摘要
目的探讨高频超声诊断糖尿病(DM)并发腕管综合征(CTS)的临床应用价值。方法选取2014年1月～2017年12月在我院就诊的CTS患者共72例,其中非DM(non-DM)CTS患者40例,DM合并CTS患者32例。所有病例均经临床查体及电生理检查证实。DM者64只手腕中患有CTS手腕的为36只,non-DM中患有CTS手腕的为46只。将同期来我院进行健康体检的人共20例(40只手腕)设为A组,B组为non-DM合并CTS的手腕(共46只)、C组为DM无CTS的手腕(共28只)、D组为DM合并CTS的手腕(共36只)。高频超声测量每位受试者腕管入口(腕豆骨水平)与腕管出口(钩骨钩水平)正中神经(MN)的CSA值,并计算两者的比值,即肿胀率(SR)。单因素方差分析比较4组间各测值是否存在统计学差异。结果 1)各组腕管入口正中神经的CSA值分别为(8.78±0.76)mm^2(A组)、(13.36±0.18)mm^2(B组)、(10.37±0.30)mm^2(C组)以及(13.96±0.75)mm^2(D组)。各组腕管入口处正中神经CSA统计学差异显著(F=87.79,P<0.001,多重比较结果显示B组与D组无差异,但是与A、C两组差异显著,而A、C两组测值差异亦显著。腕管入口正中神经的CSA值为B组=D组>C组>A组;2)各组腕管出口处正中神经的CSA值分别为(7.82±0.66)mm^2(A组)、(11.52±0.86)mm^2(B组)、(9.43±0.40)mm^2(C组)以及(13.12±0.74)mm^2(D组)。各组腕管出口处正中神经CSA统计学差异显著(F=90.429,P<0.001),多重比较结果显示该处各CSA值均存在差异,其中以D组最大,其次为B组,然后为C组,最小者为A组;3)各组腕管SR值分别为1.12±0.07(A组)、1.17±0.11(B组)、1.10±0.06(C组)及1.07±0.07(D组)。各组SR值差异显著(F=9.850,P<0.001),多重比较结果显示B组SR值>A组=C组>D组。结论高频超声诊断CTS和DM合并CTS具有一定的临床价值,值得推广应用。
Objective To explore the clinical use of high-frequency ultrasound in diagnosing diabetic mellitus(DM) patients with carpal tunnel syndrome(CTS). Methods A total of 72 CTS patients were selected in Liuzhou Traditional Chinese Medicine Hospital from January 2014 to December 2017, of whom 40 were non diabetes mellitus patients(non-DM) with CTS and 32 DM patients with CTS. All cases were confirmed by electrophysiological examination and clinical examination. Among the DM patients, 36 of the 64 wrists had CTS, while 46 wrist of the non-DM had CTS. A total of 20 healthy people(40 wrists) in the Liuzhou traditional Chinese medicine hospital were enrolled as group A. Group B was non-DM with CTS(total 46 wrists), group C was DM without CTS(total 28 wrists), group D was DM with CTS(36 wrists). High frequency ultrasound was used to measure the CSA(cross session area) of the median nerve(MN) in the carpal tunnel entrance(pea bone level) and the carpal canal exit(hook of the hamate bone level), and the ratio of the two was calculated, that is, the swelling rate(SR). The difference between the 4 groups was statistically significant by one-way ANOVA. Results 1) the CSA values of the median nerve at the entrance of the carpal tunnel were(8.78±0.76) mm^2(group A),(13.36±0.18) mm^2(group B),(10.37±0.30) mm^2(group C) and(13.96±0.75) mm^2(group D) respectively. The statistical difference of median nerve CSA at the entrance of carpal tunnel was significant(F=87.79, P<0.001). The results of multiple comparison showed that there was no difference between group B and D, but the difference was significant with that of group A and C, the difference in the values of A and C two groups was also significant. The CSA value of the median nerve of the carpal tunnel was group B = group D > group C > group A;2) The CSA values of median nerve were( 7. 82 ± 0. 66) mm2( group A),( 11. 52 ± 0. 86) mm2( group B),( 9. 43 ± 0. 40) mm2( group C)and( 13. 12 ± 0. 74) mm2( group D) at the carpal tunnel exit. The statistical difference between the median nerve’s CSA at the carpal tunnel exit was significant( F = 90. 43,P < 0. 001). Multiple comparison results showed that there was significant difference of the CSA values among the four groups,the largest was group D and the next the group B,and then group C,and the smallest was the group A;3) The SR values of carpal tunnel in each group were 1. 12 ± 0. 07( group A),1. 17 ± 0. 11( group B),1. 10 ± 0. 06( group C) and 1. 07 ± 0. 07( group D),respectively. The SR values of each group were significantly different( F= 9. 850,P < 0. 001),and multiple comparisons showed that the SR values of group B > group A = group C > group D. Conclusion There was certain clinical value of high frequency ultrasound in diagnosing CTS and diabetic patients with CTS. This method is worthy of popularization and application.
作者
李红波
韦艳华
冼丽娅
韦小葵
钟伟华
李震宇
尼建平
黄健源
LI Hongbo;WEI Yanhua;XIAN Liya;WEI Xiaokui;ZHONG Weihua;LI Zhenyu;NI Jianping;HUANG Jianyuan(Guangxi Liuzhou Traditional Chinese Medicine Hospital,Liuzhou 545001,P.R.China;Guangxi Medical University First Affiliated Hospital Guangxi Nanning,Nanning 530021,P.R.China)
出处
《医学影像学杂志》
2019年第3期472-476,共5页
Journal of Medical Imaging
基金
广西壮族自治区卫生和计划委员会自筹课题项目(编号:Z2014640)
关键词
超声诊断
糖尿病
腕管综合征
High frequency ultrasound
Diabetes mellitus
Carpal tunnel syndrome
作者简介
李红波(1976-),男,广西博白人,医学硕士,副主任医师,主要从事超声诊断工作;通信作者:黄健源,主任医师,E-mail:wellbeing2005@sina.com。
