卡压性神经损害的另类发现

Alternative discovery of compressive never damage

摘要:

目的观察上肢神经卡压患者的神经超声图像特征，明确卡压神经除受压处损害外是否有其他部位的合并性损害，研究卡压神经合并性损害与性别及卡压点横截面积（CSA）的关系。方法回顾性总结2013年10月-2015 年10 月在贵州医科大学附属医院神经科确诊为腕管综合征（CTS）、肘管综合征（CubTS）患者（49 例）的高频超声图像资料。将卡压神经分为CTS 伴CSA 增粗组、CTS 伴CSA 正常组、CubTS 伴CSA 增粗组和CubTS 伴CSA 正常组，统计各组卡压神经合并性损害的情况，分析各组出现合并性损害与性别及卡压点CSA的关系。结果79 条卡压神经中有48 条合并该神经其他部位损害。CTS 伴CSA 增粗组中有合并性损害与无合并性损害的神经卡压点CSA 比较，差异有统计学意义（p <0.05）；CTS 是否同时伴有CSA增粗，其性别间比较，差异有统计学意义（p <0.05）。结论卡压性神经损害除卡压点外，可能涉及神经其他部位，CTS 出现合并性损害可能与卡压点神经增粗程度有关。神经有卡压不一定有卡压点神经肿胀，性别可能是影响神经卡压后是否出现卡压点神经肿胀的一个因素。高频超声对神经卡压的有重要诊断意义，对其早期诊断有潜在价值。

Abstract:

Objective To determine whether there is any other combined damage except the parts of compression in the compressive nerves by characterizeing the ultrasonic images of the patients with upper limb nerve compression, and to obtain the relationships of the combined nerve damage with gender and the cross sectional area (CSA) of the compressive site. Methods Ultrasonographic data of 49 patients with carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CubTS) in our hospital from October 2013 to October 2015 were reviewed. The compressive nerves were divided into CTS with increased CSA group, CTS with normal CSA group, CubTS with increased CSA group and CubTS with normal CSA group. The situation of combined nerve damage in each group was studied, and the correlations of the combined nerve damage with gender and the CSA of the compressive site were analyzed. Results Of the 79 compressive nerves, 48 had combined damage. In the CTS with increased CSA group, the CSA of the nerve compressive site in the patients with combined damage was larger than that in the patients without combined damage (p < 0.05). There was significant difference in gender between the CTS with increased CSA group and the CTS with normal CSA group (p < 0.05). Conclusions The study suggests that damage of the compressive nerve is not only in the compressive site, but also involves other parts of the nerve. The combined lesion of CTS may be related to the thicking of the compressive nerve. Nerve compression is not necessarily accompanied by nerve swelling at the compressive point. Gender may be a factor affecting the CSA of the compressive point. High-frequency ultrasonography has important implications for the diagnosis of nerve compression, and has a potential value in the early diagnosis.