高频超声在腕管综合征诊断中的临床应用研究

The value of high frequency ultrasound in the diagnosis of carpal tunnel syndrome

目的:探讨高频超声在腕管综合征(Carpal tunnel syndrome,CTS)中的诊断及临床价值方法:收集符合纳入和排除标准的CTS组32例(39侧),对照组20例(40侧)。行高频超声检查并计算以下测量指标:豌豆骨平面横截面面积、钩骨远端平面横截面面积、腕管入口处腕横韧带厚度、腕管入口及出口处正中神经面积比、腕管出口处腕横韧带厚度及钩骨勾平面扁平率。结果:超声检查发现,CTS组豌豆骨平面腕横韧带厚度、钩骨平面腕横韧带厚度值、豌豆骨平面横截面面积、钩骨远端平面横截面面积、腕管入口及出口处正中神经面积比及钩骨勾平面扁平率方面均高于对照组(P <0.05)。ROC曲线统计学分析结果显示,豌豆骨平面横截面面积、钩骨远端平面横截面面积、腕管出口处腕横韧带厚度、腕管入口及出口处正中神经面积比、腕管出口处腕横韧带厚度及腕管综合征钩骨勾平面扁平率的诊断阈值为0.117、0.123、0.256、0.886、0.376和3.154,敏感度为84.6、79.5、89.7、87.0、73.6和92.3%,特异度为72.5、77.2、82.5、78.1、71.1和74.6%。结论:高频超声检查可以较好的反应腕管正中神经形态学变化,并可量化腕管综合征及损伤程度。

Objective To investigate the value of high frequency ultrasound in the diagnosis of carpal tunnel syndrome(CTS).Methods 32 patients(39 hands)with CTS were enrolled in CTS group,and 20 asymptomatic controls(40 hands)in control group.They all underwent high frequency ultrasound test pre-operatively and post-operatively.The following measurements were evaluated:the cross-sectional area of pea bone,the cross-sectional area of the distal Hamate plane,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane.Results The baseline from CTS and control groups has no significant difference(P>0.05).Compared with control group,the cross-sectional area of pea bone,the cross-sectional area of the distal Hamate plane,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane were higher in CTS group.ROC curve showed the diagnostic thresholds of the cross-sectional area of pea bone,the cross-sectional area of the distal Hamate plane,thickness of transverse carpal ligament,area ratio of the median nerve to the inlet and outlet of carpal tunnel,thickness of transverse carpal ligament at the exit of carpal tunnel and flattening of the hook plane were 0.117、0.123、0.256、0.845、0.375,3.225,Sensitivity:89.6、79.5、89.7、87.2、74.4,87.3%,specificity:72.5、77.2、82.5、77.5、71.5,75.0%.Conclusion High frequency ultrasonography provides a better morphological evidence for the median nerve,and quantify the severity of CTS.It is preferable in the diagnosis of CTS.