| Background Radial nerve injury, is commonly seen in peripheral nerve injury, which mainly cause extension dysfunction of wrist, thumb and other fingers, together with the sensation reduction of the thumb and first web[1]. There are so many patients received little therapeutic effect because of the misdiagnosis or delayed treatment. Although some of them underwent times of operations, the affected limbs could not reach complete recovery, and disability was finally left to them. Therefore, right diagnosis of the injury degree pre-operation is a key way, which could not only help evaluate prognosis, but also can guide clinical treatment[2-3]. To guide the treatment more precisely, it is meaningful for us to find a method in clinical work which can improve the diagnosis accuracy of the radial nerve injury.At present, the clinical diagnosis methods of radial nerve injury include clinical physical examination, Electromyography(EMG), Magnetic Resonance Imaging(MRI). Clinical physical examination is an important way of peripheral nerve injury diagnosis. Based on the clinical features and signs, the injury and other history, together with the anatomy and special tests, we could make an original diagnosis whether there is a nerve injury or not, generally. But to some of the patients, they cannot cooperate with the examinations because of the severe injury with coma, pain or swelling. This may lead to inaccuracy of the examination results. Electromyography(EMG) also plays an important role in peripheral nerve injury diagnosis. Not only can it distinguish the nerve or neuromuscular junction from the different stage of lesion, but also can determine the location and characteristic of the injury. But the Wallerian degeneration has an negative effect on EMG test, which may lead to misdiagnosis because of the false-negative result of EMG in early injury(in 3 weeks)[4-5]. Although MRI test can be used to observe the anatomy changes, because of the angle of scan, contraindications, high price, and bad visualization of radial nerve, it only has accessory diagnostic value in brachial plexus avulsion[6].In recent years, with the development of the ultrasonic medicine, many scholars find that High Frequency Ultrasonography(HFU) can serve the images of the shape[7-8], continuity, swelling and the anatomy with surrounding tissue[9], at the same time, it can differ the characteristics from normal nerves, vessels, muscles, fascias and tendons. HFU is not confined to injury time and has the advantages of visualization, accuracy, non-invasion, etc[10]. All the specialties can compensate the shortages of EMG and MRI, which help us make diagnosis more early and clearly through the images it served. It also provides us valuable information for making treatment plan. Because HFU is too sensitive to tendon tissue, there is also a shortage of misdiagnosis when used[11]. Moreover, subjected to distinguish ability, under the condition of neurapraxia and axonotmesis, the HFU still has the difficulty in diagnosing, though the nerve continuity is fine. False-negative results also will appear[12].In conclusion, both EMG and HFU make a diagnosis of peripheral nerve injury to some extent, and each of them has their advantages and clinical limitations. Can the combined use of them help increase the diagnosis accuracy of peripheral nerve injury? Based on the hypothesis, in this research project, radial nerve injury is the main subject be used, in order to investigate the characteristic and clinical value of EMG combined HFU in the degree diagnosis of radial nerve injury for further clinical treatment. To provide theoretical support and diagnostic criteria for the transition from peripheral nerve injury to EHC examination.Objectives To investigate the characteristic and clinical value of EMG combined HFU in the diagnosis of radial nerve injury.Methods 45 patients was followed(29 males and 16 females) in this group. Age ranges from 13 ys to 56.4ys(mean age 39.6ys).Process of injury ranges from 2 weeks to 2.8 years, including 12 left side and 33 right side. All the patient had a injury history and single side injury. EMG and HFU are performed on all the patients pre-operation. According to the intraoperative findings and Intraoperative Electrophysiological Examination(IEE) results, we analyze the diagnostic value of EMG combined HFU.Results 1.EMG test: 25 patients’ nerves were nearly completely ruptured. The Sunderland classification type V and type IV are hard to be distinguished; 8 patients’ nerves were damage, the Sunderland type III; 7 patients’ nerves were damage, the Sunderland type II; 5 cases of the lateral intermuscular septum damage may, because the history is less than 3 weeks that recommendations were followed. The area under the curve(AUC) of neurotmesis was 0.890, which had statistical significance(P<0.05),and the sensitivity and the specificity of the diagnosis of neurotmesis were 88.5% and 89.5%.2.HFU test: 16 patients’ nerves were completely ruptured. The degree of the injury is Sunderland V, including 12 nerve injuries beyond 2cm.2 cases of radial nerve distal end nerves were not seen; 18 patients’ nerves were fracture; 11 patients’ nerves were entrapment. The area under the curve(AUC) of neurotmesis was 0.808, which had statistical significance(P<0.05),and the sensitivity and the specificity of the diagnosis of neurotmesis were 61.5% and 100.0%.3.EHC test: 28 patients’ nerves were completely ruptured. 16 patients’ nerves were completely ruptured. The degree of the injury is Sunderland V, including 12 nerve injuries beyond 2cm.2 cases of radial nerve distal end nerves were not seen; 17 patients’ nerves were fracture; 10patients’ nerves were damage, the Sunderland type III; 7 patients’ nerves were damage, the Sunderland type II. The area under the curve(AUC) of neurotmesis was 0.947, which had statistical significance(P<0.05),and the sensitivity and the specificity of the diagnosis of neurotmesis were 89.5%% and 100%.Conclusions 1. Electromyography(EMG) test could be use in the diagnosis of the degree and position of the radial nerve injury, which could provide qualitative and quantitative basis for us. EMG is meaningless if the length of the injury time is shorter than 3 weeks, and EMG cannot provide morphology information at that time either.2. High Frequency Ultrasonography(HFU) can show the normal shape and anatomy of the radial nerve from axilla to the middle forearm, Accurate judgment of nerve injury. But in condition of the epineurium is intact, the HFU cannot determine the degree of the injury.3. EHC test is not subjected to the injury time. It can provide us the information such as the specific position of the injury, the degree of it, the anatomy of the surrounding tissue and the region of the injury. Each of them can compensate its disadvantages, and finally increase the diagnostic ratio of the radial nerve injury. Clinical significance of the development of EHC tester. |
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