高频超声测量腕横韧带厚度对腕管综合征的临床辅助诊断价值

Clinical auxiliary diagnosis value of high frequency ultrasonographic measurements of the thickness of transverse carpal ligaments in carpal tunnel syndrome patients

目的:评价高频超声对诊断腕管综合征(carpal tunnel syndrome,CTS)的价值及意义。方法:选择48例(单侧)CTS患者,用高频超声测量钩骨钩水平的腕横韧带厚度,所有病例均行腕管切开减压术,术中直视下采用游标卡尺测量钩骨钩水平的腕横韧带厚度,评价高频超声测量腕横韧带厚度的准确性。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析其测定腕横韧带厚度的诊断阈值,计算敏感性与特异性,探讨超声检测CTS患者腕横韧带于豌豆骨及钩状骨位置的厚度与神经传导检测的相关性。结果:在钩骨钩采用超声和术中测量CTS患者的腕横韧带,分别为(0.42±0.08)cm和(0.41±0.06)cm,两者差异无统计学意义(t=0.672,P>0.05),表明超声可准确测量腕横韧带。钩状骨水平腕横韧带厚度与神经传导取最佳截点0.385 cm,灵敏度为0.775,特异度为0.788。豌豆骨水平腕横韧带厚度的最佳截点为0.315 cm,灵敏度为0.950,特异度1.000。豌豆骨及钩状骨位置处腕横韧带的厚度与腕-示指感觉神经传导速度(sensory nerve conduction velocity,SCV)、腕-中指SCV均呈负相关性。结论:高频超声测量腕横韧带厚度协助诊断腕管综合征可能是一种有价值的方法。

Objective： To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome（ CTS）. Methods： In this study,48 patients（ unilateral hand） with CTS were analyzed. The thickness of transverse carpal ligaments at the pisiform bone was measured using high-frequency ultrasound. Open carpal tunnel release procedure was performed in the 48 CTS patients,and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under direct vision. The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound. High-frequency ultrasound measurement of thickness of transverse carpal ligaments at the hamate hook bone and pisiform bone,and determination of the diagnostic threshold measurement index using receiver operating characteristic（ ROC） curve,sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study（ NCS） analyzed. Results： The thickness of transverse carpal ligaments in the CTS patients were（ 0. 42 ± 0. 08） cm（ high-frequency ultrasound） and（ 0. 41 ± 0. 06） cm（ operation） at hamate hook bone,and there was no significant difference between the two ways（ t = 0. 672,P〉0. 05）. The optimal cut-off value of the transverse carpal ligaments at hamate hook bone was 0. 385 cm,the sensitivity 0. 775,and the specificity0. 788. The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0. 315 cm,the sensitivity 0. 950,and the specificity 1. 000. The transverse carpal ligaments thickness and wrist-index finger sensory nerve conduction velocity（ SCV）,wrist-middle finger SCV showed a negative correlation. Conclusion： High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.