小儿孟氏骨折桡神经损伤的超声诊断价值  

Ultrasonographic features of radial nerve injury resulting from pediatric Monteggia fracture

作　　者：蒋珺[1] 陈亚青[1] 刘卫勇[1] 邹韧[1] 赵黎[2] 

机构地区：[1]上海交通大学医学院附属新华医院超声科,200092 [2]上海交通大学医学院附属新华医院小儿骨科,200092

出　　处：《中华医学超声杂志（电子版）》2011年第11期2372-2380,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨小儿孟氏骨折桡神经损伤的超声声像图特征。方法对18例临床诊断孟氏骨折桡神经损伤的患儿行桡神经超声检查,以上臂中1/2、上臂中下1/3、肘关节及前臂上1/4作为A、B、C、D4个观察平面,对比健侧与患侧桡神经内部回声变化及周围组织结构改变,并测量和比较4个平面上健侧和患侧桡神经的横截面积(CSA)及神经主干(RN-S)、浅支(RNS-S)、深支(RND-S)至皮肤的最短距离测值。对其中8例桡神经损伤患儿超声、肌电图和手术探查结果进行对比分析。结果超声显示18例孟氏骨折患儿的桡神经损伤侧神经增粗,内部回声减低,伴有创伤性神经瘤(2例)和神经周围瘢痕粘连(6例);健侧A、B平面桡神经主干及C、D平面桡神经浅支、深支CSA分别为(6.32±1.05)mm2、(7.05±1.12)mm2、(3.07±0.42)mm2、(3.21±0.45)mm2、(2.87±0.92)mm2、(3.01±0.77)mm2,患侧神经CSA相应测值分别为(6.53±0.79)mm2、(9.31±2.39)mm2、(4.21±0.45)mm2、(5.64±1.16)mm2、(4.39±0.67)mm2、(3.61±1.24)mm2,患侧与健侧相比,A平面桡神经主干以及D平面桡神经深支的CSA超声测值差异均无统计学意义(P>0.05);B和C平面患侧桡神经主干、桡神经浅支和深支以及D平面患侧桡神经浅支的CSA超声测值均大于健侧,差异有统计学意义(t=3.20、6.92、7.33、4.99,P<0.05)。健侧A、B平面RN-S及C、D平面RNS-S、RND-S分别为(15.42±2.60)mm、(9.96±1.22)mm、(10.03±2.85)mm、(11.21±2.94)mm、(10.27±2.52)mm、(11.31±2.71)mm,患侧相应测值分别为(15.92±1.29)mm、(7.65±1.07)mm、(3.66±1.83)mm、(4.47±1.22)mm、(9.94±3.32)mm、(10.20±2.42)mm,A平面健侧与患侧RN-S及D平面健侧与患侧RNS-S、RND-S测值比较差异均无统计学意义(P>0.05);B平面患侧RN-S及C平面患侧RNS-S、RND-S均小于健侧,差异有统计学意义(t=4.31、7.24、8.62,P<0.05)。对8例患儿行桡神经手术探查,显示桡神经主干、浅支及深支损伤均为8支,与术前超声诊断结果一致,超声诊Objective To assess the features of radial nerve injury resulting from pediatric Monteggia fracture by ultrasonography.Methods Ultrasonography examination was performed in 18 pediatric patients who were diagnosed as radial nerve injury caused by Monteggia fracture.Four ultrasonographic planes were defined:A,midway in the upper arm;B,in lower one-third of the upper arm;C,articulatio cubiti;D,in upper one-forth of the forearm.The ultrasonic measurement of cross-sectional area(cross-sectional area,CSA) and the distances among the trunk,superficial branch and deep branch of radial nerve and skin(distance between the radial nerve and skin,RN-S;distance between the superficial branch of the radial nerve and skin,RNS-S;distance between the deep branch of the radial nerve and skin,RND-S) were achieved from both the affected sides and the normal side in the four planes.The diagnostic coincidence rate of radial nerve injury and the detectable rate of traumatic neuroma and encasing scar by ultrasonography were calculated.Results The injured radial nerves were appeared as swelling and hypoechoic nerves partly with traumatic neuroma and encasing scar.The CSAs of the normal radial nerve in plane A,B,C and D were(6.32±1.05)mm2,(7.05±1.12)mm2,(3.07±0.42)mm2,(3.21±0.45)mm2,(2.87±0.92)mm2 and(3.01±0.77)mm2,respectively.The CSAs of the affected radial nerve in plane A,B,C and D were(6.53±0.79)mm2,(9.31±2.39)mm2,(4.21±0.45)mm2,(5.64±1.16)mm2,(4.39±0.67)mm2 and(3.61±1.24)mm2,respectively.No significant difference of CSA was found between the normal side and the affected side of radial nerve in plane A(P>0.05).The CSA of radial nerve trunk,deep branch of the radial nerve and superficial branch of the radial nerve in affected side were thickener than the normal side in plane B and C(t=3.20,6.92,7.33,4.99,P<0.05).In plane D,the superficial branch of the radial nerve in affected side was thickener than the normal side(P<0.05),while the deep branch of the radial nerve was not thickener than the normal side(P<0.05).The RN-S,RNS

关 键 词：超声检查 小儿 孟氏骨折 桡神经 损伤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R726.8[医药卫生—诊断学]