高频超声诊断腕管综合征的价值

Value of High-Frequency Ultrasound in Diagnosis of Carpal Tunnel Syndrome

目的探讨高频超声诊断腕管综合征(CTS)的价值。方法选择经手术证实的21例(共33只手腕)腕管综合征患者为观察组,21例(共33只手腕)无腕管综合征的健康志愿者为对照组。采用Mylab 90型彩色多普勒超声诊断仪矢状位观察腕管正中神经的形态、回声改变,测量豌豆骨水平正中神经及钩骨勾水平正中神经的横截面积,计算豌豆骨水平正中神经肿胀率,并对2组结果进行比较。绘制2组豌豆骨水平正中神经横截面积及肿胀率的ROC曲线,计算其诊断腕管综合征的诊断阈值、敏感度及特异度。结果 CTS患者的正中神经卡压最常见的部位为钩骨水平,卡压两端神经肿胀,肿胀处回声减低,豌豆骨水平横截面积最大。观察组豌豆骨水平正中神经横截面积与肿胀率均显著高于对照组(P<0.001)。豌豆骨水平正中神经横截面积对CTS的诊断阈值为9.60mm2,敏感度为90.9%,特异度为84.8%;豌豆骨水平正中神经肿胀率对CTS的诊断阈值为1.09,敏感度为93.9%,特异度为90.9%。结论高频超声检查可以从正中神经的形态、横截面积、肿胀率方面诊断腕管综合征,是诊断腕管综合征的可靠方法。

Objective To evaluate the value of high-frequency ultrasonography in the diagnosis of carpal tunnel syndrome （CTS）. Methods Twenty-one patients with CTS confirmed by operation（33 wrists,observation group） and 21 healthy volunteers（33 wrists, control group） were selected in this study. The morphology and echo changes of median nerve in the carpal tunnel were measured with MyLab 90 color Doppler ultrasound system in sagittal plane. The cross-sectional areas of median nerve at the levels of pisiform bone and hamate hook were determined and the swelling rates of median nerve at the level of pisiform bone were calculated to produce the ROC curve. The threshold value, sensitivity and specificity of ultrasonic diagnosis were calculated. Results In CTS patients,median nerve compression was most commonly found at the level of ha- mate bone. The proximal and distal segments of the compressed nerve showed swelling, which was characterized by a hypoechoic echo pattern. The largest cross-sectional area was found at the level of pisiform bone. Compared with control group,cross-sectional area and swelling rate of median nerve at the level of pisiform bone significantly increased in observation group （P〈0. 001）. The diagnostic threshold value, sensitivity and specificity of cross-sectional area of median nerve were 9.60 mm2 ,90.9% and 84.8% ,respectively. The diagnostic threshold value,sensitivity and specificity of swelling rate of median nerve were 1.09,93.9% and 90.9%, respectively. Conclusion High-frequency ultrasound is reliable to diagnose CTS from aspects of the shape, cross-sectional area and swelling rate of median nerve.