高频超声技术诊断肘管综合征的价值

目的：探讨超声技术诊断肘管综合征（CTS）的准确性。方法：对30例肘管综合征患者的30只手和50例无CTS志愿者的100只手肘部行动态超声检查,测量并比较两组尺神经的上下径、横径及截面积,并用ROC曲线评价超声诊断肘管综合征标准值的准确性。结果：CTS患者的尺神经在内上髁水平的截面积、上下径及左右径明显大于正常对照组,两组比较差异有统计学意义,尺神经的截面积增大对于诊断肘管综合征最有预测价值。以尺神经在内上髁水平的截面积7.5mm2为阈值,诊断敏感度为93%,诊断特异性为91%。结论：超声测量尺神经的截面积是诊断肘管综合征的可靠方法。     

肘管综合征行高频超声检查的价值

目的探讨高频超声检查技术对肘管综合征(CUTS)的诊断价值。方法选择31例肘管综合征患者的患侧手臂尺神经作为CUTS组,健侧手臂尺神经作为对照组,应用高频超声成像技术观察尺神经的连续性、内部结构、回声、有无局限性膨大及比邻结构关系,取横断面测量所有患者患侧尺神经与健侧尺神经的横截面积(CSA)。结果尺神经受压明显时神经局段变细,变细处回声明显减低,束状结构欠清晰,卡压近端及远端神经增粗;尺神经卡压瘢痕粘连时,神经增粗回声减低,外膜及束膜回声增强,与周围组织界限模糊;个别患者未见明显卡压段,仅见肘管内尺神经全程肿胀。31例肘管综合征患者患侧肘管尺神经与健侧肘管尺神经比较,患侧尺神经横截面积较健侧明显增大并存在统计学差异(P<0.05)。结论高频超声能动态观察尺神经卡压征象及其周围结构损伤情况,对肘管综合征的诊断有着重要的应用价值。     

MRI诊断肘管综合征的影像与临床应用研究

目的:探讨MRI对肘管综合征的影像及临床应用价值.方法:对18例肘管综合征患者和20例健康成年人行肘部3.0T MR横轴面、冠状面及矢状面扫描,扫描序列包括SE T1 WI、脂肪抑制SE T2 WI和脂肪抑制SE PDWI.对比分析患者组和对照组中肘部尺神经的信号及形态特点.结果:患者组和对照组中尺神经的横截面积分别为(0.17±0.08)和(0.07±0.01)cm2,两组间差异有统计学意义(P＜0.001);两组中尺神经/肌肉信号强度比分别为2.82±1.41和1.56±0.38,两组间差异有统计学意义(P=0.002).18例肘管综合征患者中有13例行肘管内尺神经减压术,5例行保守治疗.结论:MRI可显示肘管综合征患者肘部尺神经的变化,是一种能较好地评估肘管综合征的检查方法.     

肘管综合征患者尺神经及其支配肌肉的MRI表现

目的 探讨肘管综合征患者尺神经及其支配肌肉的MR表现.方法 回顾性分析经临床症状、体检和肌电图检查临床诊断为肘管综合征的28例患者,作为肘管综合征组.招募28名健康志愿者作为对照组.所有受试者均行单侧肘关节MR平扫,其中15例肘管综合征组患者行三维T2可变反转角快速自旋回波(3DT2SPACE)序列扫描,观察尺神经形态、信号特征、在肘管内是否增粗及信号增高,并观察周围肌肉改变.测量尺神经横截面积及神经肌肉信号强度比,并采用组间t检验进行比较.结果 28例肘管综合征患者中,24例尺神经增粗,26例尺神经信号增高;4例尺神经周围肌肉信号增高和(或)萎缩.28名对照组受试者中,2名尺神经增粗,16名尺神经信号增高;1名出现滑车上肘肌.15例行3D T2SPACE序列扫描的肘管综合征患者中,14例表现为局部尺神经增粗或信号增高,1例神经未见明显异常.对照组和肘管综合征组受试者尺神经横截面积分别为(0.06±0.01)和(0.15±0.06)cm2,神经肌肉信号强度比分别为1.57±0.39和2.86± 1.45,差异均有统计学意义(t值分别为2.220和4.546,P均＜0.05).结论 MRI上肘部尺神经信号增高、增粗及其所支配的肌肉萎缩、信号增高是肘管综合征的直接征象.     

尺神经前移治疗肘管综合征83例分析

83例肘管综合征（CUTS）患者采用尺神经皮下前移术治疗后,经6个月～3年的随访,优良率达89．2％。尺神经皮下前移术疗效确切,操作简便,为治疗CUTS较好方式。     

彩超诊断妊娠高血压综合征的临床应用价值

彩色多普勒超声检测可了解胎儿脐动脉血流、双顶径、股骨长、体重、胎盘等胎儿发育情况。及时发现妊娠高血压综合征(妊高征)对胎儿的影响。对围产期保健有重要意义。     

肘管综合征的研究进展

肘管综合征是最常见的神经嵌压性疾病之一，发病率仅次于腕管综合征。人类对其认识经历了近两个世纪，了解该病的发展史可更好地预防和治疗本病。笔者就其外科治疗史、肘管解剖的特殊性以及特殊类型肘管综合征等方面的近期文献进行综述。     

军事训练致肘管综合征23例

肘管综合征 ,又称肘部尺神经卡压综合征。1996年 7月～ 2 0 0 1年 7月 ,我们收治武警部队官兵军训致肘管综合征 2 3例。1　临床资料1 1　一般情况　均为男性 ,年龄 17～ 2 8岁 ,平均2 2 5岁。全部单侧受累 ,右侧 14例 ,左侧 9例。肘部骨折后骨痂增生压迫 2例 ,肘外翻畸形 1例 ,无明显诱因 2 0例。病程 1 5个月～ 3年 ,平均 11 6个月。临床症状 :手尺侧及环、小指麻木 ,手活动笨拙 ,握物不紧 ,有的出现肘部酸痛。体征 :手掌、手背尺侧和尺侧一指半刺痛觉减退 2 3例 ;手拇收肌、骨间肌萎缩 (+～ ) 17例 ;爪形手畸形 8例 ,小指内收试验阳性 1…     

肘管综合征B超诊断评价

肘管综合征Ｂ超诊断评价于亚东洪光祥郭瑞军张克亮龚志欣王明花肘管综合征是Ｆｅｉｎｄｅｌ等［１］于１９５８年首先提出，临床上主要表现为手内在肌萎缩及手尺侧感觉障碍等。临床主要依靠此体征及肌电图检查等做出诊断。笔者通过对正常肘管和病理肘管及其内容物的对照研...     

高原军训致肘管综合征169例

探讨高原军事训练致肘管综合征的病因、临床特点、防治对策,早期尺神经减压或移位是减少并发症的方法之一。     

Sonoanatomy of the ulnar nerve in the cubital tunnel: a multicentre study by the GEL

The objective is to determine the normal appearance of the ulnar nerve on a posterior axial sonogram section of the elbow through the medial epicondyle and the humeroulnar joint space. Ultrasound evaluation was carried out on 400 elbows with measurement of the ulnar nerve cross-sectional area and ulnar nerve-cortex distance, as well as recording of apparent ulnar nerve division. Factors that significantly influenced the study variables were sought by statistical analysis. Mean cross-sectional area of the ulnar nerve at the elbow was 7.9±3.1 mm² overall. Values were lower in females than in males and increased between 40 and 60 years of age. The ulnar nerve-cortex distance was 0.8±0.4 mm and varied widely across individuals. Apparent ulnar nerve division at the elbow was noted in about one-fifth of individuals, with no difference between females and males or between the right and left elbows. When present, apparent division was often bilateral and was not associated with changes in cross-sectional area or in distance from the medial epicondyle cortex. This study provides normative data on ulnar nerve sonoanatomy at the elbow and establishes that apparent ulnar nerve division at the elbow is a normal variant.     

超声在腕管综合征中的诊断价值

目的:探讨超声诊断腕管综合征(CTS)的准确性。方法:对37例腕管综合征患者的44只手腕和40例无CTS志愿者的80只手腕行动态超声检查,在腕管桡尺关节、豌豆骨及钩骨水平测量正中神经的截面积及其扁平率(长径与短径之比),两组结果进行相关性的对比研究,由ROC曲线评价超声诊断腕管综合征标准值的准确性。结果:CTS患者的正中神经在腕豆骨的截面积明显大于正常对照组,两组比较差异有统计学意义,正中神经的截面积增大对于诊断腕管综合征最有预测价值。以正中神经在豌豆骨水平的截面积9.5cm2为阈值,其诊断准确性为87%,诊断敏感度为88%,诊断特异度为87.5%。结论:超声测量正中神经的截面积是诊断腕管综合征的可靠方法。     

A minimally invasive approach for cubital tunnel release and ulnar nerve transposition

Objectives: The aim of the study is to introduce a new minimally invasive technique for ulnar nerve release and transposition.

Methods: From January 2010 to May 2011, 51 patients with cubital tunnel syndrome were treated through a 1.5 to 2 cm incision. Limb functional recovery, scar esthetics, sensitivity of scar, numbness of the operating area, and patient satisfaction were assessed.

Results: No wound hematoma nor infection was observed in the group. The time of operation was 36 ± 17.2 minutes. At the final follow-up of 63 ± 7.3 months, 2-point discrimination of the small finger was improved from 6.3 ± 2.2 mm to 5.2 ± 2.4 mm. Grip and pinch strength of the hand were improved from 14.2 ± 7.7 kg and 3.7 ± 2.4 kg to 35.2 ± 12.7 kg and 4.1 ± 2.8 kg, respectively. The motor nerve conduction velocity was improved from 36.5 ± 11.2 to 44.6 ± 6.7 (m/sec). The Disabilities of the Shoulder, Arm, and Hand questionnaire score was improved from 37.2 ± 23.8 to 10.5 ± 9.6. No patients reported scar pain, sensitivity of scar, or numbness of the operating area. No revision surgery was needed. Michigan Hand Outcome score for aesthetics was 94.6%±5.1 and satisfaction was 92 ± 8, respectively. We obtained 33 excellent, 12 good, 5 fair, and 1 poor result.

Conclusion: Ulnar nerve decompression with anterior transposition can be safely and effectively accomplished through the small incision. It can be an alternative technique producing good appearance.     

组织多普勒在评价节段性室壁运动异常中的临床价值

目的：探讨组织多普勒（tissue Doppler imaging,TDI）在评价节段性室壁运动异常中的临床价值。方法超声观察50例冠状动脉粥样硬化性心脏病（冠心病）患者（患者组）及50名健康人（对照组）,常规超声检查指标包括房室腔大小、左心功能（收缩、舒张功能）测定;超声心动图TDI条件下,于心尖两腔心、三腔心、四腔心切面获得基底段、中段的室间隔、侧壁、后壁、下壁、前壁、前间隔室壁运动达到最大位移时间,通过Q-分析软件（quantification analysis system）计算同一短轴切面不同节段达到最大位移的延迟时间。结果病例组较对照组时间明显延迟。结论 TDI测定同一短轴切面不同节段达到最大位移延迟时间对于评价节段性室壁运动异常具有重要的临床价值。     

甲状腺彩色超声检查在飞行员健康体检中的临床价值

目的 调查飞行员甲状腺彩色超声检查结果及鉴定情况,为航空卫生保障提供依据.方法 回顾分析在解放军第四五六医院因健康体检行甲状腺彩色超声检查的629名飞行员的超声检查结果、病理诊断以及医学鉴定情况,并进行统计学分析. 结果 ①629名飞行员中,检出甲状腺疾病139例,阳性率22.10％.②随年龄增长,飞行员甲状腺疾病发病率逐步增高（x2=35.564,P＜0.01）.③甲状腺疾病与飞行员所飞机种无关.④139例患甲状腺疾病的飞行员中飞行合格124例,其中桥本甲状腺炎6例,急性/亚急性甲状腺炎4例;暂时飞行不合格13例,其中原发性甲状腺功能亢进2例,桥本甲状腺炎合并甲状腺功能亢进3例,甲状腺腺瘤术后5例;飞行不合格（停飞）2例,均为甲状腺癌. 结论 结节性甲状腺肿在飞行人员中较常见,对飞行安全无明显影响.甲状腺癌及继发性甲状腺功能亢进患病率有增加趋势,且对飞行安全有着直接或间接影响,应加强预防和早期治疗.甲状腺彩色超声检查对甲状腺疾病的早发现、早诊断、早治疗具有重要意义.     

Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome

AIM: To investigate the diagnostic value of ultrasonography in mild and moderate idiopathic carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Cross-sectional areas (CSA), flattening ratios at three different levels, swelling ratio, and palmar displacement were analysed in 26 patients (14 with bilateral and 12 with unilateral disease, 40 wrists in total) for the presence and the severity of CTS. Twenty had normal nerve conduction studies (NCS) defined as "mild", and 20 of them had abnormal NCS defined as "moderate". The control group consisted of 20 healthy participants. RESULTS: All parameters were significantly different between patient and control groups. Palmar displacement, swelling ratio, CSA at all levels and distal flattening ratio had the highest significance (p < 0.0001). The criterion with the highest sensitivity was the swelling ratio > or = 1.3 (72.5%), followed by the middle CSA > 9 mm2 and the palmar displacement > 2.5 mm. All of these criteria had a higher sensitivity in diagnosing moderate cases (85-100%) than diagnosing mild cases (30-55%). There was a significant difference between normal and mild CTS groups regarding palmar displacement, distal flattening ratio, middle CSA and swelling ratio (p < 0.0001 for all) and between normal and moderate groups regarding all parameters (p < 0.01 - 0.0001) When combined middle CSA, palmar displacement and swelling ratio had an overall discriminatory accuracy of 83.8%. CONCLUSION: Additional diagnostic confirmation can be provided by ultrasonography and may be preferred as the initial step instead of electrophysiological studies. Detection of at least two of the three criteria (median nerve CSA > 9 mm2 at pisiform level, swelling ratio > or = 1.3, and palmar displacement > 2.5 mm) may be helpful for the verification of the diagnosis.     

高频超声对腕管综合征断面面积的测量研究

目的:研究高频超声定量测量腕管断面面积与腕管内容物断面面积之比,从而提高超声诊断腕管综合征的敏感性、特异性。方法:对经电生理及临床症状确诊的26例35侧患者组及30例60侧健康志愿者,高频超声测量豌豆骨水平及钩骨钩水平腕横韧带厚度、腕管断面积与腕管内容物断面积之比,采用ROC曲线分析测定各测量指标的诊断阈值,计算敏感度与特异度;并分析腕横韧带厚度与断面积比值之间相关性。结果:豌豆骨水平腕管断面积与腕管内容物断面积比值取最佳截点值2.447时,灵敏度为61.7%,特异度为77.1%。钩骨钩水平腕管断面积与腕管内容物断面积比值取最佳截点值2.177,灵敏度为83.3%,特异度为62.9%。腕横韧带厚度与断面积比值呈负相关性。结论:高频超声测量腕管断面积比值是诊断腕管综合征的一种有价值的新方法。