高频超声检查在周围神经损伤鉴定中的应用价值  

The application value of high frequency ultrasonography in appraising peripheral nerve injuries

作　　者：王晓刚[1] 鄂占森[1] 陈一武[1] 尹倩[1] 陈峥[1] 陈敏[1] 

机构地区：[1]遵义医学院附属深圳市龙岗中心医院超声科,广东深圳518116

出　　处：《中国法医学杂志》2015年第3期252-255,共4页Chinese Journal of Forensic Medicine

基　　金：深圳市科技研发资金项目(CXZZ20130322110626487);公安部应用创新计划项目(2011YYCXGDST079)

摘　　要：目的探讨高频超声检查在周围神经损伤鉴定中应用的价值。方法收集38例锐器伤、钝挫伤、骨折及撞击造成的单侧肢体外伤病例,应用东芝Aplio 500型彩色多普勒超声诊断仪进行高频超声检查,将其特征性表现与30例正常周围神经的高频超声图表现进行对比分析。结果经高频超声检查,确诊38例周围神经损伤中发生于颈部5例、下肢5例,上肢27例(肘部以上3例、以下24例)。损伤类型包括卡压性损伤8例、创伤性神经瘤28例、神经完全断裂2例。特征性表现为:卡压性损伤神经受压处变细,近端神经节段性增粗;创伤性神经瘤与神经干相连的梭形增粗段,增粗段神经外膜的线性强回声中断,内部回声紊乱;神经完全断裂表现为神经外膜强回声线与神经纤维低回声束完全中断,断端两侧均呈梭形瘤样改变。结论高频超声能够明确周围神经损伤类型及发生节段,可为法医学人体损伤程度鉴定提供有价值的参考依据。Objective To explore the application value of high frequency ultrasonography in appraising peripheral nerve injury. Methods 38 patients with peripheral nerve injury caused by trauma, bone fracture and collision lesion were recruited,and then examined by the Aplio 500 Platinum system. Next,the characteristic features were compared with the sonograms of 30 cases with normal peripheral nerve. Results By using high frequency ultrasonography, it was confirmed that 5 wounds were on the neck, 5 wounds were on the lower limb, and 27 wounds were on the upper limb in these cases. Among the patients with upper limb nerves injury,3 wounds were located at upper arm and 24 cases were located at elbow,forearm and wrist. The specific types including 8 cases of peripherial nerve compression injury,28 cases of traumatic neuroma, and 2 cases of nerve rupture. The characteristic features were as follows：peripherial nerve compression injury was described as diminution of inner diameter at the site of compression and it＇ s proximal segment thicken; traumatic neuroma was described as fusiform segment linked with nerve trunk with discontinuous epineurium and internal echo disorder; nerve rupture was described as epineurium hyperechoic line and hypoechoic bands were completely ruptured as well as proximal and distal broken ends present on a fusiform lump. Conclusion High frequency ultrasonography can definitely diagnose peripheral nerve injuries and their location＇, which can provide valuable reference for human injury degree evaluation.

关 键 词：法医临床学 高频超声检查 周围神经损伤 

分 类 号：D919[医药卫生—法医学]