神经电生理与高频超声在肘管综合征诊断中的应用

Application of neuroelectrophysiology and high frequency ultrasound in the diagnosis of cubital tunnel syndrome

目的探讨神经电生理与高频超声在肘管综合征诊断中的应用价值。方法选取2020年1月至2021年12月西安市红会医院收治的70例肘管综合征患者作为观察组,选择同期我院30例健康体检者作为对照组。两组受检者均行神经电生理与高频超声检查。比较两组受检者的运动神经传导、感觉神经传导、尺神经指标。并以手术诊断结果为金标准,比较神经电生理、高频超声单独及联合检查对肘管综合征的诊断效果。结果观察组患者肘上至肘下的运动传导速度(MCV),腕部至小鱼际肌、肘下至小鱼际肌、肘上至小鱼际肌的运动传导波幅(CMAP)及腕部至小指的感觉传导速度(SCV)明显小于对照组,差异均有统计学意义(P<0.05);观察组患者的尺神经前后径、左右径、横截面积(CSA)明显高于对照组,差异均有统计学意义(P<0.05),而两组受检者的腕部至小指的感觉传导波幅(SNAP)比较差异无统计学意义(P>0.05);观察组患者行第一骨间肌、小指展肌及尺侧腕屈肌肌电图检测静息状态时出现纤颤、正相电位的比例分别为50.00%、28.57%、15.71%,大力收缩时呈单纯相或单混相的比例分别为28.57%、15.71%、10.00%;对照组的各运动单位电位时限、波幅及相位均无异常。以手术诊断结果为金标准,神经电生理及高频超声分别及联合使用诊断肘管综合征的阳性预测值分别为95.24%(60/63)、95.00%(57/60)、98.51%(66/67),阴性预测值分别为42.86%(3/7)、50.00%(5/10)、33.33%(1/3)。结论神经电生理与高频超声在诊断肘管综合征中均具有一定应用价值,且两者联合检查对肘管综合征的诊断更具参考价值。

Objective To explore the application value of neuroelectrophysiology and high frequency ultra-sound in the diagnosis of cubital tunnel syndrome.Methods Seventy patients with cubital tunnel syndrome admitted to Xi'an Honghui Hospital from January 2020 to December 2021 were selected as the observation group,and 30 healthy people in the hospital during the same period were selected as the control group.The subjects of both groups underwent neuroelectrophysiology and high frequency ultrasound.The results of motor,sensory nerve conduction,and ulnar nerve indexes of the subjects of two groups were compared.The results of surgical diagnosis were used as the gold standard,and the diagnostic effects of neuroelectrophysiology,high frequency ultrasound alone and combined examination in cubi-tal tunnel syndrome were compared.Results The motor conduction velocity(MCV)of above elbow to below elbow,the compoundmuscle motor action potential(CMAP)of wrist to hypothenar muscles,below elbow to hypothenar mus-cles,above elbow to hypothenar muscles,and the sensory conduction velocity(SCV)of wrist to the little finger of the pa-tients in the observation group were significantly less than those in the control group,with statistically significant differ-ences(P<0.05).The anterior and posterior diameter,left and right diameter,and cross sectional area(CSA)of ulnar nerve of the patients in the observation group were significantly higher than those in the control group,with statistically significant differences(P<0.05).There was no significant difference in the sensory nerve action potential(SNAP)of wrist to the little finger between the two groups(P>0.05).In the observation group,the proportion of fibrillation and pos-itive phase potential at rest in electromyography of the first interosteoid muscle,abductor of little finger muscle,and flex-or carpi ulnar muscle were 50.00%,28.57%,and 15.71%,while the proportion of pure phase or mono-miscible phase at vigorous contraction were 28.57%,15.71%,and 10.00%.In the control group,the duration,amplitude,and phase of each motor unit potential were not abnormal.Using surgical diagnosis as the gold standard,the positive predictive values of neuroelectrophysiology and high frequency ultrasound alone and the combined diagnosis for cubital tunnel syndrome were 95.24%(60/63),95.00%(57/60),98.51%(66/67),and the negative predictive values were 42.86%(3/7),50.00%(5/10),33.33%(1/3),respectively.Conclusion Neuroelectrophysiology and high frequency ultrasound have certain appli-cation value in the diagnosis of cubital tunnel syndrome,and the combined examination of the two has more reference value for the diagnosis of cubital tunnel syndrome.