高频超声与肌电图诊断正中神经腕管综合征的临床研究  

Clinical study of high frequency ultrasound and electromyography in diagnosis of carpal tunnel syndrome of median nerve

作　　者：曹亚坤[1] 郭卫东[1] 师朝岭[1] 焦雷红[1] 赵刚[1] 高霞 CAO Ya-kun;GUO Wei-dong;SHI Chao-ling;JIAO Lei-hong;ZHAO Gang;GAO Xia(Department of Functional Section,the Third Hospital of Shijiazhuang,Hebei Province,Shijiazhuang 050011,China;Department of Epidemiology and Health Statistics,School of Public Health,Hebei Medical University,Shijiazhuang 050017,China)

机构地区：[1]河北省石家庄市第三医院功能科,河北石家庄050011 [2]河北医科大学公共卫生学院流行病与卫生统计学教研室,河北石家庄050017

出　　处：《河北医科大学学报》2018年第4期440-443,449,共5页Journal of Hebei Medical University

基　　金：石家庄市科学技术研究与发展指导计划(131461403)

摘　　要：目的应用高频超声和肌电图,结合形态和功能诊断正中神经腕管综合征。方法选择临床拟诊腕管综合征患者30例和健康志愿者30例,应用高频浅表超声检查腕部正中神经,观察正中神经的回声变化,测量左右径、前后径及横截面积;同时应用肌电图仪对正中神经进行神经传导及针极肌电图检查,测定正中神经远端潜伏期及波幅、中指-腕感觉神经传导速度及波幅、拇短展肌肌电图等电生理指标;比较2种检查方法的相关性;运用受试者工作特征(receiver operating characteristic,ROC)曲线确定诊断值。结果腕管综合征组正中神经回声减低,内部点状回声紊乱消失,神经肿胀,正中神经左右径、前后径及横截面积均大于对照组(P<0.05)。正中神经远端潜伏期明显延长、波幅减低,感觉传导速度明显减慢、波幅减低(P<0.05)。高频超声测量的横截面积与正中神经远端潜伏期呈正相关,与中指-腕段感觉传导速度呈负相关(P<0.01)。由ROC曲线可得横截面积的诊断价值最大,灵敏度为86.7%,特异度为93.3%。结论高频超声可清晰显示腕部正中神经形态,测量卡压处数值。应用高频超声和肌电图2种诊断方法可对腕管处正中神经损伤进行形态和功能诊断。Objective To diagnose carpal tunnel syndrome by high frequency and electromyography(EMG),and to study the diagnosis from two aspects of morphology and function.Methods Thirty patients and 30 healthy volunteers were tested in ultrasound and EMG respectively.The echo changes,left and right diameter,anteroposterior diameter and cross-sectional area were observed by high frequency ultrasound.At the same time,distal motor latency and amplitude,middle finger to wrist sensory nerve conduction velocity and electrophysiological index of abductor pollicis brevis muscle were performed by EMG.The correlation analysis between the two methods was made.While the receiver operating characteristic(ROC)curve was used to determine the diagnostic value.Results In the carpal tunnel syndrome group,the median nerve echo was decreased,the internal punctate echo disorder was disappeared,the nerve swelling,the median nerve left and right diameter,anteroposterior diameter and cross-sectional area were greater than those in the control group(P<0.05).The latency of the median nerve was significantly prolonged,the amplitude was decreased,and the sensory conduction velocity was slowed down and amplitude was decreased(P<0.05).The cross-sectional area measured by high frequency ultrasound was positively correlated with the distal latency of the median nerve,and negatively correlated with the median sensory conduction velocity(P<0.01).The diagnostic value of the cross-sectional area obtained by ROC curve was the highest,with the sensitivity of 86.7%and the specificity of 93.3%.Conclusion High frequency ultrasound can clearly display the shape of median nerve in wrist and measure the value of clamp pressure.The diagnosis of median nerve injury at the carpal tunnel can be performed by high frequency ultrasound and EMG.

关 键 词：腕管综合征 超声检查 肌电图 

分 类 号：R681.7[医药卫生—骨科学]