、豌豆骨及钩状骨切面测量正中神经的前后、左右径及截面积 ,并计算正中神经的扁平率和肿胀率。结果 :高频超声能纵、横向显示正中神经。横断面上正中神经呈圆形或类圆形低回声区 ,周围包绕以稍强回声 ;纵断面上 ,正中神经呈条带状弱回声。本组正中神经的前后、左右径及截面积分别为 :桡骨远端平面 4 2 5± 0 5 0mm、 1 92± 0 2 0mm、 6 0 4± 1 0 0mm2 ;豌豆骨平面5 0 8± 0 4 6mm、 1 88± 0 2 0mm、 7 19± 1 2 3mm2 ;钩骨平面 5 6 8± 0 6 2mm、 1 5 8± 0 2 0mm、 6 3± 1 17mm2 。正中神经平均扁平率和腕横韧带的膨隆率分别为 :桡骨远端平面 2 2 4± 0 4 1;豌豆骨平面 2 73± 0 4 5、 1 91±0 77mm ;钩骨平面 3 0 5± 0 4 7、 1 82± 0 5 9mm。正中神经平均肿胀率 :16 2 0± 0 17。结论 :高频超声能清楚显示腕管内正中神经的形态、大小及其关系 ,并能测量正中神经截面积等指标 ,有一定临床应用价值     

Review of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and a Proposed Scanning Protocol

Carpal tunnel syndrome is the most common peripheral compressive neuropathy. Ultrasonography (US) is an emerging technology that can be used in the diagnosis of carpal tunnel syndrome. Although the cross‐sectional area is the most studied and validated measurement for carpal tunnel syndrome, there is no standardized neuromuscular US scanning protocol. We review the most studied neuromuscular US characteristics and protocols in the evaluation of carpal tunnel syndrome and propose a standardized protocol for evaluating carpal tunnel syndrome with neuromuscular US based on current literature.     

Comparison of Proximal and Distal Cross-Sectional Areas of the Median Nerve,Carpal Tunnel,and Nerve/Tunnel Index in Subjects With Carpal Tunnel Syndrome

Objectives

To provide a quantitative analysis of ultrasonographic measurements and possible pathophysiology of carpal tunnel syndrome by comparing cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index and the difference in ultrasonographic findings between affected and nonaffected hands and between sexes.

Design

Blinded comparison study.

Setting

Secondary referral and training hospital of institutional practice.

Participants

Patients (N=51; 42 women, 9 men) with suspected carpal tunnel syndrome who underwent sonography within 1 week after the electrodiagnostic study.

Interventions

Not applicable.

Main Outcome Measures

Electrodiagnostic and ultrasonographic studies were conducted on both upper extremities. Cross-sectional areas of the median nerve and carpal tunnel were measured at 2 separate levels; proximal and distal cross-sectional areas of the carpal tunnel were each measured at the scaphoid-pisiform and trapezium-hamate levels, respectively.

Results

Comparison between normative (n=24) and abnormal hands (n=78) revealed the following: the mean proximal cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index of electrodiagnostically normative hands were 10.941mm², 192.43mm², and 5.635%, respectively, whereas those of abnormal hands were 13.74mm², 208.87mm², and 6.693%, respectively, showing statistically significant differences for all (P<.05). Distal measurements of the cross-sectional area of the median nerve, carpal tunnel, and nerve/tunnel index were 10.088mm², 150.4mm², and 6.762%, respectively, in normative hands, and 11.178mm², 149.6mm², and 7.493%, respectively, in abnormal hands, showing no statistically significant differences (P>.05). In women, proximal cross-sectional areas of the median nerve and nerve/tunnel index of abnormal hands showed statistically significant differences, but no ultrasonographic measurement with a statistically significant difference was observed in men.

Conclusions

Compared with nonaffected hands, the proximal cross-sectional areas of the median nerve and carpal tunnel were greater, but the distal ultrasonographic measurements were not in affected hands. Ultrasonographic findings of carpal tunnel syndrome were different according to sex.     

腕舟状骨骨折超声诊断

目的： 探讨Ｂ 超对腕舟状骨骨折的诊断价值。方法： 应用７．５Ｍ Ｈｚ 探头对２０ 例正常成人和 １３ 例患者共计 ６６ 块的腕舟状骨进行了检查, 并与Ｘ 线诊断做了对比研究。结果： 超声检查可以清晰显示舟状骨的形态, 明确骨折部位, 确诊率与Ｘ 线诊断相近, 对部分早期Ｘ 线不显示骨折者, 超声诊断优于Ｘ 线。结论： 超声诊断腕舟状骨骨折简便、易行, 有助于早期发现骨折。     

曲安奈德腕管内注射治疗轻度腕管综合征的临床研究

目的 观察曲安奈德腕管内注射治疗轻度腕管综合征的临床疗效.方法 选取74例轻度腕管综合征患者随机分为观察组和对照组,观察组37例使用曲安奈德药物腕管内注射治疗;对照组37例使用超短波治疗仪患处局部疗法加用丹参和维生素B1、B6、B12等药物治疗.结果 观察组疗效与对照组的差别有显著性意义(P＜0.05)、观察组复发率与对照组的差别也有显著性意义(P＜0.05).结论 曲安奈德腕管内注射治疗轻度腕管综合征的临床疗效明显,优于其他保守疗法,且见效快,复发率低,临床评价疗效满意.