剪切波弹性成像技术在肘管综合征诊断中的应用价值

Application value of shear wave elastography in diagnosis of cubital tunnel syndrome

目的探讨剪切波弹性成像技术(SWE)在肘管综合征(CuTS)诊断中的应用价值。方法选取2015年1月至2018年7月该院骨科收治并经手术确诊为CuTS的患者53例(均为单侧病变),另选取同期健康志愿者70例为对照组。受试者行常规二维超声检查和SWE检查,CuTS组行肌电图检查。记录内上髁水平尺神经的横截面积(CSA)、弹性模量均值(EI)及剪切波速度(V),比较参数之间的差异并绘制受试者工作特征曲线(ROC曲线),分析EI与感觉传导速度(SCV)及运动传导速度(MCV)的相关性。结果CuTS组CSA、EI、V与对照组比较,差异均有统计学意义(P<0.001),CSA、EI、V诊断CuTS的ROC曲线下面积分别为0.774、0.858、0.858,三者诊断效能无明显差异(P>0.05)。CuTS中、重度患者CSA、EI及V值均较轻度增加,差异有统计学意义(P<0.001),中、重度之间差异无统计学意义(P>0.05)。随着卡压程度加重,EI及V值增高(r=0.588、0.592,P<0.001)。CuTS组EI与MCV、SCV均呈线性负相关(r=-0.707、-0.671,P<0.001)。结论SWE为诊断CuTS提供了一种无创定量的诊断方法。

Objective To explore the value of shear wave elastorgraphy(SWE)in the diagnosis of cubital tunnel syndrome(CuTS).Methods Fifty-three patients with CuTS(single side lesion)treated in the orthopedic department and definitely diagnosed by operation from January 2015 to July 2018 were selected.Contemporaneous 70 healthy volunteers were selected as the control group.The subjects conducted the dimensional ultrasound and SWE examinations.The CuTS group conducted the electromyogram examination.The cross-sectional area(CSA),elasticity modulus mean value(EI),and the shear wave velocity(V)of ulnar nerve at medial epicondylar level were recorded.The differences were compared among the parameters,and the ROC curve was drawn.Then the correlation between EI with motor-nerve conduction velocity(MCV)and sensory-nerve conduction velocity(SCV)was analyzed.Results There were significant differences in CSA,EI and V between the CuTS group and control group(P<0.001).The areas under the ROC curve of CSA,EI and V for diagnosing CuTS were 0.774,0.858 and 0.858 respectively.There was no significant difference in the diagnostic efficiency among the three parameters(P>0.05).The CSA,EI,and V values in the patients with moderate and severe CuTS were higher than those in the patients with mild CuTS,and the differences were statistically significant(P<0.001).There was no statistically significant difference in the CSA,EI and V values between the patients with moderate CuTS and patients with severe CuTS.With the increase of entrapment degree,the values of EI and V were increased(r=0.588,0.592,P<0.001).In the CuTS group,EI was negatively correlated with MCV and SCV(r=-0.707,-0.671,P<0.001).Conclusion SWE provides a noninvasive quantitative diagnostic method for CuTS.