超声评价肘管综合征尺神经卡压的诊断价值

目的 探讨超声诊断肘管综合征（cubital tunnel syndrome，CuTS）的临床价值及意义。方法 选择40例（单侧）CuTS患者（健侧为对照组）用超声仪自带的软件测量肘部尺神经沟内尺神经卡压处和最粗处的横截面积（cross-sectional area，CSA）和周长，所有病例均行肘管切开前置术，术中直视下用手术线包绕尺神经卡压处和最粗处一圈后剪断，再用直尺进行测量，对两种测量方法进行比较。采用受试者工作特征（receiver operating characteristic curve，ROC）曲线进行分析，确定其尺神经最粗处的横截面积和周长的诊断阈值、敏感度与特异性。结果 CuTS组尺神经最粗处的横截面积和周长均大于对照组，差异有统计学意义（P<0.01）；超声测量和术中测量CuTS组卡压处和最粗处周长，差异均无统计学意义（P>0.05），表明超声具有测量尺神经周长的准确性；CuTS组尺神经最粗处横截面积和周长的最佳截断点分别为14.2mm²、14.8mm，其敏感度分别为92.5%、90%，特异性分别为97.5%、87.5%。结论 超声测量肘管内尺神经横截面积和周长用于诊断肘管综合征是一种新的有价值的方法，其最粗处最佳截断点分别为14.2mm²、14.8mm。

Evaluation of the Diagnostic Value of Ulnar Nerve Compression in Cubital Tuunel Syndrome by Ultrasonography

Objective To evaluae the meaning and value of ultrasonography in the diagnosis of cubital tunnel syndrome(CuTS). Methods Forty patients(unilateral) of cubital tunnel syndrome(contralateral control group)were used to measure the ulnar nerve entrapment and the most extensive cross-sectional area and circumference. All cases underwent cubital incision preoperative, intraoperative direct vision under surgical line wrapped around the ulnar nerve compression and the most rough after a lap cut, and then we measured with a ruler, the two measurement methods comparison. The diagnostic threshold and the sensitivity and specificity of the most extensive cross-sectional area of the ulnar nerve and perimeter was analysed by using the receiver operating characteristic (ROC) curve. Results The most extensive cross-sectional area and circumference of the ulnar nerve in the CuTS group were significantly higher than those in the control group, and the difference was statistically significant. Forthe ultrasound measurement and intraoperative measurement of CuTS group at the pressure and the most rough circumference, the difference was not statistically significant, indicating that ultrasound can accurately measure the ulnar nerve circumference. The optimal cut-off point of the most rough cross-sectional area of the ulnar nerve and the circumference of the CuTS group were respectively 14.2mm² and 14.8mm, and sensitivity were respectively 92.5% and 90%, the specificity were respectively 97.5% and 87.5%. Conclusion Ultrasonography is a new and valuable method for the diagnosis of cubital tuunel syndrome by measuring cross-sectional area and circumference of elbow. The optimal cut-off point of the most rough cross-sectional area of the ulnar nerve and the circumference of the CuTS group were respectively 14.2mm² and 14.8mm.