高频超声联合神经电生理检查在尺神经卡压定位诊断中的应用

目的探讨应用高频超声检查技术联合神经电生理检查对尺神经损伤段定位诊断的应用及微创手术切口的临床评价。方法选择27例肘管尺神经卡压患者手术前进行超声及神经电生理检查,健侧手臂尺神经作为对照组。检测分析高频超声测得尺神经最大横断面积（cross-sectional area,CSA）,肘上—肘下段,肘—腕段运动及感觉神经波幅及传导速度。结果高频超声显示患侧尺神经卡压处明显局限性变细,神经纤维束状结构欠清晰,其卡压近端肿胀,神经增粗,回声减低,纤维束状结构模糊,此处横截面积明显增大。明确标识尺神经卡压点17例,占63.0%;3例未见明显卡压点或卡压段,仅见肘管内尺神经全程肿胀;5例术后神经卡压瘢痕粘连,纵断面神经束状回声不清晰或消失,与周围组织界限模糊而无法标识定位。2例超声未检测出明显卡压病变。患者肘管内尺神经CSA与对照组肘管内尺神经CSA明显增大并差异存在统计学意义（P〈0.05）。肘管内尺神经神经传导波幅减低,神经传导速度减慢;与对照组肘管内尺神经神经传导波幅及神经传导速度差异存在统计学意义（P〈0.05）。结论高频超声能动态观察尺神经卡压征象及其周围结构损伤情况并联合神经电生理检查能有效提高定位诊断的准确率。

Application of High-frequency Ultrasound Combined with Electro-neurophysiology in the Localization Diagnosis of Ulnar Ner- eve Entrapments in Elbow

Objective To discuss the the value of high frequency ultrasound combined with nerve electrophysiology in diagnosing ulnar nerve injury and evaluate the incision of minimally invasive surgery. Methods 27 patients suffering from Cubital Tunnel Syndrome （CUTS group） accepted ultrasound and ulnar nerve electrophysiology examination before surgery. All these patients＇ healthy ulnar nerve were also examined as control group.The cross-sectional area （CSA） of ulnar nerve was measured by high frequency ultrasound, the amplitude and conduction velocity of motor nerve and senso- ry nerve were measured by nerve electrophysiology.Results The nerve was thinner at the compressed point, the structure of nerve fiber bundle was not clear and the near-end of compressed nerve was swelling, its interior echo was decreased and the CSA here was increased obviously. 17 patient （63%） were identified compressed point of ulnar nerve by high frequency ultrasound 3 cases with swelling of the ulnar nerve in cubital tunnel without obvious compressed point.5 cases were identi- fied with scars and adhesions of the ulnar nerve after the operation appeared and it＇s difficult to identify the compressed point because the border of nerve and adjacent structure was ambiguous.The ultrasonic appearance of the left 2 cases was negative.The CSA of ulnar nerve in CUTS group was obviously larger than that of control group （P〈0.05） , the ampli- tude and conduction velocity of ulnar nerve in CUTS group was smaller than that of control groups （P〈0.05） .Conclusion High frequency ultrasound could identify the compressed point of ulnar nerve and assess the degree of damaged surround- ing soft tissue.Furthermore, combined with nerve electrophysiology, it could improve the diagnostic accuracy rate of loca- ting injured ulnar nerve.