以上肢麻木不适为主要表现患者的周围神经高频超声和电生理研究

Study of high-frequent ultrasonography and Electroneurophysiology in the patients with upper limb numbness

目的：探讨用高频超声和神经电生理方法来评估以上肢的麻木不适伴疼痛、肌无力、肌萎缩等为主要症状的患者周围神经病变的价值。方法：对具有上肢不适的患者37例（共74只上肢）（病例组）和健康志愿者26例（共52只上肢）（对照组）进行高频高分辨力超声和神经电生理的检查，超声重点测量正中神经、桡神经、尺神经上臂以及正中神经在腕管内的横截面积，电生理主要测定这三条神经的传导速度（NCV）。结果：病例组正中神经在上臂及腕管内的横截面积分别为上臂11．66（7．1～19．3）mm^2，桡尺关节平面处为11．94（5．3～18．2）mm^2，豌豆骨平面处为10．75（4．4～14．1）mm^2，钩骨钩平面处为12．51（6．2～18．9）mm^2，均大于对照组，（P〈0．01）；尺神经在肘管上缘的横截面积为7．85（3．3～22．8）mm^2，桡神经在上臂的横截面积为5．71（4．0～10．2）mm^2，与对照组比较差异不显著（P〉0．05）。超声和电生理检测得单纯正中神经损害率分别为62％和50％；正中神经、尺神经联合损害率分别为24％和19％；单纯尺神经的损害率分别为5．4％和8％，桡神经损害最少。正中神经损害最常见部位在腕管，但有35％的患者合并正中神经在上臂的增粗。尺神经最常损害部位在肘管。结论：高频超声和电生理检测都有助于明确上肢周围神经病变。出现上肢症状者正中神经损害最为常见，其次为正中神经尺神经联合病变，单独的尺神经异常不是太多，涉及桡神经的病变发生率最低。正中神经腕管内损害合并上臂的增粗应予以关注。

Objective： To explore the value of assessing the peripheral nerve morphology and neurophysiological function with high-frequent ultasonography（HUS） and electroneuro physiology in the pa tients with chronic neuropathy. Methods： HUS and electrodiagnostic evaluation were prospectively performed in 37 patients with upper limbs numbness and clinical diagnosis of peripheral neuropathy and 26 normal controls. Median nerves, ulnar nerves and radial nerves were observed, and the cross-sectional areas of nerves were measured at different levels： radial carpal joint, pisiform, hook of hamate （median nerves） ,4 cm above elbow of the upper arm（median nerves and radial nerves）, superior margin of cubital tunnel（ulnar nerves）. Motor and sensory nerve conduction velocity were measured with Nicolet Wiking EMG Unit. Results： Cross-sectional areas of median nerves were significantly higher in the patients corn pared with the controls. Median （range） areas were 11.66 （7.1±19.3）mm2, 11.94 （5.3±18.2）mm2,10. 75 （4.4±14.1）mm^2 , 12. 51 （6.2±18.9）mm^2 respectively （P〈0.01）. No significant difference in the cross-sectional areas of ulnar nerves and radial nerves were observed in both groups. Only median nerve impairment in HUS and electrodiagnostic examination were found in 23 （62 %） and 59 （50 %） patients respectively; 9 （24%）and 7 （19%） patients were proved to suffer from median nerve plus ulnar nerve damages respectively; 2 （5.4 %0 ） and 3 （8% ） patients were confirmed to have ulnar nerve abnormal- ity. Radial nerves were rarely injured. The common location of median nerve damages were carpal tunnel, but 13 （35%） patients were combined with increased cross-sectional areas in upper arms; Ulnar nerves were injured in cubital tunnel frequently. Conclusion： HUS and electrodiagnostic examination are both benefitial in the assess ment of the peripheral nerve injuries occure patients with upper limbs complaints. The most common nerve impairment is occure median nerves, the second is in median nerve plus ulnar nerve and the third in ulnar nerves, radial nerves are rarely injured . Median nerve injuries in cubital tunnel with increased cross-sectional areas in upper arms should be paled attention to.