骨间前神经沙漏样狭窄的超声诊断

Value of ultrasonography in diagnosing hourglass-like fascicular constrictions of the anterior interosseous nerve

目的探讨骨间前神经沙漏样狭窄的超声诊断价值。方法对2010年7月至2020年7月山东大学附属山东省医学影像学研究所12例骨间前神经沙漏样狭窄的患者进行回顾性分析,总结其高频超声图像特征,并与临床外科手术进行对照。结果12例骨间前神经沙漏样狭窄均位于上臂远段正中神经内,其中单发沙漏样改变9例,多发沙漏样改变3例,高频超声可精确定位骨间前神经沙漏样狭窄的位置以及病变的累及范围。骨间前神经沙漏样狭窄声像图表现为上臂正中神经主干内束组单发或者多发的沙漏样改变,沙漏样改变两侧神经束增粗。病变束组直径与对侧肢体相应位置束组直径之间差异有统计学意义[(0.20±0.04)cm对(0.11±0.03)cm,P<0.01],病变侧束组最宽处相应的正中神经横截面积与对侧肢体相应位置正中神经横截面积之间差异有统计学意义[(0.14±0.03)cm2对(0.09±0.03)cm2,P<0.01]。结论高频超声是诊断骨间前神经沙漏样狭窄首选的影像学诊断学方法。

Objective To investigate the value of ultrasound in the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.Methods From July 2010 to July 2020,12 patients with hourglass-like fascicular constrictions of the anterior interosseous nerve diagnosed in Shandong Medical Imaging Research Institute Affiliated to Shandong University were retrospectively analyzed.The characteristics of the high-frequency ultrasonographic images were summarized and compared with clinical surgery.Results The hourglass-like fascicular constrictions of the anterior interosseous nerve were all located in the median nerve of the distal upper arm in 12 patients,including 9 cases of single hourglass change and 3 cases of multiple hourglass like changes.High-frequency ultrasound can accurately locate the location of the hourglass-like fascicular constrictions of the anterior interosseous nerve and the extent of neuropathy.The sonogram of hourglass-like fascicular constrictions of the anterior interosseous nerve showed single or multiple hourglass-like changes in the median nerve of the distal upper arm.The nerve fasciculars on both sides of hourglass-like changes were thickened.There was significant difference between the diameter of the affected fascicular and the corresponding position of the contralateral fascicular[(0.20±0.04)cm vs(0.11±0.03)cm,P<0.01].There was significant difference between the cross-sectional area of the median nerve at the widest part of the lesion side and the corresponding position of the contralateral side[(0.14±0.03)cm2 vs(0.09±0.03)cm2,P<0.01].Conclusions High-frequency ultrasound is the preferred image method for the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.