神经电生理联合MRI在尺神经卡压综合征诊疗中的应用  

Application of electrophysiological examination combined with MRI in diagnosis and treatment for ulnar nerve entrapment syndrome

作　　者：李国伟[1] 张文川[1] 杨敏[1] 杨晓笙[1] 马秋峰[1] 

机构地区：[1]上海交通大学医学院附属新华医院神经外科,200092

出　　处：《中国微侵袭神经外科杂志》2012年第12期533-535,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨神经电生理联合MRI在尺神经卡压综合征中的应用价值。方法回顾性分析470例尺神经卡压综合征病人的临床资料,均采用尺神经显微减压术治疗。病人手术前后进行神经电生理及MRI检查,检测并分析不同时间点病侧、健侧的感觉传导速度(sensory conduction velocity,SCV)、运动传导速度(movement conduction velocity,MCV)和尺神经横截面积(cross sectional area,CSA)。采用MRI观察健侧和病侧尺神经结构。结果健侧和术前病侧的MCV、SCV、CSA差异均具有统计学意义(均P<0.05)。术前和术后4周病侧的MCV、SCV、CSA差异均具有统计学意义(均P<0.05)。MCV与CSA呈负相关(r=-0.813),SCV与CSA呈负相关(r=-0.844)。MRI显示:受损尺神经明显肿胀,神经呈现高低不等的信号,肿胀部位(内上髁沟、尺侧腕屈肌)明显受到旋前圆肌、指浅屈肌、肘管、屈肌总腱等组织卡压。结论神经电生理适用于早期诊断尺神经卡压综合征,MRI适用于制定手术方案,两者联合有助于评价手术效果,提高手术疗效。Objective To explore the applicative va lue of electrophysiological examination and MRI in ulnar nerve entrapment syndrome.Methods Clinical data of 470 patients with ulnar nerve entrapment syndrome were analyzed retrospectively,who underwent microsurgical decompression of the ulnar nerve.The patients were examined by electrophysiological method and MRI before and after surgery.The sensory conduction velocity（SCV）,motor conduction velocity（MCV） and cross sectional area（CSA） of ulnar nerve were detected and analyzed in uninjured and injured sides in different times.The structures of ulnar nerves in uninjured and injured sides were observed by using MRI.Results There were significant differences in MCV,SCV and CSA between the uninjured side and injured side before surgery（all P 0.05）.There were significant differences in MCV,SCV and CSA of injured side between before surgery and 4 weeks after surgery（all P 0.05）.MCV and CSA were negatively correlated（r =-0.813）,and SCV and CSA were negatively correlated（r =-0.844）.MRI results showed that the injured ulnar nerve swelled obviously,which presented both high and low signals.The swelling part in epicondyle groove and flexor carpi ulnaris was compressed by pronator teres muscle,flexor digitorum superiicialis muscle,cubital tunnel and common flexor tendon.Conclusions Electrophysiological method is suitable for the early diagnosis of ulnar nerve entrapment syndrome and MRI is proper to make the surgery plan.The combination of two above techniques can help to evaluate the surgical outcome and improve the outcome of ulnar nerve decompression.

关 键 词：尺神经压迫综合征 电生理学 磁共振成像 显微减压术 

分 类 号：R651.3[医药卫生—外科学]