高频多普勒超声诊断肘管综合征和腕管综合征的临床价值

Clinical application of high-frequency Doppler ultrasound in the diagnosis of cubital tunnel syndrome and carpal tunnel syndrome

目的 :探讨高频多普勒超声(High-frequency Doppler ultrasound,HFU)在肘管综合征(Cubital tunnel syndrome,CuTS)和腕管综合征(Carpal tunnel syndrome,CTS)诊断和病因检测中的临床价值。方法 :选择2021年1-12月在我院就诊的CTS(n=46例)、CuTS(n=41例)患者作为研究对象,所有患者均行HFU检查,观察健侧和患侧HFU检查结果 、HFU诊断CuTS和CTS的临床价值、HFU预测CuTS和CTS病因与手术结果的一致性。结果:41例CuTS患者患侧尺神经卡处直径和横截面面积(CSA)均低于健侧相应位置,差异有统计学意义(P<0.05);患侧尺神经肿胀处直径、CSA、面积肿胀率、厚度肿胀率均高于健侧相应位置,差异有统计学意义(P<0.05)。CTS患者患侧正中神经腕管入口处前后径、左右径和CSA均高于健侧相应位置,差异有统计学意义(P<0.05)。尺神经肿胀处CSA预测CuTS的曲线下面积(AUC)最高。正中神经腕管入口处CSA预测CTS的AUC高于前后径和左右径。HFU检测CuTS病因中滑膜瘤、骨赘结缔组织增生、肿大淋巴结、关节腔滑膜炎结果与手术结果完全一致(P=0.000),肘管中囊肿、关节腔积液与手术结果高度相关(P<0.001)。HFU检测CTS病因与手术结果完全一致(P=0.000)。结论:HFU在CuTS和CTS诊断和病因检测中均具有重要价值,值得临床推广应用。

Objective:To explore the clinical value of high-frequency Doppler ultrasound(HFU)in the diagnosis and etio-logical testing of cubital tunnel syndrome(CuTS)and carpal tunnel syndrome(CTS).Methods:Patients with CTS(n=46)and CuTS(n=41)in our hospital were enrolled from January 2021 to December 2021,and all patients performed HFU.We ana-lyzed the HFU findings,the prediction capacity of HFU in CuTS and CTS,and the consistency between HFU and surgical findings on both healthy and affected sides.Results:In 41 patients with CuTS,the diameter and cross-sectional area(CSA)of ulnar nerve on the affected side were lower than those on the corresponding position of the healthy side(P<0.05),and the di-ameter,CSA,area swelling rate and thickness swelling rate of ulnar nerve on the affected side were higher than those on the corresponding position of the healthy side(P<0.05).In 46 patients with CTS,the anterior-posterior diameter,lef-right diameter,and CSA of the carpal tunnel of the median nerve on the affected side were higher than those on the corresponding position of the healthy side(P<0.05).CSA of the ulnar nerve at the swelling position predicted the highest cut value of area under the curve(AUC).The AUC of the median nerve CSA at the entrance of carpal tunnel for predicting CTS was higher than the AUC of the anterior-posterior diameter and left-right diameter.The HFU results of synovial tumors,osteophyte connective tissue hy-perplasia,enlarged lymph nodes,and synovitis in CuTS were completely consistent with the surgical findings(P=0.000).Cysts and joint effusions in the cubital canal had significant correlations with the surgical results(P<0.001).The CTS diagnosed by HFU was completely consistent with the surgical findings(P-O.00O).Conclusion:HFU has important value in the detection and diagnosis of CuTS and CTS,which provides an invaluable asset in clinical application.