正中神经横断面积及扁平率的超声参数与腕管综合征严重程度的相关性分析  

Correlation analysis of ultrasound parameters of median nerve cross-sectional area and flat rate with severity of carpal tunnel syndrome

作　　者：纪柳[1] JI Liu(Department Of Hand Surgery,Yuquan Hospital of Tsinghua University,Beijing 100049,China)

机构地区：[1]清华大学玉泉医院手外科,北京100049

出　　处：《新疆医科大学学报》2021年第8期922-926,共5页Journal of Xinjiang Medical University

基　　金：北京市科技计划项目(320678015837)。

摘　　要：目的探讨超声检测正中神经横断面(CAS)和扁平率(FR)与腕管综合征(CTS)严重程度相关性。方法选取2017年2月-2021年2月清华大学玉泉医院就诊的CTS患者90例(136只腕关节),根据严重程度分为轻度组(43只)、中度组(48只)和重度组(45只)。超声检测患者豌豆骨水平正中神经横径和前后径,计算扁平率(FR),检测腕管入口和出口之间最大正中神经横断面积(CSAC)、旋前方肌水平正中神经-横断面积(CSAP),计算两者差值(ΔCSA)和相对横断面积(RCSA);神经电生理检测感觉传导速度(SCV)和运动传导速度(MCV)。构建受试者工作特征曲线(ROC),计算曲线下面积(AUC),分析FR、ΔCSA、RCSA对CTS严重程度的诊断价值,Pearson法分析FR、ΔCSA、RCSA与SCV、MCV相关性。结果轻、中、重度组正中神经横径、FR、CSAC、CSAP、ΔCSA、RCSA逐渐增加(P<0.05);FR、ΔCSA、RCSA诊断轻中度CTS的最佳截断点分别为3.07、6.32 mm^(2)、1.81,三者单独及联合检测诊断AUC分别为0.682、0.703、0.711、0.768;FR、ΔCSA、RCSA诊断中重度CTS的最佳截断点分别为3.29、8.82 mm^(2)、2.07,三者单独及联合检测诊断AUC分别为0.712、0.786、0.773、0.814。轻、中、重度CTS患者SCV、MCV逐渐减慢(P<0.05);ΔCSA、RCSA与SCV和MCV呈负相关(P<0.05)。结论超声检测CAS和FR可反映CTS严重程度。Objective To investigate the correlation between the median nerve cross section(CAS)and flatness rate(FR)detected by ultrasound and the severity of carpal tunnel syndrome(CTS).Methods Ninety patients with CTS(136 wrist joints)who were treated in our hospital from February 2017 to February 2021 were selected and divided into mild group(43),moderate group(48)and severe group(45).The transverse and anteroposterior diameters of the median nerve at the level of the pea bone were detected by ultrasound,the flatness rate(FR)was calculated,the carpal tunnel cross-sentional area(CSAC)between the entrance and exit of the carpal tunnel,and the pranator quadralus muscle cross-sentional area(CSAP)at the level of the pronator muscle were detected.The difference between the twoΔCSA and relative cross-sectional area(RCSA)were calculated.Neuroelectrophysiological was used to detect sensory conduction velocity(SCV)and motor conduction velocity(MCV).Receiver operating characteristic curve(ROC)was constructed to calculate the area under curve(AUC),and analyze the diagnostic value of FR,ΔCSA,RCSA to the severity of CTS,and analyze the correlation between FR,ΔCSA,RCSA and SCV,MCV by Pearson's method.Results The median nerve transverse diameter,FR,CSAC,CSAP,ΔCSA,RCSA gradually increased in the mild,moderate,and severe groups(P<0.05).The best cutoff points for FR,ΔCSA,and RCSA in the diagnosis of mild to moderate CTS were respectively 3.07,6.32 mm^(2) and 1.81;the three separate and combined detection diagnostic AUC were 0.682,0.703,0.711 and 0.768,respectively.The best cutoff points for FR,ΔCSA,RCSA in the diagnosis of moderate to severe CTS were 3.29,8.82 mm^(2) and 2.07;the three diagnostic AUC of single and combined tests were 0.712,0.786,0.773 and 0.814,respectively.SCV and MCV in the patients with mild,moderate and severe CTS slowed down gradually(P<0.05).ΔCSA and RCSA were negatively correlated with SCV and MCV(P<0.05).Conclusion Ultrasound detection of CAS and FR can reflect the severity of CTS.

关 键 词：腕管综合征 超声 正中神经横断面积 扁平率 神经传导速度 

分 类 号：R745.4[医药卫生—神经病学与精神病学]