腕管综合征患者正中神经的解剖学变化

Anatomical changes of the median nerve in patients with carpal tunnel syndrome

目的观察腕管综合征患者正中神经的解剖学变化。方法选取腕管综合征患者15例(30侧)作为观察组,其中轻度10侧、中度12侧、重度8侧,另选择同期匹配的15例健康者作为对照组。对两组患者进行彩色多普勒超声检查,计算正中神经在桡尺关节、豌豆骨、钩骨钩3个平面的横截面积,计算不同病情程度腕管综合征患者在豌豆骨、钩骨钩平面腕横韧带厚度、正中神经扁平率。结果观察组与对照组桡尺关节平面的正中神经横截面积分别为(0.10±0.02)、(0.06±0.01)cm2,豌豆骨平面的正中神经横截面积分别为(0.15±0.03)、(0.08±0.02)cm2,钩骨钩平面的正中神经横截面积分别为(0.12±0.02)、(0.06±0.02)cm2,两组比较,P均<0.01。轻、中、重度腕管综合征患者钩骨钩截面腕横韧带厚度分别为(0.40±0.02)、(0.43±0.03)、(0.46±0.03)cm,正中神经扁平率分别为3.32%±0.43%、3.47%±0.23%、3.69%±0.12%,轻、中、重度间比较,P均<0.05;轻、中、重度腕管综合征患者豌豆骨截面腕横韧带厚度分别为(0.30±0.02)、(0.36±0.06)、(0.40±0.03)cm,正中神经扁平率分别为2.87%±0.34%、3.12%±0.43%、3.33%±0.11%,轻、中、重度间比较,P均<0.05。结论腕管综合征患者正中神经解剖学变化表现为在桡尺关节、豌豆骨、钩骨钩3个平面的横截面积均明显增大;随着病情加重,正中神经在钩骨钩截面、豌豆骨截面腕横韧带厚度及正中神经扁平率均明显增加。

Objective To observe the anatomical changes of the median nerve （MN） in patients with carpal tunnel syndrome （CTS）. Methods 15 patients with CTS （observation group） , including t0 mild cases, 12 moderate cases and 8 severe cases, and 15 healthy persons （control group） were selected. Color Doppler ultrasonography was performed on two groups. The cross section areas（CSAs） of MN at three cross sections of articulatio radioulnaris, pisiform bone and hook of hamate bone were calculated. Results The thickness of ligament carpi transversum at cross section of pisiform bone and hook of hamate bone, the MN flattening ratio（MNFR） in patients with different state of illness were calculated. In observa- tion group and control group, C SAs of M N were （0.10 ± 0.02）and（0. 06 ± 0. 01 ）cm2, （0.15 ± 0.03 ）and （0.08 ± 0. 02） cm2, （0.12 ±0.02） and（0.06 ± 0. 02） cm2 at cross sections of articulatio radioulnaris, pisiform bone, hook of hamate bone respectively, compared the two groups, P 〈0. 01. In mild cases, moderate cases and severe eases, the thickness of ligament carpi transversum at cross section of hook of hamate bone was （ 0. 40 ± 0.02 ） , （ 0. 43 ± 0. 03 ） , （ 0.46 ±0. 03 ） cm respectively, the MNFR was 3.32% ±0.43%, 3.47% ±0.23%, 3.69% ±0.12% respectively, compared the mild, moderate and severe cases, P 〈 0. 05. In mild cases, moderate cases and severe cases, the thickness of ligament carpi transversum at cross section of pisiform bone was （0.30 ± 0.02 ） , （ 0.36 ± 0. 06 ） , （ 0.40 ± 0. 03 ） em respectively, the MNFR was 2.87% ±0.34% , 3.12%±0.43% , 3.33% ±0.11% respectively,compared the mild, moderate and severe cases, P 〈 0.05. Conclusions The anatomical changes of the MN in patients with CTS are CSAs obviously increasing at three cross sections of articulatio radioulnaris, pisiform bone and hook of hamate bone. With the aggravation of state of ill- ness, the thickness of ligament carpi transversum at cross seetion of pisiform bone and hook of hamate bone, and the MNFR are obviously increasing.