脑卒中康复期患者屈腕姿势腕管正中神经弹性硬度值和横截面积变化及意义

Changes and significances of shear wave elasticity and cross-sectional area of the median nerve at the carpal tunnel in flexed wrist posture in convalescent stroke patients

目的应用超声弹性虚拟触觉组织成像量化(virtual touch tissue imaging quantification,VTIQ)技术检测脑卒中康复期患者屈腕姿势腕管正中神经弹性硬度(shear wave elasticity,SWE),高频超声测量其横截面积(cross-sectional area,CSA),探讨其变化及临床意义。方法脑卒中康复期患者48例,均应用高频超声测量患侧和健侧屈腕姿势腕管正中神经CSA,采用VTIQ技术测量患侧和健侧腕管正中神经SWE,比较患侧与健侧SWE、CSA差异,Spearman相关分析患侧SWE、CSA与脑卒中病程的相关性。结果患侧屈腕姿势腕管正中神经CSA[(6.86±1.27)mm2]较健侧[(8.02±1.50)mm2]小(P<0.05),SWE[(4.37±0.53)m/s]较健侧[(3.07±0.53)m/s]高(P<0.05);患侧屈腕姿势腕管正中神经CSA与脑卒中病程呈负相关(r=-0.58,P=0.036),SWE与脑卒中病程无明显线性相关(r=0.21,P=0.650)。结论脑卒中康复期患者屈腕姿势可引起腕管正中神经萎缩,其机制可能是局部慢性压迫造成正中神经硬度增加。

Objective To investigate the changes and clinical significances of the shear wave elasticity（SWE）and cross-sectional area（CSA）of the median nerve at the carpal tunnel in flexed wrist posture measured by virtual touch tissue imaging quantification（VTIQ）in convalescent stroke patients.Methods Forty-eight convalescent stroke patients were measured the CSA and SWE of the median nerve at bilateral carpal tunnel by high-frequency ultrasound and VTIQ.The SWE and CSA of the median nerves were compared between two sides of carpal tunnels,and the correlation between SWE and CSA at the affected carpal tunnel with the disease course was analyzed by Spearman correlation analysis.Results The CSA of the median nerve was significantly smaller at the affected side（（6.86±1.27）mm2）than that at the unaffected side（（8.02±1.50）mm2）（P0.05）,while the SWE was significantly higher at the affected side（（4.37±0.53）m/s）than that at the unaffected side（（3.07±0.53）m/s）（P0.05）.The CSA at the affected side was negatively correlated with the disease course（r=-0.58,P=0.036）,while the SWE was not correlated with the onset time of stroke（r=0.21,P=0.650）.Conclusion The flexed wrist posture may cause atrophy of the median nerve probably by the increase of the stiffness of the median nerve after chronic compression in convalescent stroke patients.