摘要
目的 应用肌骨超声测量正中神经(MN)超声参数,探讨其对不同程度腕管综合征(CTS)的诊断价值.方法 选取经我院临床确诊的CTS患者52例(CTS组),依据神经传导检查结果分为轻度组13例、中度组24例、重度组15例,另选同期健康体检者39例为正常组.应用肌骨超声获取MN钩骨水平横径、前后径、神经扁平率(FR)、豌豆骨水平横截面积(CSA1)和前臂旋前方肌近侧端水平横截面积(CSA2),并计算CSA1与CSA2的差值(ΔCSA)和比值(R-CSA);能量多普勒观察MN内部血流情况;神经传导检查获取感觉神经传导速度(SCV)、MN运动末端潜伏期(DML)、远端复合肌肉动作电位(CMAP)波幅,比较各组上述检查结果的差异.分析MN超声参数与神经传导检查参数的相关性.绘制受试者工作特征(ROC)曲线分析MN超声参数对不同程度CTS的诊断效能.结果 正常组和CTS各组FR、CSA1、CSA2、ΔCSA、R-CSA、血流异常占比比较差异均有统计学意义(均P＜0.05);中、重度组FR、CSA1、ΔCSA、R-CSA、血流异常占比均较轻度组增加,差异均有统计学意义(均P＜0.05);重度组CSA2较轻、中度组增加,中度组CSA2较轻度组减低,差异均有统计学意义(均P＜0.05).各组SCV、DML、CMAP波幅比较差异均有统计学意义(均P＜0.001);轻、中度组DML高于正常组和重度组(均P＜0.05);轻、中、重度组CMAP波幅低于正常组,差异均有统计学意义(均P＜0.05).相关性分析显示,CSA1与SCV、CMAP波幅,ΔCSA、R-CSA与SCV均呈高度负相关(r=-0.797、-0.615、-0.717、-0.658,均P＜0.001).ROC曲线分析显示,CSA1、ΔCSA、R-CSA诊断中、重度CTS的AUC均＞0.70(均P＜0.05),其中CSA1诊断重度CTS、ΔCSA和R-CSA诊断中度CTS的AUC最高,均为0.917.结论 MN超声参数CSA1、ΔCSA、R-CSA能准确诊断不同程度CTS,可作为临床评估CTS分级的可靠参数,具有较好的临床价值.
Abstract
Objective To measure the ultrasound parameters of median nerve(MN)by musculoskeletal ultrasound,and to explore its diagnostic value for different degrees of carpal tunnel syndrome(CTS).Methods A total of 52 clinically diagnosed CTS patients(CTS group)in our hospital were selected and divided into mild group(13 cases),moderate group(24 cases),and severe group(15 cases)according to the nerve conduction test results.Additionally,39 healthy individuals who underwent physical examinations during the same period were selected as the normal group.Musculoskeletal ultrasound was used to measure the horizontal transverse diameter and anterior posterior diameter of the MN hook bone,neural flatness ratio(FR),the horizontal cross-sectional area of the pea bone(CSA1),the horizontal cross-sectional area of the proximal end of the forearm pronator muscle(CSA2),the difference and ratio between CSA1 and CSA2(ΔCSA,R-CSA)were calculated.Nerve conduction test was performed to obtain the sensory nerve conduction velocity(SCV),MN distal motor latency(DML),and distal compound muscle action potential(CMAP).The differences of the above examination results among the groups were compared.The correlation between ultrasound parameters of MN and nerve conduction test results were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of ultrasound parameters of MN for different degrees of CTS.Results There were significant differences in FR,CSA1,CSA2,ΔCSA,R-CSA and the proportion of abnormal blood flow between the normal group and CTS group(all P＜0.05).The FR,CSA1,ΔCSA,R-CSA and the proportion of abnormal blood flow in the moderate group and severe group were increased compared with these in the mild group(all P＜0.05).The CSA2 in the severe group was increased compared with that in the mild group and the moderate group,while CSA2 in the moderate group was decreased compared with that in the mild group(all P＜0.05).The differences in SCV,DML and CAMP among the groups were statistically significant(all P＜0.05).The DML in the mild group and the moderate group was higher than that in the normal and severe groups(all P＜0.05).The CMAP in the mild,moderate,and severe groups was lower than in the normal group(all P＜0.05).Correlation analysis showed that CSA1 was highly negatively correlated with SCV and CMAP,and ΔCSA,R-CSA were highly negatively correlated with SCV(r=-0.797,-0.615,-0.717,-0.658,all P＜0.001).ROC curve analysis showed that the area under the curve(AUC)of CSA1,ΔCSA,and R-CSA in diagnosing moderate amd severe CTS were higher than 0.70(all P＜0.05),while the AUC of CSA1 in diagnosing severe CTS,and ΔCSA and R-CSA in diagnosing moderate CTS were all 0.917 and were the highest.Conclusion CSA1,ΔCSA and R-CSA can accurately diagnose different degrees of CTS and can be used as reliable parameters for grading the severity of CTS with good clinical diagnostic value.
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万方数据