[1]王艳蕾 范田依 宋鹏杰 王守业.高频超声联合肌电图在腕部正中神经受压诊断中的应用价值[J].卒中与神经疾病杂志,2019,26(02):198-201.[doi:10.3969/j.issn.1007-0478.2019.02.016]
　Wang Yanlei,Fan Tianyi,Song Pengjie,et al.The value of high-frequency ultrasound combined with electromyography in the diagnosis of wrist median nerve[J].Stroke and Nervous Diseases,2019,26(02):198-201.[doi:10.3969/j.issn.1007-0478.2019.02.016]
点击复制

高频超声联合肌电图在腕部正中神经受压诊断中的应用价值()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第26卷
期数:
2019年02期
页码:
198-201
栏目:
论 著
出版日期:
2019-04-20

文章信息/Info

Title:
The value of high-frequency ultrasound combined with electromyography in the diagnosis of wrist median nerve
文章编号:
1007-0478(2019)02-0198-05
作者:
王艳蕾 范田依 宋鹏杰 王守业
066000 河北省秦皇岛军工医院超声诊断科[王艳蕾 范田依(通信作者)宋鹏杰 王守业]
Author(s):
Wang Yanlei; Fan Tianyi; Song Pengjie; et al.
Department of Ultrasonic Diagnosis,Qinhuangdao Military Hospital,Qinhuangdao 066000
关键词:
高频超声 肌电图 正中神经
Keywords:
High-frequency ultrasound Electromyography Nervi medianus
分类号:
R745.4
DOI:
10.3969/j.issn.1007-0478.2019.02.016
文献标志码:
A
摘要:
目的 探讨高频超声联合肌电图在腕部正中神经受压诊断中的应用价值。方法 选取本院2017年2月-2018年3月110例疑似腕部正中神经受压患者为研究对象,手术确诊腕部正中神经受压患者为WZ组,非腕部正中神经受压患者24例为NZ组,分别应用高频超声与肌电图仪对所有患者进行检查,并观察2组患者正中神经运动传导的远端潜伏期(DML)、复合肌肉动作电位(CMAP)、腕-肘段运动传导速度(MCV)、正中神经感觉传导速度(SCV)、感觉神经的动作电位波幅(SNAP)等肌电图参数,同时观察2组患者高频超声检查的声像图; 以手术确诊为金标准,比较分析不同方案的灵敏度、特异度与准确度。结果 与NZ组比较,WZ组MCV、CMAP、SCV及SNAP均显著降低(P<0.05),而DML显著升高(P<0.05); WZ组患者腕部正中神经横截面面积显著高于NZ组(P<0.05); 肌电图检测显示腕部正中神经受压阳性患者共55例,阴性共55例,诊断灵敏度为56.98%,特异度为75.00%,准确度为60.91%,误诊率为25.00%,漏诊率为43.02%; 高频超声检测显示腕部正中神经受压阳性患者共57例,阴性共53例,诊断灵敏度为58.14%,特异度为70.83%,准确度为60.91%,误诊率为29.17%,漏诊率为41.86%; 联合检测显示腕部正中神经受压阳性患者共84例,阴性共26例,诊断灵敏度为95.35%,特异度为91.67%,准确度为94.55%,误诊率为8.33%,漏诊率为4.65%; 肌电图、高频超声联合检测腕部正中神经受压患者的灵敏度与准确度均显著高于单项检测(P<0.05)。结论 肌电图可有效诊断早期腕部正中神经受压,高频超声可准确判断卡压部位,肌电图与高频超声联合检测可互为补充并提高诊断准确率、降低漏诊率及误诊率。
Abstract:
ObjectiveTo explore the value of high-frequency ultrasound combined with electromyography in the diagnosis of wrist median nerve.Methods 110 patients with suspected median nerve injury of wrist from February 2017 to March 2018 were selected as the research subjects,after the surgical diagnosis,they was divided into WZ group with wrist median nerve injury and NZ group without wrist median nerve injury(24 cases),all patients were examined by high-frequency ultrasound and electromyography respectively,the electromyographic parameters in distal molor latency(DML),complex muscle action potential(CMAP),wrist-elbow motor conduction velocity(MCV),median nerve sensory conduction velocity(SCV)and sensory nerve action potential amplitude(SNAP)of the two groups were observed,at the same time the ultrasonograms of high frequency ultrasonography in the two groups were observed.The surgical results were as the gold standard,the sensitivity,specificity and accuracy of different protocols were compared and analyzed.Results Compared with NZ group,MCV,CMAP,SCV and SNAP in WZ group decreased significantly(P<0.05),but DML increased significantly(P<0.05); the cross sectional area of wrist median nerve in WZ group was significantly higher than that in NZ group(P<0.05).The results of electromyography showed that 55 cases were positive,55 cases were negative,the diagnostic sensitivity was 56.98%,the specificity was 75.00%,the accuracy was 60.91%,the misdiagnosis rate was 25.00%,and the missed diagnosis rate was 43.02%.The results of high-frequency ultrasonography showed that 57 cases were positive and 53 cases were negative,the diagnostic sensitivity was 58.14%,the specificity was 70.83%,the accuracy was 60.91%,the misdiagnosis rate was 29.17%,and the missed diagnosis rate was 41.86%.The combined test results showed that 84 cases were positive,26 cases were negative,the diagnostic sensitivity was 95.35%,specificity was 91.67%,accuracy was 94.55%,misdiagnosis rate was 8.33%,and missed diagnosis rate was 4.65%; the sensitivity and accuracy of EMG combined with high-frequency ultrasound in the detection of wrist median nerve injury were significantly higher than those of single test(P<0.05).Conclusion Electromyography could effectively diagnose the median nerve injury in the early period,high-frequency ultrasound could accurately determine the location of compression,EMG combined with high-frequency ultrasound could complement each other and improve the accuracy of diagnosis,reduce the rates of missed diagnosis and misdiagnosis.

参考文献/References:

[1] 谭耀灵,许球祥,马坪楠.腕管综合征患者正中神经的解剖学变化[J].山东医药,2015,55(3):26-28.
[2] 倪雪君,王怡.超声在周围神经病变中的应用进展[J].中国医学计算机成像杂志,2015,21(1):90-92.
[3] Ring D C.Clinical faceoff:routine electrodiagnostic testing is not helpful in the management of carpal tunnel syndrome[J].Clinical Orthopaedics and Related Research,2016,474(8):1770-1774.
[4] 高培森,任水明,刘磊,等.高频超声在类风湿关节炎患者神经卡压诊断中的应用价值[J].中国医学科学院学报,2016,38(3):327-330.
[5] Sohn MK,Jee SJ,Hwang SL,et al.Motor unit number estimation and motor unit action potential analysis in carpal tunnel syndrome[J].Annals of Rehabilitation Medicine,2011,35(6):816-825.
[6] 陈欣,田德润,王植,等.神经肌电图与超声在腕管综合征诊断中的应用[J].天津医科大学学报,2015,20(3):252-255.
[7] 任玲,李巍,张铁山,等.高分辨力超声对糖尿病合并腕管综合征诊断价值的研究[J].北华大学学报:自然科学版,2017,18(2):220-223.
[8] 陈飘飞,刘超美,曹婷婷.高频超声联合肌电图对腕管综合征的诊断价值[J].皖南医学院学报,2018,37(2):180-182.
[9] 马彦,段玉琼,樊继军.神经根型颈椎病合并腕管综合征98例肌电图分析[J].宁夏医学杂志,2018,40(5):449-450.
[10] 陈涛,郭稳,陈山林,等.高频超声对医源性周围神经损伤的诊断价值[J].中国超声医学杂志,2015,31(6):527-529.
[11] 李国,吕贵荣,王传洲.膝关节镜下治疗老年骨关节炎退行性变的疗效研究[J].河北医学,2016,22(2):272-275.
[12] 柳三凤,刘春华,庄智勇,等.肌电图在腕管综合征分期诊断及鉴别诊断中的应用价值[J].实用手外科杂志,2017,31(2):224-228.
[13] 张景锋,李文龙,顿国亮,等.探讨超声检查在诊断腕管综合征中的应用价值[J].陕西医学杂志,2016,45(4):472-473.
[14] Toosi KK,Hogaboom NS,Oyster ML,et al.Computer keyboarding biomechanics and acute changes in median nerve indicative of carpal tunnel syndrome[J].Clinical Biomechanics,2015,30(6):546-550.
[15] Pelosi L,Mulroy E,Leadbetter R,et al.Peripheral nerves are pathologically small in cerebellar ataxia neuropathy vestibular areflexia syndrome:a controlled ultrasound study[J].European Journal of Neurology,2018,25(4):659-665.
[16] 刘智,张文川,华兴,等.高频超声在周围神经损伤诊断和治疗中的应用[J].中华神经外科杂志,2015,31(4):358-361.
[17] 王守业,王艳蕾,范田依,等.高频超声联合肌电图在外周神经卡压或损伤临床康复中的应用价值探讨[J].中华保健医学杂志,2017,19(3):227-230.
[18] 陈欣,田德润,王植,等.神经肌电图与MRI诊断早期腕管综合征的功用[J].中华手外科杂志,2016,32(1):12-15.
[19] Crnkovic T,Trkulja V,Bilic R,et al.Carpal tunnel and median nerve volume changes after tunnel release in patients with the carpal tunnel syndrome:a magnetic resonance imaging(MRI)study[J].International Orthopaedics,2016,40(5):981-987.
[20] 古旸,何芳,张科勋,等.高频超声与神经肌电图对于腕管综合征诊断价值的对比分析[J].重庆医学,2018,47(2):239-241.

备注/Memo

备注/Memo:
(2018-10-08收稿)
更新日期/Last Update: 2019-04-20