超声对肘管综合征的临床应用价值
发布时间：2019-02-15 22:31
【摘要】：目的:了解肘管综合征中尺神经的超声下改变,测量最粗处横截面积,利用其结果对患者进行严重程度的判定,初步探讨超声作为肘管综合征患者临床分型辅助检查的可行性。并利用超声观察尺神经术后的形态变化,初步探讨超声用于评估术后神经恢复情况的可行性。方法:本研究从2013年5月开始至2014年12月结束,从我院骨科共收集肘管综合征患者65例,其中双侧患病19例,单侧患病46例,共84个患病肘关节。根据临床结果将患病肘关节分为轻、中、重型三组,其中轻型24例,中型25例,重型35例。对肘管综合征患者行超声检查,纵切面与横切面相结合,观察尺神经的形态变化,确认卡压部位及造成卡压的原因,并测量最粗处横截面积;对轻、中、重三组进行方差分析,分析组间是否有统计学差异,并根据ROC曲线确定组间分级诊断指标。对于尺神经术后患者行超声复查,观察尺神经的形态变化。结果:1.肘管综合征患者声像图表现:55例肘管综合征患者尺神经可见卡压,卡压处局部神经变细、变扁,卡压近端及远端神经明显增粗,内部回声减低;15例肘管综合征患者神经未见明显卡压点,仅见神经于肘管处肿胀、增粗;12例轻度肘管综合征患者超声下未见神经卡压,仅见神经于肘管处略增粗或形态改变不明显。2.超声可发现神经卡压原因:大部分是关节表面增生性骨赘引起,另可见有腱鞘囊肿、瘢痕组织、软组织肿物等引起。3.对轻中重三组间行方差分析,三组间差异有统计学意义(0.0820.010VS0.122±0.025VS0.225±0.092,P0.001)。用ROC曲线分别判定轻、中、重度组的划分阈值,轻度组与中度组最粗处横截面积≥0.097cm2,敏感度为92%,特异度为88%;中度组与重度组最粗处横截面积≥0.164cm2,敏感度为96%,特异度为83%。4.肘管综合征患者术后早期尺神经的形态改变不明显。结论:1.高频超声能清楚显示肘管综合征患者尺神经的形态改变,指出卡压部位,明确卡压的原因,为手术治疗提供参考依据,并可以观察神经周围软组织的病变特别是腱鞘囊肿,避免了再次手术的机率。2.高频超声可测量神经最粗处横截面积,并根据其测值判断神经损伤的程度,为临床提供参考信息。3.高频超声可以观察神经术后切口的恢复情况,可以检测神经周围软组织的再生病变情况,但对术后神经恢复状况的早期评估不理想。4.高频超声检查是一种有效的辅助检查方法,对肘管综合征术前术后均有临床诊断价值。
[Abstract]:Objective: to investigate the ultrasonic changes of ulnar nerve in cubital tunnel syndrome, to measure the area of the roughest cross section, to judge the severity of the patients with cubital tunnel syndrome by using the results, and to explore the feasibility of ultrasound as an auxiliary examination for clinical classification of cubital tunnel syndrome. The morphologic changes of ulnar nerve were observed by ultrasound, and the feasibility of using ultrasound to evaluate the recovery of ulnar nerve was discussed. Methods: from May 2013 to December 2014, 65 patients with cubital tunnel syndrome were collected from orthopedic department of our hospital, including 19 bilateral and 46 unilateral elbow joints. According to the clinical results, the elbow joints were divided into three groups: mild, moderate and severe, including 24 mild cases, 25 moderate cases and 35 severe cases. Ultrasonic examination was performed on the patients with cubital tunnel syndrome, the longitudinal section and transverse plane were combined to observe the morphological changes of ulnar nerve, to confirm the position of compression and the cause of compression, and to measure the cross sectional area of the roughest part. The variance analysis of light, medium and heavy groups was carried out to analyze whether there were statistical differences between the three groups, and to determine the grading diagnostic index according to the ROC curve. After ulnar nerve operation, ultrasonic examination was performed to observe the morphological changes of ulnar nerve. Results: 1. In 55 patients with cubital tunnel syndrome, the ulnar nerve was compressed, the local nerve became thin and flattened, the proximal and distal nerve became thicker and the internal echo decreased. In 15 cases of cubital tunnel syndrome, there was no obvious compression point of nerve, only swelling and thickening of nerve in cubital canal, 12 cases of mild cubital tunnel syndrome had no nerve compression under ultrasound, but only a little thickening or no obvious morphological change of nerve in cubital tunnel. 2. The causes of nerve compression can be found by ultrasound: most of them are caused by hyperplastic osteophyte on the surface of joint, and there are tendon sheath cyst, scar tissue, soft tissue mass and so on. 3. 3. There was a significant difference among the three groups (0.0820.010VS0.122 卤0.025VS0.225 卤0.092, P0.001). ROC curves were used to determine the threshold of the classification of mild, moderate and severe groups. The roughest cross-sectional area was 鈮，
本文编号：2423762
[Abstract]:Objective: to investigate the ultrasonic changes of ulnar nerve in cubital tunnel syndrome, to measure the area of the roughest cross section, to judge the severity of the patients with cubital tunnel syndrome by using the results, and to explore the feasibility of ultrasound as an auxiliary examination for clinical classification of cubital tunnel syndrome. The morphologic changes of ulnar nerve were observed by ultrasound, and the feasibility of using ultrasound to evaluate the recovery of ulnar nerve was discussed. Methods: from May 2013 to December 2014, 65 patients with cubital tunnel syndrome were collected from orthopedic department of our hospital, including 19 bilateral and 46 unilateral elbow joints. According to the clinical results, the elbow joints were divided into three groups: mild, moderate and severe, including 24 mild cases, 25 moderate cases and 35 severe cases. Ultrasonic examination was performed on the patients with cubital tunnel syndrome, the longitudinal section and transverse plane were combined to observe the morphological changes of ulnar nerve, to confirm the position of compression and the cause of compression, and to measure the cross sectional area of the roughest part. The variance analysis of light, medium and heavy groups was carried out to analyze whether there were statistical differences between the three groups, and to determine the grading diagnostic index according to the ROC curve. After ulnar nerve operation, ultrasonic examination was performed to observe the morphological changes of ulnar nerve. Results: 1. In 55 patients with cubital tunnel syndrome, the ulnar nerve was compressed, the local nerve became thin and flattened, the proximal and distal nerve became thicker and the internal echo decreased. In 15 cases of cubital tunnel syndrome, there was no obvious compression point of nerve, only swelling and thickening of nerve in cubital canal, 12 cases of mild cubital tunnel syndrome had no nerve compression under ultrasound, but only a little thickening or no obvious morphological change of nerve in cubital tunnel. 2. The causes of nerve compression can be found by ultrasound: most of them are caused by hyperplastic osteophyte on the surface of joint, and there are tendon sheath cyst, scar tissue, soft tissue mass and so on. 3. 3. There was a significant difference among the three groups (0.0820.010VS0.122 卤0.025VS0.225 卤0.092, P0.001). ROC curves were used to determine the threshold of the classification of mild, moderate and severe groups. The roughest cross-sectional area was 鈮，
本文编号：2423762
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