超声测量正中神经横断面积与腕管综合征患者严重程度的相关性研究-东南大学学报医学版

超声测量正中神经横断面积与腕管综合征患者严重程度的相关性研究

单位：南京医科大学附属无锡人民医院超声医学科, 江苏无锡 214023

分类号：R445.1

出版年·卷·期（页码）：2017·36·第六期（1004-1008）

摘要：

目的：应用ROC曲线法，探讨超声测量计算腕管综合征（CTS）患者腕管水平和旋前方肌近端1/3处的正中神经横断面积与神经肌电图检测严重程度结果的相关性。方法：84例患者140个手腕经肌电图诊断为CTS。在腕管水平（CSAC）和旋前方肌近端1/3处（CSAP）进行正中神经横断面积的测量。计算CSAC和CSAP横断面积的差值（△CSA）以及CSAC和CSAP横断面积的比值（R-CSA）。结果：CTS患者经NCS诊断分级为轻度、中度、重度三组，三组平均△CSA分别为（4.6±2.5）mm²、（7.2±2.2）mm²、（10.9±4.7）mm²；平均R-CSA分别为（1.5±0.3）、（1.9±0.4）、（2.5±0.8），各组间均有显著差异（P<0.01）。△CSA和R-CSA区分轻度和中度CTS的最佳临界值分别为6 mm²和1.7 mm²，特异性分别为82.6%和78.3%，敏感性分别为80.0%和76.3%，准确性分别为80.6%和76.7%。区分中度和重度CTS的最佳临界值分别为9 mm²和2.2 mm²，特异性分别为87.5%和83.8%，敏感性分别为62.2%和51.4%，准确性分别为79.5%和73.5%。结论：ROC曲线分析表明，△CSA和R-CSA有助于反映CTS患者的严重程度。

Objective: To evaluate the correlation between ultrasonographic measurement of median nerve cross-sectional area obtained at the level of the carpal tunnel (CSAc) and the more proximally (CSAp), and the severity of carpal tunnel syndrome (CTS) confirmed by electromyography (EMG) with ROC curve analysis. Methods: One hundred and forty wrists of 84 patients with CTS confirmed by EMG were examined with ultrasonography. The maximal median nerve CSA was measured at the level of the carpal tunnel and the third proximal of the pronator quadratus muscle. The value of the difference between CSAc and CSAp (△CSA) and the ratio of CSAc and CSAp (R-CSA) were calculated for each wrist. Results: The severity of CTS was classified as mild, moderate and severe based on the nerve conduction studies (NCS). The mean △CSA in the three groups was (4.6±2.5)mm²、(7.2±2.2)mm² and(10.9±4.7)mm², respectively. The mean R-CSA was (1.5±0.3)、(1.9±0.4) and (2.5±0.8), respectively. A significant difference was seen among the groups(all P<0.01). The best diagnostic discrimination between moderate and severe CTS with △CSA and R-CSA threshold values were 6 mm² and 1.7 mm², the specificity were 87.5% and 83.8%, the sensitivity were 62.2% and 51.4%, respectively. Conclusions: ROC curve analysis shows that △CSA and R-CSA may be helpful to evaluate the severity of CTS.

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