【摘要】：目的:了解肘管綜合征中尺神經(jīng)的超聲下改變,測量最粗處橫截面積,利用其結果對患者進行嚴重程度的判定,初步探討超聲作為肘管綜合征患者臨床分型輔助檢查的可行性。并利用超聲觀察尺神經(jīng)術后的形態(tài)變化,初步探討超聲用于評估術后神經(jīng)恢復情況的可行性。方法:本研究從2013年5月開始至2014年12月結束,從我院骨科共收集肘管綜合征患者65例,其中雙側患病19例,單側患病46例,共84個患病肘關節(jié)。根據(jù)臨床結果將患病肘關節(jié)分為輕、中、重型三組,其中輕型24例,中型25例,重型35例。對肘管綜合征患者行超聲檢查,縱切面與橫切面相結合,觀察尺神經(jīng)的形態(tài)變化,確認卡壓部位及造成卡壓的原因,并測量最粗處橫截面積;對輕、中、重三組進行方差分析,分析組間是否有統(tǒng)計學差異,并根據(jù)ROC曲線確定組間分級診斷指標。對于尺神經(jīng)術后患者行超聲復查,觀察尺神經(jīng)的形態(tài)變化。結果:1.肘管綜合征患者聲像圖表現(xiàn):55例肘管綜合征患者尺神經(jīng)可見卡壓,卡壓處局部神經(jīng)變細、變扁,卡壓近端及遠端神經(jīng)明顯增粗,內(nèi)部回聲減低;15例肘管綜合征患者神經(jīng)未見明顯卡壓點,僅見神經(jīng)于肘管處腫脹、增粗;12例輕度肘管綜合征患者超聲下未見神經(jīng)卡壓,僅見神經(jīng)于肘管處略增粗或形態(tài)改變不明顯。2.超聲可發(fā)現(xiàn)神經(jīng)卡壓原因:大部分是關節(jié)表面增生性骨贅引起,另可見有腱鞘囊腫、瘢痕組織、軟組織腫物等引起。3.對輕中重三組間行方差分析,三組間差異有統(tǒng)計學意義(0.0820.010VS0.122±0.025VS0.225±0.092,P0.001)。用ROC曲線分別判定輕、中、重度組的劃分閾值,輕度組與中度組最粗處橫截面積≥0.097cm2,敏感度為92%,特異度為88%;中度組與重度組最粗處橫截面積≥0.164cm2,敏感度為96%,特異度為83%。4.肘管綜合征患者術后早期尺神經(jīng)的形態(tài)改變不明顯。結論:1.高頻超聲能清楚顯示肘管綜合征患者尺神經(jīng)的形態(tài)改變,指出卡壓部位,明確卡壓的原因,為手術治療提供參考依據(jù),并可以觀察神經(jīng)周圍軟組織的病變特別是腱鞘囊腫,避免了再次手術的機率。2.高頻超聲可測量神經(jīng)最粗處橫截面積,并根據(jù)其測值判斷神經(jīng)損傷的程度,為臨床提供參考信息。3.高頻超聲可以觀察神經(jīng)術后切口的恢復情況,可以檢測神經(jīng)周圍軟組織的再生病變情況,但對術后神經(jīng)恢復狀況的早期評估不理想。4.高頻超聲檢查是一種有效的輔助檢查方法,對肘管綜合征術前術后均有臨床診斷價值。
[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 鹵0.025VS0.225 鹵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，

本文編號：2423762