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目的应用高频超声(HFUS)对上肢神经卡压综合征患者进行术前、术后对比分析,部分患者行超声造影(CEUS)检查,探讨HFUS在上肢神经卡压综合征中的诊断价值及治疗应用中的指导意义,进而为临床制定最佳诊疗方案、改善手术预后提供影像学依据。方法选择健康志愿者30例为对照组(60腕,60肘),其中男性10例,女性20例;年龄25~65岁,平均年龄46岁。上肢神经卡压综合征并拟行手术的患者60例为病例组,其中腕管综合征(CTS)患者40例(52腕),肘管综合征(CuTS)患者20例(25肘)。40例CTS患者,其中男性18例,女性22例;年龄31~67岁,平均年龄49岁。20例CuTS患者,其中男性12例,女性8例;年龄29~78岁,平均年龄51岁。患者术前均行HFUS及肌电图(EMG)检查、术后行HFUS检查。EMG测量正中神经(MN)、尺神经(UN)的运动神经传导速度(MNCV)和感觉神经传导速度(SNCV)及运动神经潜伏期(DML)和感觉神经潜伏期(DSL),HFUS分别测量MN、UN前后径、左右径、横截面积(CSA),以上各参数均进行统计学分析。结果与对照组比较,病例组术后神经前后径、左右径、CSA增大,差异有统计学意义(P<0.05);HFUS检测CTS、CuTS的灵敏度分别为91.67%、91.30%;特异度分别为75%、100%;阳性预测值分别为97.78%、100.00%;阴性预测值分别为42.86%、50.00%。结论 HFUS可作为临床上诊断上肢神经卡压综合征的有效方法 ,与EMG相结合可从形态和功能方面对上肢神经卡压综合征进行综合评估,为临床提供相应的定量诊断依据,从而提高诊断率。此外,应用HFUS对术前、术后患者进行比较研究,可为手术方案的制定及术后疗效的预测提供理论依据。
Objective To compare the preoperative and postoperative comparisons of patients with upper extremity nerve compression syndrome by high frequency ultrasonography (HFUS). Some patients underwent contrast-enhanced ultrasonography (CEUS) to investigate the value and treatment of HFUS in upper extremity nerve compression syndrome Application of the guiding significance, and then for the clinical development of the best treatment plan to improve the prognosis of surgery to provide imaging basis. Methods Thirty healthy volunteers were selected as the control group (60 wrists, 60 elbows), including 10 males and 20 females, aged from 25 to 65 years with a mean age of 46 years. Sixty patients with upper extremity nerve compression syndrome were enrolled in the study. Among them, 40 patients (52 wrists) had carpal tunnel syndrome (CTS) and 20 patients (25 elbow) had cubital tunnel syndrome (CuTS). 40 CTS patients, including 18 males and 22 females; aged 31 to 67 years, mean age 49 years. 20 cases of CuTS patients, including 12 males and 8 females; aged 29 to 78 years, mean age 51 years. Patients underwent preoperative HFUS and electromyography (EMG) examination, postoperative HFUS examination. EMG measures the motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) and motor nerve latency (DML) and sensory nerve latency (DSL) of the median nerve (MN) and ulnar nerve (UN) Before and after the diameter, left and right diameter, cross-sectional area (CSA), the above parameters were statistically analyzed. Results Compared with the control group, the anterior, posterior diameter, left and right diameter and CSA of patients in the case group were significantly increased (P <0.05). The sensitivities of HFTS to CTS and CuTS were 91.67% and 91.30% The positive predictive value was 97.78% and 100.00% respectively. The negative predictive values were 42.86% and 50.00% respectively. Conclusion HFUS can be used as an effective method for the diagnosis of upper extremity nerve compression syndrome. Combined with EMG, HFUS can be used to evaluate the morphology and function of upper extremity nerve compression syndrome comprehensively to provide quantitative diagnosis basis for clinical diagnosis rate. In addition, the use of HFUS for preoperative and postoperative patients to conduct a comparative study can provide a theoretical basis for the development of surgical options and prognosis of postoperative efficacy.