【摘要】：目的：通過對腕管綜合征(Carpal Tunnel Syndrome,CTS)患者行高頻超聲和神經(jīng)傳導速度檢查,多點位測量腕管處正中神經(jīng)的橫截面面積,探討超聲對CTS的診斷價值,并根據(jù)超聲測量正中神經(jīng)的橫截面面積與神經(jīng)傳導速度異常程度及癥狀持續(xù)時間相關性進行比較。方法：本研究共選取49人(70只手)參與此項研究,其中病例組26人(36只手)為在神經(jīng)科就診患者,存在上肢麻木感覺異常或疼痛等癥狀,經(jīng)神經(jīng)傳導速度檢查確診為腕管綜合征,對照組23人(34只手)為同期在本院體檢或本院職工無上肢麻木、疼痛等癥狀的健康志愿者,經(jīng)神經(jīng)傳導速度檢查除外CTS,應用高頻超聲對其腕管處正中神經(jīng)進行測量,以橫截面面積為測量指標,分別在腕橫紋上3cm、腕橫紋上2cm、腕橫紋上1cm、腕橫紋、腕橫紋下1cm、腕橫紋下2cm、腕橫紋下3cm、腕橫紋下4cm處測量正中神經(jīng)橫截面面積,比較病例組與對照組的橫截面面積,根據(jù)數(shù)據(jù)分布特征,兩組間差異采用t檢驗或Mann-Whitney U秩和檢驗對比。根據(jù)臨床癥狀和神經(jīng)傳導速度檢查結果為診斷標準,采用受試者工作特征曲線(ROC曲線)進行分析,確定超聲下正中神經(jīng)橫截面積在診斷腕管綜合征的敏感性、特異性和診斷閾值。同時根據(jù)神經(jīng)傳導速度嚴重程度將CTS患者分級為輕、中、重3組,臨床癥狀持續(xù)時間按3個月、3個月至1年、1年3組,各組之間橫截面面積分別和對照組比較,兩組間差異采用t檢驗或Mann-Whitney U秩和檢驗,以P0.05為差異,認為有統(tǒng)計學意義。結果：1.通過對CTS患者和對照組之間年齡、性別、身高、體重的比較發(fā)現(xiàn),年齡、性別、身高之間無差異(P0.05),無統(tǒng)計學意義。體重在兩者之間有差異(P0.05),有統(tǒng)計學意義。2.通過對CTS患者腕部正中神經(jīng)橫截面面積8點測量并和對照組比較,病例組所測各點橫截面面積與對照組比較均有差異(P0.05),有統(tǒng)計學意義。通過對8個點所測得橫截面積進行ROC曲線分析,發(fā)現(xiàn)在腕橫紋下4cm處曲線下面積最大,為0.874,選取此處為CTS最佳診斷閾值為0.095cm2,其敏感性為88.9%,特異性為76.5%。3.將CTS患者按神經(jīng)傳導速度檢測結果分為輕、中、重三組,各組所測橫截面面積分別與對照組比較,在輕度CTS患者腕橫紋下1cm、腕橫紋下2cm、腕橫紋下3cm、腕橫紋下4cm處與對照組相比有差異(P0.05),有統(tǒng)計學意義。在中度和重度CTS患者腕部8點所測量的橫截面積與對照組比較均有差異(P0.05),有統(tǒng)計學意義。4.CTS患者按臨床癥狀持續(xù)時間分為3個月、3個月至1年、1年3組,各組所測橫截面面積分別與對照組比較,在3個月至1年和1年這兩組CTS患者的腕部8點所測量的橫截面積與對照組比較均有差異(P0.05),有統(tǒng)計學意義,而3個月的CTS患者腕部8點所測量的橫截面積與對照組比較無差異(P0.05),無統(tǒng)計學意義。5.通過對腕管部正中神經(jīng)檢查,病例組發(fā)現(xiàn)1例正中神經(jīng)走行變異,對照組發(fā)現(xiàn)1例腕管內(nèi)存在正中動脈。結論：1.高頻超聲測量正中神經(jīng)橫截面積診斷CTS與神經(jīng)電生理有很好的一致性,是有效的輔助檢查方法。2.在腕橫紋下4cm處測量橫截面積正常閾值為0.095cm2對于診斷CTS具有較好的敏感性和特異性。3.正中神經(jīng)橫截面積與患有CTS的嚴重程度及癥狀持續(xù)時間相關。4.體重因素與CTS的發(fā)病具有一定的相關性。5.高頻超聲能夠顯示CTS患者正中神經(jīng)形態(tài)、變異、伴行血管,為手術治療提供局部解剖關系。
[Abstract]:Objective: To investigate the diagnostic value of ultrasonography for CT by examining the high frequency ultrasound and nerve conduction velocity in patients with Carpal Tunnel Syndrome (CTS) and measuring the cross-sectional area of median nerve at the carpal tunnel at multiple points. Methods: A total of 49 patients (70 hands) were enrolled in the study. 26 patients (36 hands) in the case group were diagnosed as carpal tunnel syndrome by nerve conduction velocity test, and 23 patients (34 hands) in the control group were examined in the same period. The median nerve at the carpal canal was measured by high-frequency ultrasonography. The cross-sectional area of the median nerve at the carpal canal was taken as the measurement index. The wrist striae were 3 cm above the wrist striae, 2 cm above the wrist striae, 1 cm above the wrist striae, 1 cm below the wrist striae, 2 cm below the wrist striae. The cross-sectional area of the median nerve was measured at the lower 3 cm and 4 cm below the wrist stria. The cross-sectional area of the median nerve was compared between the case group and the control group. Meanwhile, according to the severity of nerve conduction velocity, the patients with CTS were classified into three groups: mild, moderate, and severe. The duration of clinical symptoms was 3 months, 3 months to 1 year, and 1 year, respectively. Results: 1. There was no significant difference in age, sex, height and weight between CTS patients and control group (P 0.05). There was no significant difference in weight between the two groups (P 0.05). The cross-sectional area of the median nerve in the wrist of CTS patients was measured at 8 points and compared with that of the control group. The cross-sectional area of each point in the case group was significantly different from that of the control group (P The largest area was 0.874. The best diagnostic threshold of CTS was 0.095 cm 2. The sensitivity and specificity were 88.9% and 76.5% respectively. 3. According to the results of nerve conduction velocity, the patients with CTS were divided into three groups: light, medium and heavy. The cross-sectional area measured in each group was 1 cm below the wrist stria, 2 cm below the wrist stria, and 3 cm below the wrist stria. Comparing with the control group, the cross-sectional area measured at 8:00 in moderate and severe CTS patients was significantly different (P 0.05). 4. According to the duration of clinical symptoms, the patients with CTS were divided into 3 months, 3 months to 1 year, 1 year 3 groups. Comparing with the control group, the cross-sectional area measured at 8:00 in the wrist of the two groups of CTS patients from 3 months to 1 year and 1 year was significantly different from that of the control group (P 0.05), but the cross-sectional area measured at 8:00 in the wrist of the CTS patients from 3 months to 1 year was not significantly different from that of the control group (P 0.05). One case of median nerve variation was found in the case group and one case of median artery in the control group. Conclusion: 1. High-frequency ultrasound measurement of median nerve cross-sectional area in the diagnosis of CTS and neuroelectrophysiology has a good consistency, is an effective auxiliary examination method. 2. Measuring the normal threshold of cross-sectional area at 4 cm below the wrist stria is 0.095 cm 2 pairs. Median nerve cross-sectional area is associated with the severity of CTS and the duration of symptoms. 4. Weight factors have a certain correlation with the onset of CTS. 5. High-frequency ultrasound can show the morphology of median nerve in CTS patients, variation, accompanied by blood vessels, and provide local anatomical relationship for surgical treatment.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R688

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