短节段神经传导检测联合高频超声检查定位定性诊断肘管综合征

Short-segment nerve conduction test and high-frequency ultrasonography test in localization diagnosis and qualitative diagnosis for cubital tunnel syndrome

目的研究短节段神经传导检测及高频超声检查在肘管综合征定位定性诊断中的价值,为临床治疗提供有效的依据。方法对36例单侧肘管综合征患者术前均进行高频超声检查和神经电生理检查,对尺神经运动传导异常的患者进行短节段神经传导检测,分别确定卡压位点及卡压原因,并与手术结果进行对照,验证其诊断准确性。以同期健康志愿者18例(36个上肢)作为对照组,对比观察相关参数差异。结果神经电生理检查中运动神经传导速度及动作电位波幅肘上-肘下段两组的差异有统计学意义(P<0.05),肘下-腕段两组的差异无统计学意义(P>0.05)。高频超声检查中病例组尺神经卡压位点处及肿胀处的长轴内径、横截面积(CSA)及CSA肿胀率与对照组比较差异有统计学意义(P<0.05),诊断价值:CSA肿胀率>肿胀处CSA>卡压处CSA>肿胀处长轴内径>卡压处长轴内径。31例超声能明确卡压原因。短节段神经传导检测和高频超声检查对尺神经卡压位点的诊断准确率分别为88.9%(32/36)、86.1%(31/36)。结论神经电生理检查和高频超声检查均可对肘管综合征进行诊断,对于早期病变电生理检查更敏感,对于形态学发生改变的尺神经高频超声检查更加直观,短节段神经传导检测和高频超声检查均可对肘管综合征卡压位点进行定位,高频超声能检出卡压原因,可协助临床医师有针对性地选择治疗方案。

Objective To study the value of short-segment nerve conduction test and highfrequency ultrasonography test in localization diagnosis and qualitative diagnosis for cubital tunnel syndrome, and to provide effective basis for clinical treatment. Methods Thirty-six patients with unilateral cubital tunnel syndrome were performed with preoperative high frequency ultrasonography and neural electrophysiological test. Patients with abnormal ulnar nerve motor conduction were performed with short-segment nerve conduction test. The compressed sites and compressed factors were determined by the examination methods and were compared with surgery to verify the diagnostic accuracy. Results The results of neural electrophysiological examination as well as the high frequency ultrasonography examination in patients with cubital tunnel syndrome were analyzed. The motor nerve conduction velocity and compound muscle action potential of above elbow-below elbow segment had a significant statistical difference between the two groups(P<0.05) and these of below elbow-wrist segment had no significant statistical difference between the two groups(P>0.05). The long axis diameter, cross-sectional area(CSA) and the swelling rate of CSA had a significant statistical difference between the two groups(P<0.05). The diagnostic value: the swelling rate of CSA>the CSA of swelling section>the CSA of compressed section>the long axis diameter of swelling section>the long axis diameter of compressed section. The compressed factors of 31 patients were detected by high-frequency ultrasonography test accurately. The diagnostic accuracy in localization of the cubital tunnel syndrome by short-segment nerve conduction test and high-frequency ultrasonography test was 88.9%(32/36), 86.1%(31/36) respectively. Conclusions The cubital tunnel syndrome can be diagnosed by neural electrophysiological examination or high frequency ultrasonography examination. The electrophysiological examination is advantageous for the early stage of the compressed nerve lesion and the high frequency ultrasonography examination is more visual for the nerve with morphological changes. The compressed sites can be located by both short-segment nerve conduction test and high-frequency ultrasonography test. The compressed factors can be found by high-frequency ultrasonography. It can help clinicians to choose a specific therapy plan.