高频超声诊断血液透析相关腕管综合征的价值

Application of high frequency musculoskeletal ultrasound in the diagnosis of hemodialysis related carpal tunnel syndrome

目的:应用高频超声对血液透析相关腕管综合征(CTS)患者正中神经压迫率进行评估,探讨超声诊断血液透析相关CTS的价值。方法:回顾性分析行血液透析的患者84例,根据临床症状、体征及电生理检查结果将患者分为试验组52例(血液透析伴CTS)、对照组32例(血液透析不伴CTS)。高频超声探查正中神经,测量腕管内受压正中神经最小与最大径,计算正中神经压迫率。体格检查患者有无Tinel征,测量握力,问卷评估患者麻木和疼痛程度;线性回归分析影响正中神经压迫率的相关因素。结果:与对照组相比,试验组透析时间长,糖尿病史比例高,透析前CRP、BUN、β2-MG水平高,握力减小,Tinel征阳性率高,Quick-DASH上肢功能障碍评分、VAS疼痛评分高。试验组正中神经最小径减小,正中神经压迫率增高。线性回归分析发现,透析时间、β2-MG、Tinel征阳性、腕管松解手术史和握力强度是影响正中神经压迫率的重要因素。结论:高频超声能够评估透析相关CTS患者正中神经受压迫程度,对早期发现和诊断透析相关CTS具有重要临床意义。

Objective:To evaluate the median nerve compression rate of patients with dialysis related carpal tunnel syndrome(CTS)by high frequency ultrasound,and to explore the clinical value of musculoskeletal ultrasound in the early diagnosis of hemodialysis related CTS.Methods:A total of 84 outpatients and inpatients receiving hemodialysis were analyzed retrospectively.According to the clinical symptoms,signs and electrophysiological examination results,the patients were divided into hemodialysis with CTS group(52 cases)and hemodialysis without CTS group(32 cases).The median nerve compression rate was calculated by measuring the minimum and maximum diameter of the compression nerve.Tinel sign and the grip strength of the patients were observed.The numbness and pain with questionnaire were assessed.Linear regression was used to analyze the impact of median nerve compression rate related factors.Results:Compared with hemodialysis without CTS group,hemodialysis with CTS group had longer dialysis time and higher rate of diabetes history,higher levels of CRP,BUN andβ2-MG before dialysis,lower grip strength,higher positive rate of Tinel sign and higher scale score.Hemodialysis with CTS group had lower median nerve minimum diameter and higher median nerve compression rate.Linear regression analysis showed that dialysis time,β2-MG,positive Tinel sign,history of carpal tunnel release operation and grip strength were important factors affecting median nerve compression rate.Conclusions:High frequency musculoskeletal ultrasound can evaluate the degree of median nerve compression in patients with dialysis related CTS.As a noninvasive examination method,ultrasound has an important clinical significance in the early detection and diagnosis of dialysis related CTS.