高频超声在周围神经损伤诊断和治疗中的应用

The utilization of hight-frequency ultrasonography in diagnosis and treatment of peripheral nerve injury

目的 评价高频超声诊断技术在周围神经病变中的应用价值.方法 对22例周围神经病变患者行超声检查,明确其病变原因,并结合神经电生理检查评价是否有手术指征.同时根据术中情况评价超声诊断的准确率,并随访治疗1年后的神经功能,评价治疗效果.结果 22例患者均能有效协助诊断周围神经病变的原因、损伤部位,并且与手术中所见完全符合,符合率为100％.患者随访1年观察发现受损神经的功能均明显提高.其中保守治疗的12名患者运动神经传导速度较治疗前提高（P＜0.01）,术前平均神经传导速度为（36.7±12.2）m/s,术后平均传导速度为（48.2±14.4） m/s,平均提高35.0％;10名手术患者运动神经传导速度术前平均为（20.8 ±7.9）m/s,术后平均传导速度为（39.6 ±13.2）m/s,平均提高102.8％,较术前明显提高（P＜0.01）.结论 高频超声结合神经电生理检查能有效明确周围神经病变的病因,避免不必要的手术,有利于选择手术时机和方式。

Objective To observe the value of high-frequency ultrasonography in the diagnosis and treatment of peripheral nerve injury.Methods A total of 22 patients with peripheral nerve injury were examined by high-frequency ultrasonography for the cause of nerve injury.The operative decisions were made according the results of ultrasonography and electroneurophysiology examination.The coincidence rate of ultrasongraphy with intraoperative findings was calculated and the nerve function of patients was followed-up for 1 year to estimate the therapy effects.Results The causes and positions of nerve injury were found by ultrasonography,which were consisted with the intraoperation findings and the coincidence rate was 100%.The function of lesioned nerves was improved after the surgical treatment.The motor nerve conduction velocities （MCV） of 12 patients with conservative treatment were increased （P 〈 0.01） after 1 year of follow-up,the pre-operation MCV,postoperation MCV and the increased rate were （36.7 ± 12.2） m/s,（48.2 ± 14.4） m/s and 35.0%,respectively.While the MCV of 10 operating patients were increased （P 〈 0.01） too,the pre-operation MCV,postoperation MCV and the increased rate were （20.8 ± 7.9） m/s,（39.6 ± 13.2） m/s and 102.8%,respectively.Conclusions High-frequency ultrasonography was a suitable imaging diagnosis tool for peripheral nerve injury.Accompanying with electrophysiological examination,it could explore the causes of nerve injury,determine the treatment and avoid unnecessary operation.