高频超声横截面积法在诊断腕管综合征中定位定量研究

发布时间：2018-08-27 08:20

【摘要】：目的：通过对腕管综合征(Carpal Tunnel Syndrome,CTS)患者行高频超声和神经传导速度检查,多点位测量腕管处正中神经的横截面面积,探讨超声对CTS的诊断价值,并根据超声测量正中神经的横截面面积与神经传导速度异常程度及症状持续时间相关性进行比较。方法：本研究共选取49人(70只手)参与此项研究,其中病例组26人(36只手)为在神经科就诊患者,存在上肢麻木感觉异常或疼痛等症状,经神经传导速度检查确诊为腕管综合征,对照组23人(34只手)为同期在本院体检或本院职工无上肢麻木、疼痛等症状的健康志愿者,经神经传导速度检查除外CTS,应用高频超声对其腕管处正中神经进行测量,以横截面面积为测量指标,分别在腕横纹上3cm、腕横纹上2cm、腕横纹上1cm、腕横纹、腕横纹下1cm、腕横纹下2cm、腕横纹下3cm、腕横纹下4cm处测量正中神经横截面面积,比较病例组与对照组的横截面面积,根据数据分布特征,两组间差异采用t检验或Mann-Whitney U秩和检验对比。根据临床症状和神经传导速度检查结果为诊断标准,采用受试者工作特征曲线(ROC曲线)进行分析,确定超声下正中神经横截面积在诊断腕管综合征的敏感性、特异性和诊断阈值。同时根据神经传导速度严重程度将CTS患者分级为轻、中、重3组,临床症状持续时间按3个月、3个月至1年、1年3组,各组之间横截面面积分别和对照组比较,两组间差异采用t检验或Mann-Whitney U秩和检验,以P0.05为差异,认为有统计学意义。结果：1.通过对CTS患者和对照组之间年龄、性别、身高、体重的比较发现,年龄、性别、身高之间无差异(P0.05),无统计学意义。体重在两者之间有差异(P0.05),有统计学意义。2.通过对CTS患者腕部正中神经横截面面积8点测量并和对照组比较,病例组所测各点横截面面积与对照组比较均有差异(P0.05),有统计学意义。通过对8个点所测得横截面积进行ROC曲线分析,发现在腕横纹下4cm处曲线下面积最大,为0.874,选取此处为CTS最佳诊断阈值为0.095cm2,其敏感性为88.9%,特异性为76.5%。3.将CTS患者按神经传导速度检测结果分为轻、中、重三组,各组所测横截面面积分别与对照组比较,在轻度CTS患者腕横纹下1cm、腕横纹下2cm、腕横纹下3cm、腕横纹下4cm处与对照组相比有差异(P0.05),有统计学意义。在中度和重度CTS患者腕部8点所测量的横截面积与对照组比较均有差异(P0.05),有统计学意义。4.CTS患者按临床症状持续时间分为3个月、3个月至1年、1年3组,各组所测横截面面积分别与对照组比较,在3个月至1年和1年这两组CTS患者的腕部8点所测量的横截面积与对照组比较均有差异(P0.05),有统计学意义,而3个月的CTS患者腕部8点所测量的横截面积与对照组比较无差异(P0.05),无统计学意义。5.通过对腕管部正中神经检查,病例组发现1例正中神经走行变异,对照组发现1例腕管内存在正中动脉。结论：1.高频超声测量正中神经横截面积诊断CTS与神经电生理有很好的一致性,是有效的辅助检查方法。2.在腕横纹下4cm处测量横截面积正常阈值为0.095cm2对于诊断CTS具有较好的敏感性和特异性。3.正中神经横截面积与患有CTS的严重程度及症状持续时间相关。4.体重因素与CTS的发病具有一定的相关性。5.高频超声能够显示CTS患者正中神经形态、变异、伴行血管,为手术治疗提供局部解剖关系。
[Abstract]:Objective: To investigate the diagnostic value of ultrasonography for CT by examining the high frequency ultrasound and nerve conduction velocity in patients with Carpal Tunnel Syndrome (CTS) and measuring the cross-sectional area of median nerve at the carpal tunnel at multiple points. Methods: A total of 49 patients (70 hands) were enrolled in the study. 26 patients (36 hands) in the case group were diagnosed as carpal tunnel syndrome by nerve conduction velocity test, and 23 patients (34 hands) in the control group were examined in the same period. The median nerve at the carpal canal was measured by high-frequency ultrasonography. The cross-sectional area of the median nerve at the carpal canal was taken as the measurement index. The wrist striae were 3 cm above the wrist striae, 2 cm above the wrist striae, 1 cm above the wrist striae, 1 cm below the wrist striae, 2 cm below the wrist striae. The cross-sectional area of the median nerve was measured at the lower 3 cm and 4 cm below the wrist stria. The cross-sectional area of the median nerve was compared between the case group and the control group. Meanwhile, according to the severity of nerve conduction velocity, the patients with CTS were classified into three groups: mild, moderate, and severe. The duration of clinical symptoms was 3 months, 3 months to 1 year, and 1 year, respectively. Results: 1. There was no significant difference in age, sex, height and weight between CTS patients and control group (P 0.05). There was no significant difference in weight between the two groups (P 0.05). The cross-sectional area of the median nerve in the wrist of CTS patients was measured at 8 points and compared with that of the control group. The cross-sectional area of each point in the case group was significantly different from that of the control group (P The largest area was 0.874. The best diagnostic threshold of CTS was 0.095 cm 2. The sensitivity and specificity were 88.9% and 76.5% respectively. 3. According to the results of nerve conduction velocity, the patients with CTS were divided into three groups: light, medium and heavy. The cross-sectional area measured in each group was 1 cm below the wrist stria, 2 cm below the wrist stria, and 3 cm below the wrist stria. Comparing with the control group, the cross-sectional area measured at 8:00 in moderate and severe CTS patients was significantly different (P 0.05). 4. According to the duration of clinical symptoms, the patients with CTS were divided into 3 months, 3 months to 1 year, 1 year 3 groups. Comparing with the control group, the cross-sectional area measured at 8:00 in the wrist of the two groups of CTS patients from 3 months to 1 year and 1 year was significantly different from that of the control group (P 0.05), but the cross-sectional area measured at 8:00 in the wrist of the CTS patients from 3 months to 1 year was not significantly different from that of the control group (P 0.05). One case of median nerve variation was found in the case group and one case of median artery in the control group. Conclusion: 1. High-frequency ultrasound measurement of median nerve cross-sectional area in the diagnosis of CTS and neuroelectrophysiology has a good consistency, is an effective auxiliary examination method. 2. Measuring the normal threshold of cross-sectional area at 4 cm below the wrist stria is 0.095 cm 2 pairs. Median nerve cross-sectional area is associated with the severity of CTS and the duration of symptoms. 4. Weight factors have a certain correlation with the onset of CTS. 5. High-frequency ultrasound can show the morphology of median nerve in CTS patients, variation, accompanied by blood vessels, and provide local anatomical relationship for surgical treatment.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R688

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