腕管内正中神经变异的声像图表现及其临床意义

Sonographic appearance and clinical significance of anatomic variation of carpal tunnel median nerve

目的探讨腕管正中神经及伴行结构变异在人群中的发生率、超声表现及其在腕管综合征诊断中的意义。方法对180位健康志愿者的360只手腕部腕管结构及前臂进行高频超声检查。检查前臂和腕部正中神经走行，先进行腕管结构的横断面扫查，确认正中神经位置后，采用连续横断面扫查法向近端前臂进行动态观察并适当结合纵断面扫查，记录图像资料。结果腕管正中神经及伴行结构变异：①正中神经高位分叉2例（0．56％）；②正中神经裂17例（4．72％）；③腕部正中神经区发现永存正中动脉22例（6．11％），并且2例（0．56％）永存正中动脉周有静脉伴存。永存正中动脉出现伴随正中神经走形变异16例（4．44％）。结论腕部高频超声检查能够敏感地发现正中神经变异，认识这些变异，有助于正确诊断腕管综合征。

Objective To investigate the incidence,sonographic appearance of the anatomic variation of carpal tunnel median nerve and its accompanying structures in healthy volunteers and explore the value of this variation in carpal tunnel syndrome. Methods A total of 360 hands of 180 healthy volunteers were included in the study. The full course of the median nerve in the forearm and carpal tunnel was examined with high-frequency ultrasound. The median nerve was first located in cross section at wrist and then with continuous cross-sectional scanning to observe the the full course of the median nerve in the forearm and carpal tunnel with high-frequency ultrasound. Results Anatomic variation of carpal tunnel median nerve and its accompanying structures were observed ：①High division median nerve were found in 2 wrists （0.56 %） ; ②Bifid median nerve were found in 17 wrists （4.72%） ;③Persistent median artery were found in 22 wrists （6.11%） ,and 2 wrists （0. 56%） were also found accompanied vein. Aanatomic variation of carpal tunnel median nerve accompanied with persistent median artery were observed in 16 wrists （4.44%）. Conclusions High-frequency ultrasound was sensitive to diagnose the anatomic variation of carpal tunnel median nerve and its accompanying structures. Recognition of these variations can help us to make correct diagnosis of carpal tunnel syndrome.