【摘要】：目的:了解肘管綜合征中尺神經(jīng)的超聲下改變,測(cè)量最粗處橫截面積,利用其結(jié)果對(duì)患者進(jìn)行嚴(yán)重程度的判定,初步探討超聲作為肘管綜合征患者臨床分型輔助檢查的可行性。并利用超聲觀察尺神經(jīng)術(shù)后的形態(tài)變化,初步探討超聲用于評(píng)估術(shù)后神經(jīng)恢復(fù)情況的可行性。方法:本研究從2013年5月開始至2014年12月結(jié)束,從我院骨科共收集肘管綜合征患者65例,其中雙側(cè)患病19例,單側(cè)患病46例,共84個(gè)患病肘關(guān)節(jié)。根據(jù)臨床結(jié)果將患病肘關(guān)節(jié)分為輕、中、重型三組,其中輕型24例,中型25例,重型35例。對(duì)肘管綜合征患者行超聲檢查,縱切面與橫切面相結(jié)合,觀察尺神經(jīng)的形態(tài)變化,確認(rèn)卡壓部位及造成卡壓的原因,并測(cè)量最粗處橫截面積;對(duì)輕、中、重三組進(jìn)行方差分析,分析組間是否有統(tǒng)計(jì)學(xué)差異,并根據(jù)ROC曲線確定組間分級(jí)診斷指標(biāo)。對(duì)于尺神經(jīng)術(shù)后患者行超聲復(fù)查,觀察尺神經(jīng)的形態(tài)變化。結(jié)果:1.肘管綜合征患者聲像圖表現(xiàn):55例肘管綜合征患者尺神經(jīng)可見卡壓,卡壓處局部神經(jīng)變細(xì)、變扁,卡壓近端及遠(yuǎn)端神經(jīng)明顯增粗,內(nèi)部回聲減低;15例肘管綜合征患者神經(jīng)未見明顯卡壓點(diǎn),僅見神經(jīng)于肘管處腫脹、增粗;12例輕度肘管綜合征患者超聲下未見神經(jīng)卡壓,僅見神經(jīng)于肘管處略增粗或形態(tài)改變不明顯。2.超聲可發(fā)現(xiàn)神經(jīng)卡壓原因:大部分是關(guān)節(jié)表面增生性骨贅引起,另可見有腱鞘囊腫、瘢痕組織、軟組織腫物等引起。3.對(duì)輕中重三組間行方差分析,三組間差異有統(tǒng)計(jì)學(xué)意義(0.0820.010VS0.122±0.025VS0.225±0.092,P0.001)。用ROC曲線分別判定輕、中、重度組的劃分閾值,輕度組與中度組最粗處橫截面積≥0.097cm2,敏感度為92%,特異度為88%;中度組與重度組最粗處橫截面積≥0.164cm2,敏感度為96%,特異度為83%。4.肘管綜合征患者術(shù)后早期尺神經(jīng)的形態(tài)改變不明顯。結(jié)論:1.高頻超聲能清楚顯示肘管綜合征患者尺神經(jīng)的形態(tài)改變,指出卡壓部位,明確卡壓的原因,為手術(shù)治療提供參考依據(jù),并可以觀察神經(jīng)周圍軟組織的病變特別是腱鞘囊腫,避免了再次手術(shù)的機(jī)率。2.高頻超聲可測(cè)量神經(jīng)最粗處橫截面積,并根據(jù)其測(cè)值判斷神經(jīng)損傷的程度,為臨床提供參考信息。3.高頻超聲可以觀察神經(jīng)術(shù)后切口的恢復(fù)情況,可以檢測(cè)神經(jīng)周圍軟組織的再生病變情況,但對(duì)術(shù)后神經(jīng)恢復(fù)狀況的早期評(píng)估不理想。4.高頻超聲檢查是一種有效的輔助檢查方法,對(duì)肘管綜合征術(shù)前術(shù)后均有臨床診斷價(jià)值。
[Abstract]:Objective: to investigate the ultrasonic changes of ulnar nerve in cubital tunnel syndrome, to measure the area of the roughest cross section, to judge the severity of the patients with cubital tunnel syndrome by using the results, and to explore the feasibility of ultrasound as an auxiliary examination for clinical classification of cubital tunnel syndrome. The morphologic changes of ulnar nerve were observed by ultrasound, and the feasibility of using ultrasound to evaluate the recovery of ulnar nerve was discussed. Methods: from May 2013 to December 2014, 65 patients with cubital tunnel syndrome were collected from orthopedic department of our hospital, including 19 bilateral and 46 unilateral elbow joints. According to the clinical results, the elbow joints were divided into three groups: mild, moderate and severe, including 24 mild cases, 25 moderate cases and 35 severe cases. Ultrasonic examination was performed on the patients with cubital tunnel syndrome, the longitudinal section and transverse plane were combined to observe the morphological changes of ulnar nerve, to confirm the position of compression and the cause of compression, and to measure the cross sectional area of the roughest part. The variance analysis of light, medium and heavy groups was carried out to analyze whether there were statistical differences between the three groups, and to determine the grading diagnostic index according to the ROC curve. After ulnar nerve operation, ultrasonic examination was performed to observe the morphological changes of ulnar nerve. Results: 1. In 55 patients with cubital tunnel syndrome, the ulnar nerve was compressed, the local nerve became thin and flattened, the proximal and distal nerve became thicker and the internal echo decreased. In 15 cases of cubital tunnel syndrome, there was no obvious compression point of nerve, only swelling and thickening of nerve in cubital canal, 12 cases of mild cubital tunnel syndrome had no nerve compression under ultrasound, but only a little thickening or no obvious morphological change of nerve in cubital tunnel. 2. The causes of nerve compression can be found by ultrasound: most of them are caused by hyperplastic osteophyte on the surface of joint, and there are tendon sheath cyst, scar tissue, soft tissue mass and so on. 3. 3. There was a significant difference among the three groups (0.0820.010VS0.122 鹵0.025VS0.225 鹵0.092, P0.001). ROC curves were used to determine the threshold of the classification of mild, moderate and severe groups. The roughest cross-sectional area was 鈮，

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