实时动态超声在肘管综合征诊断中的临床价值

Clinical Value of Real-time Dynamic Ultrasonography in the Diagnosis of Cubital Tunnel Syndrome

目的探讨实时动态超声检查在肘管综合征(Cu TS)诊断中的临床价值及意义。方法选择2016年6月—2017年3月于唐山市第二医院就诊且经手术证实的Cu TS患者40例为研究对象,采用Philips HD15超声诊断仪行超声检查,以Cu TS患者患侧肢体为Gu TS组,以健侧肢体为对照组,采用纵切面与横切面相结合的扫查方法来观察尺神经的形态学变化。纵切面上测量尺神经卡压处厚度和最粗处厚度,计算厚度比(卡压处/最粗处);横切面上分别于伸肘位和屈肘位测量肱骨内上髁处、近端髁上2 cm处及远端髁下2 cm处3个水平面尺神经的横截面积(CSA),计算伸肘位与屈肘位的CSA差值(ΔCSA)。结果 Cu TS组尺神经卡压处厚度和厚度比均小于对照组,Cu TS组尺神经最粗处厚度大于对照组(P<0.05)。Cu TS组伸肘位和屈肘位肱骨内上髁处、近端髁上2 cm处及远端髁下2 cm处尺神经的CSA及ΔCSA均大于对照组(P<0.05)。结论通过在伸肘位和屈肘位对尺神经CSA进行测量,表明实时动态超声可显示伸肘位和屈肘位时肘管内尺神经CSA的减小值,为临床治疗选择合适的手术方式提供依据。

Objective To explore the clinical value and significance of real-time dynamic ultrasonography in the diagnosis of cubital tunnel syndrome(CuTS).Methods Forty patients with surgically confirmed CuTS receiving treatment in the Second Hospital of Tangshan from June 2016 to March 2017 were enrolled.All of them underwent ultrasonography using HD15 Ultrasound System produced by Philips.The affected upper limbs as well as the healthy upper limbs of the patients were set as the CuTS group,and control group,respectively.Both longitudinal and cross-sectional scanning were used to detect the ulnar nerve morphology.The thickness of the entrapment and the most thickest part of the ulnar nerve on the longitudinal section was measured,and the ratio between the two was calculated.The cross-sectional area(CSA)of the ulnar nerve at three sites(humeral medial epicondyle,2 cm above the supracondylar and 2 cm below the distal end of the condyle)was measured in the cross-section at elbow extension and flexion,respectively,and the difference between the two(ΔCSA)was calculated.Results The thickness and the ratio of the ulnar nerve at the CuTS group were less than those of control group,and the thickness of the ulnar nerve in the CuTS group was greater than that of the control group(P<0.05).The average CSA of the ulnar nerve at the aforementioned three sites at elbow extension and flexion,as well as the averageΔCSA between the two for the affected upper limb of GuTS group were all greater than those of control group(P<0.05).Conclusion ΔCSA can be calculated based on the measurement results of real-time dynamic ultrasonography,which provides a reference for clinical selection of surgical treatment.