超声在判断外周神经缝合后再生状况中的应用

Application of ultrasound in the determination of the regeneration of sutured peripheral nerve

目的探讨高频超声(ultrasonography,US)在判断缝合后外周神经再生状况中的作用。方法对43例功能恢复不良患者的66条缝合神经进行术前超声检查,观察神经连续性,记录缝合口声像图特征,判断缝合后神经束通过吻合口的状况,与术中肌电图比较,计算超声诊断准确率。结果缝合后神经功能恢复不良患者的声像图表现归纳成6型。以术中肌电图体感诱发电位(somatosensory evoked potential,SEP)作为判断吻合后神经通路是否建立的金标准,超声漏检1处吻合口,误判6处吻合口,诊断准确率90%。结论超声可根据声像图对一些类型的吻合口早于肌电图做出诊断,发现导致缝合后神经功能仍然障碍的原因;对外周神经吻合后再生状况作出较准确的判断,为进行二次手术提供有效的帮助。

Objective To discuss the role of high-resolution uttrasonography in determining the regeneration of sutured peripheral nerves. Methods A total of 43 patients with 66 sutured nerves received high-resolution ultrasonography （US） before operation. The continuity of nerves was observed. The characteristic images of the anastomotic stomas was recorded and compared with the intraoperative electromyogram （EMG） to calculate the ultrasonic accuracy. Results The echoic image of the anastomotic stomas was classified into 6 categories. Ultrasonographic accuracy was 90 with intraoperative somatosensory evoked potential （SEP） as a golden standard. Conclusions US can be used correctly diagnose the image of anastomotic stomas precede to EMG, point out the exact reasons leading to function loss of the regenerated nerves. US has a high accuracy in determinging the regeneration of sutured peripheral nerves, providing effective help to advise patients to accept the second repaired operation as early as possible.