高频超声和SWE定量参数与肘管综合征患者尺神经电生理相关性及诊断价值

艾丽菲娅·吉力力; 李文娟; 缪旭; 王霞

doi:10.16766/j.cnki.issn.1674-4152.003515

高频超声和SWE定量参数与肘管综合征患者尺神经电生理相关性及诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.003515

新疆医科大学第二附属医院超声科，新疆乌鲁木齐 830000

基金项目:

新疆维吾尔自治区自然科学基金项目 2020D01C184

详细信息

通讯作者:
王霞，E-mail：2306914558@qq.com

中图分类号: R658.2 R445.1
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出版历程
- 收稿日期: 2023-11-06
- 网络出版日期: 2024-07-20

Correlation and diagnostic value of high frequency ultrasound and SWE quantitative parameters with ulnar nerve electrophysiology in patients with cubital tunnel syndrome

Department of Ultrasound, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China

摘要

摘要: 目的探究高频超声和剪切波弹性成像(SWE)定量参数与肘管综合征(CTS)患者尺神经电生理相关性及对CTS的诊断价值。方法选取2021年12月—2022年12月期间新疆医科大学第二附属医院收治的49例CTS患者，纳入CTS组，选取同期体检健康的志愿者49例纳入对照组。所有研究对象均进行高频超声检查、SWE及尺神经电生理检查，采用Pearson法分析CTS患者高频超声参数[内上髁横截面积(CSA)、尺神经最大横径及周长]、SWE定量参数[弹性模量均值(EI)、剪切波速度(V)]与尺神经电生理检查结果[运动传导速度(MCV)、感觉传导速度(SCV)]的相关性，并采用ROC曲线分析高频超声检查、SWE定量参数对CTS的诊断价值。结果 CTS组患者CSA、EI及V水平均高于对照组(P＜0.05)，2组患者尺神经最大横径、周长比较差异均无统计学意义(P>0.05)；CTS组患者MCV及SCV水平均低于对照组(P＜0.05)。Pearson相关性分析结果显示，CSA、EI及V与MCV、SCV均呈负相关关系(P＜0.05)。ROC曲线分析结果显示，CSA、EI及V单独及联合诊断CTS的AUC(95% CI)分别为0.679(0.577~0.770)、0.718(0.618~0.804)、0.720(0.620~0.806)、0.893(0.815~0.947)，三者联合诊断效能高于各项单独检测(Z=3.065、2.899、2.734，P＜0.05)。结论 CTS患者高频超声和SWE定量参数与尺神经电生理指标存在明显的相关性，其中CSA、EI及V均可用于CTS的诊断，三者联合对CTS具有较高的诊断价值。
- 肘管综合征 /
- 高频超声 /
- 剪切波弹性成像 /
- 尺神经电生理检查 /
- 肌电图 /
- 诊断
Abstract: Objective To explore the correlation of quantitative parameters of high frequency ultrasound and shear wave elastography (SWE) with ulnar nerve electrophysiology in patients with cubital tunnel syndrome (CTS) and the diagnostic value of CTS. Methods A total of 49 patients with CTS admitted to the Second Affiliated Hospital of Xinjiang Medical University from December 2021 to December 2022 were included in the CTS group. A total of 49 healthy volunteers were included in the control group. All patients underwent high-frequency ultrasonography, SWE and ulnar nerve electrophysiological examination. Pearson method was used to analyze the correlation between high-frequency ultrasound examination [medial epicondylar cross-sectional area (CSA), maximum transverse diameter and circumference of ulnar nerve], SWE quantitative parameters [mean elastic modulus (EI), shear wave velocity (V)] with ulnar nerve electrophysiological examination results [motor conduction velocity (MCV) and sensory conduction velocity (SCV)] in CTS patients. ROC curve was used to analyze the diagnostic value of high-frequency ultrasonography and SWE quantitative parameters for CTS. Results The levels of CSA, EI and V in CTS group were significantly higher than those in control group (P < 0.05), and there was no significant difference in the maximum transverse diameter and circumference of ulnar nerve between two groups (P>0.05). The levels of MCV and SCV in CTS group were lower than those in control group (P < 0.05). The results of Pearson correlation analysis showed that CSA, EI and V were negatively correlated with MCV and SCV (P < 0.05). ROC analysis results showed that the AUC (95% CI) were 0.679 (0.577-0.770), 0.718 (0.618-0.804), and 0.720 (0.620-0.806) for CSA, EI and V in the diagnosis of CTS alone, respectively, and the value was 0.893 (0.815-0.947) when combined. The diagnostic efficiency of the three combined tests was higher than that of each single test (Z=3.065, 2.899, 2.734, P < 0.05). Conclusion In patients with high CTS, high-frequency ultrasound and SWE quantitative parameters are significantly correlated with the ulnar nerve electrophysiological indexes, among which CSA, EI and V can be used in the diagnosis of CTS, and the combination of the three has high diagnostic value.
- Cubital tunnel syndrome /
- High-frequency ultrasound /
- Shear wave elastic imaging /
- Electrophysiological examination of ulnar nerve /
- Electromyography /
- Diagnosis

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图 1 对照组高频超声图

注：健康男性，49岁，高频超声长轴切面及短轴切面提示尺神经无异常。

Figure 1. High-frequency ultrasound imaging of the control group

下载: 全尺寸图片幻灯片

图 2 CTS患者高频超声图

注：患者男性，52岁，高频超声长轴切面提示尺神经走行僵硬，卡压处神经变扁，短轴切面提示尺神经肿胀增粗。

Figure 2. High-frequency ultrasound imaging of CTS patients

下载: 全尺寸图片幻灯片

图 3 CSA、EI、V单独及联合诊断CTS的ROC曲线

Figure 3. ROC curves for the individual and combined diagnosis of CTS using CSA, EI, and V

下载: 全尺寸图片幻灯片

表 1 TS患者与对照组高频超声及SWE参数比较(x±s)

Table 1. Comparison of high-frequency ultrasound and SWE parameters between TS patients and the control group

组别	例数	CSA(mm²)	最大横径(mm)	周长(mm)	EI(kPa)	V(m/s)
对照组	49	4.76±1.38	3.29±1.04	12.37±4.05	37.86±8.61	3.51±0.44
CTS组	49	10.15±2.89	3.70±1.19	13.81±3.87	68.95±12.27	4.76±0.57
t值		11.737	1.816	1.799	14.519	12.152
P值		＜0.001	0.072	0.075	＜0.001	＜0.001

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表 2 CTS患者与对照组尺神经电生理检查结果比较(x±s，m/s)

Table 2. Comparison of ulnar nerve electrophysiological results between CTS patients and control group (x±s, m/s)

组别	例数	MCV	SCV
对照组	49	54.71±2.21	59.64±6.15
CTS组	49	25.64±7.35	44.71±3.47
t值		14.136	14.800
P值		＜0.001	＜0.001

下载: 导出CSV

表 3 高频超声及SWE定量参数与电生理检查结果的相关性

Table 3. Correlation between high-frequency ultrasound and SWE quantitative parameters with electrophysiological examination results

项目	MCV(m/s)		SCV(m/s)
项目	r值	P值	r值	P值
CSA(mm²)	-0.652	＜0.001	-0.440	＜0.001
EI(kPa)	-0.605	＜0.001	-0.441	＜0.001
V(m/s)	-0.653	＜0.001	-0.492	＜0.001

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表 4 CSA、EI及V对CTS的诊断价值

Table 4. Diagnostic value of CSA, EI, and V for CTS

项目	阈值	灵敏度(%)	特异度(%)	AUC	95% CI	约登指数
CSA	7.21 mm²	73.47	67.35	0.679	0.577~0.770	0.408
EI	52.73 kPa	65.31	71.43	0.718	0.618~0.804	0.367
V	4.06 m/s	65.31	73.47	0.720	0.620~0.806	0.388
联合		93.88	87.76	0.893	0.815~0.947	0.816
注：联合诊断采用LogP模式进行拟合；联合诊断最佳截断值依据Log(P/1-P)模型生成。

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参考文献(19)

[1]	GRAF A, AHMED A S, ROUNDY R, et al. Modern treatment of cubital tunnel syndrome: evidence and controversy[J]. J Hand Surg Glob Online, 2022, 5(4): 547-560.
[2]	GRIFFITHS T T, FLATHER R, TEH I, et al. Diffusion tensor imaging in cubital tunnel syndrome[J]. Sci Rep, 2021, 11(1): 14982. DOI: 10.1038/s41598-021-94211-7.
[3]	FERGUSON D P, GREWAL R. Cubital tunnel syndrome: review of diagnosis and management[J]. Handchir Mikrochir Plast Chir, 2022, 54(3): 253-262. doi: 10.1055/a-1808-6973
[4]	COLLINS D W, REHAK D, DAWES A, et al. Cubital tunnel syndrome: does a consensus exist for diagnosis?[J]. J Hand Surg Am, 2023. DOI: 10.1016/j.jhsa.2023.05.014.
[5]	王瀚博, 刘瑞, 赵建民, 等. 肌骨超声结合神经电生理检查对肘管综合征术前的指导意义[J]. 内蒙古医科大学学报, 2021, 43(5): 485-488. https://www.cnki.com.cn/Article/CJFDTOTAL-NMYX202105008.htm WANG H B, LIU R, ZHAO J M, et al. The significance of musculoskeletal ultrasonography combined with neuroelectrophysiological examination in preoperative treatment of cubital tunnel syndrome[J]. Journal of Inner Mongolia Medical University, 2021, 43(5): 485-488. https://www.cnki.com.cn/Article/CJFDTOTAL-NMYX202105008.htm
[6]	朱玲, 刘凤欣, 穆雅群. 高频超声与肌电图在腕管综合征中的应用价值[J]. 河北医药, 2023, 45(10): 1519-1521, 1525. doi: 10.3969/j.issn.1002-7386.2023.10.018 ZHU L, LIU F X, MU Y Q. Application value of high-frequency ultrasonography and electromyography in carpal tunnel syndrome[J]. Hebei Medical Journal, 2023, 45(10): 1519-1521, 1525. doi: 10.3969/j.issn.1002-7386.2023.10.018
[7]	沈朝明, 陈淑霞, 邬午龙, 等. 剪切波弹性成像对乳腺癌良恶性的鉴别诊断及误诊分析[J]. 中华全科医学, 2020, 18(4): 634-637. doi: 10.16766/j.cnki.issn.1674-4152.001317 SHEN C M, CHEN S X, WU W L, et al. Differential diagnosis and misdiagnosis of benign and malignant breast cancer by shear wave elastography[J]. Chinese Journal of General Practice, 2020, 18(4): 634-637. doi: 10.16766/j.cnki.issn.1674-4152.001317
[8]	BEDEWI M A, KOTB M A, ALDOSSARY N M, et al. Shear wave elastography of the ulnar nerve at the forearm[J]. Medicine (Baltimore) 2021, 100(2): e24071. DOI: 10.1097/MD.0000000000024071.
[9]	DURAND S, RAFFOUL W, CHRISTEN T, et al. Post-operative assessment of ulnar nerve tension using shear-wave elastography[J]. Neurol Int, 2021, 13(3): 469-476. doi: 10.3390/neurolint13030046
[10]	中国中医药研究促进会中西医结合工作委员会. 肘管综合征中西医诊疗专家共识[J]. 中医正骨, 2021, 33(10): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-LICX202307050.htm China Association for the Promotion of Traditional Chinese Medicine Research Working Committee of Integrated Chinese and Western Medicine. Expert consensus on Chinese and Western medicine diagnosis and treatment of cubital tunnel syndrome[J]. The Journal of Traditional Chinese Orthopedics and Traumatology, 2021, 33(10): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-LICX202307050.htm
[11]	郭瑞鹏, 常文凯. 肘管综合征诊治研究进展[J]. 国际骨科学杂志, 2021, 42(2): 71-75. https://www.cnki.com.cn/Article/CJFDTOTAL-GWGK202102002.htm GUO R P, CHENG W K. Progress on the diagnosis and treatment of cubital tunnel syndrome[J]. International Journal of Orthopaedics, 2021, 42(2): 71-75. https://www.cnki.com.cn/Article/CJFDTOTAL-GWGK202102002.htm
[12]	THAKKER A, GUPTA V K, GUPTA K K. The anatomy, presentation and management options of cubital tunnel syndrome[J]. J Hand Surg Asian Pac Vol, 2020, 25(4): 393-401. doi: 10.1142/S2424835520400032
[13]	CHAUDHARY R K, KARKALA N, NEPAL P, et al. Multimodality imaging review of ulnar nerve pathologies[J]. Neuroradiol J, 2023, 24: 19714009231166087. DOI: 10.1177/19714009231166087.
[14]	NWAWKA O K. Ultrasound imaging of the brachial plexus and nerves about the neck[J]. Ultrasound Q, 2019, 35(2): 110-119. doi: 10.1097/RUQ.0000000000000396
[15]	MORAN L, ROYUELA A, DE VARGAS A P, et al. Carpal tunnel syndrome: diagnostic usefulness of ultrasound measurement of the median nerve area and quantitative elastographic measurement of the median nerve stiffness[J]. J Ultrasound Med, 2020, 39(2): 331-339.
[16]	索燕花, 王丽, 董燕, 等. 高频超声与神经肌电图在肘部尺神经卡压病变中的诊断优势比较[J]. 临床和实验医学杂志, 2022, 21(13): 1454-1457. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC202213031.htm SUO Y H, WANG L, DONG Y, et al. Comparison of diagnostic advantages of high frequency ultrasound and neuroemg in the entrapment of the ulnar nerve of the elbow[J]. Journal of Clinical and Experimental Medicine, 2022, 21(13): 1454-1457. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC202213031.htm
[17]	张卫平, 陈莉, 谌芳群, 等. 剪切波弹性成像技术在肘管综合征诊断中的应用价值[J]. 重庆医学, 2021, 50(7): 1113-1116. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX202107007.htm ZHANG W P, CHEN L, CHEN F Q, et al. Application value of shear wave elastography in diagnosis of cubital tunnel syndrome[J]. Chongqing medicine, 2021, 50(7): 1113-1116. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX202107007.htm
[18]	DURAND S, RAFFOUL W, CHRISTEN T, et al. Post-operative assessment of ulnar nerve tension using shear-wave elastography[J]. Neurol Int, 2021, 13(3): 469-476.
[19]	刘春艳, 马超, 于大志, 等. 基于高频超声检查的护航官兵尺神经半脱位流行病学研究[J]. 中华航海医学与高气压医学杂志, 2022, 29(4): 488-491. LIU C Y, MA C, YU D Z, et al. Epidemiological study on high-frequency ultrasound diagnosed ulnar nerve subluxation in officers and sailors of an escort mission[J]. Chinese Journal of Nautical Medicine and Hyperbaric Medicine, 2022, 29(4): 488-491.