中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (2): 317-323.doi: 10.4103/1673-5374.226402

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

超声有潜力用于鉴别腕管综合征后脱鞘鞘是否与轴突变性并存

  

  • 收稿日期:2018-01-16 出版日期:2018-02-15 发布日期:2018-02-15

Exploratory use of ultrasound to determine whether demyelination following carpal tunnel syndrome co-exists with axonal degeneration

Xue Deng1, Lai-Heung Phoebe Chau2, Suk-Yee Chiu2, Kwok-Pui Leung3, Sheung-Wai Li3, Wing-Yuk Ip1   

  1. 1 Department of Orthopedics & Traumatology, The University of Hong Kong, Hong Kong Special Administrative Region, China
    2 Clinical Electro-diagnostic Unit, Tung Wah Hospital, Hong Kong Special Administrative Region, China
    3 Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
  • Received:2018-01-16 Online:2018-02-15 Published:2018-02-15
  • Contact: Wing-Yuk Ip, M.D.,wyip@hku.hk.

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摘要：

目前临床广泛应用的交叉验证超声（US）严重程度分类系统不能明确区分与继发性轴突变性相关的腕管综合征（CTS）。为明确用于鉴别诊断的超声临界值，包括横截面积（W-CSA），腕周长（WP），腕管水平(CSAC)和旋前方肌近端1/3处横断面积/周长的比值(R-CSA)，及腕管水平(CSAC)和旋前方肌近端1/3处横断面积/周长的差值。研究纳入73例腕管综合征患者，包括男13例，女60例。根据神经传导检查结果，将患者分为A组（仅脱髓鞘组，40例）和B组（脱髓鞘与轴突变性并存，33例）。绘制受试者工作特征（ROC）曲线以获得所有US参数的临界值的灵敏度、特异性和准确性77.1-88.6％），特异性中等（40％-62.2％）和准确度中上（0.676-0.758） 。2组神经传导研究得出的手腕运动潜伏期和传导速度、手腕运动波幅、远端感觉潜伏期、感觉波幅和全部超声测量值存在明显差异（P < 0.05或P < 0.01）。这些研究数据表明，超声可能有潜力用于鉴别腕管综合征脱髓鞘是否与轴突变性并存。 。总体鉴定的临界值敏感性好（

orcid:0000-0003-2966-2588(Wing-Yuk Ip)

关键词: 腕管综合征, 神经传导研究, 超声, ROC曲线, 周围神经压迫损伤, 超声, 神经传导, 神经退变, 神经再生

Abstract:

Carpal tunnel syndrome (CTS) accompanied by secondary axonal degeneration cannot be clearly discriminated using the current cross-validated ultrasound severity classification system. This study aimed at exploring cut-off values of ultrasound parameters, including wrist cross-sectional area (W-CSA), wrist perimeter (W-P), ratio of cross-sectional area (R-CSA) and perimeter (R-P), changes of CSA and P from wrist to one third distal forearm (ΔCSA&ΔP) for differentiation. Seventy-three patients (13 male and 60 female) were assigned into group A (demyelination only, n = 40) and group B (demyelination with secondary axonal degeneration, n = 33) based on the outcomes of nerve conduction studies (NCS). Receiver Operative Characteristics (ROC) curves were plotted to obtain sensitivity, specificity, and accuracy of cutoff values for all the ultrasound parameters. The overall identified cut-off values (W-CSA 12.0 mm2, W-P 16.27 mm, R-CSA 1.85, R-P 1.48, ΔCSA 6.98 mm2, ΔP 5.77 mm) had good sensitivity (77.1–88.6%), fair specificity (40–62.2%) and fair-to-good accuracy (0.676–0.758). There were also significant differences in demographics (age and severity gradation, P < 0.001), NCS findings (wrist motor latency and conduction velocity, P < 0.0001; wrist motor amplitude, P < 0.05; distal sensory latency, P < 0.05; sensory amplitude, P < 0.001) and ultrasound measurements (W-CSA, W-P, R-CSA, R-P, ΔCSA&ΔP, P < 0.05) between groups.These findings suggest that ultrasound can be potentially used to differentiate demyelinating CTS with secondary axonal degeneration and provide better treatment guidance.

Key words: carpal tunnel syndrome, nerve conduction studies, ultrasound, receiver operating characteristic curve, peripheral nerve compression injury, ultrasonography, neural conduction, axonal degeneration, neural regeneration