| Object:The wrist indexes of patients with（Carpal Tunnel Syndrome,CTS）were measured by High-frequency Ultrasound,HFUS),analysing the optimal threshold value of different detection indexes for CTS diagnosis and the diagnostic efficiency of each index.The purpose of this study is to find the optimal index for CTS diagnosis under HFUS and provide reliable basis for clinical diagnosis.Methods:We collected 34 patients（45 wrists）from October 2017 to October 2019 in our department of neurology,hand surgery and pain as CTS group,and 34 patients（44wrists）who were diagnosed by neuroelectrophysiological examination and clinical diagnosis CTS.Selected the same period to visit our department of physical examination or our hospital staff as the control group,excluding CTS and ulnar neuropathy.First,we record the individual characteristics of the patients that participating in the study,including age,sex,height,weight,body mass index（Body Mass Index,BMI）,dominant hand,education,marital status,smoking status,wrist use.Then,we record the measurement of correlation detection index under ultrasound,including,（1）The anterior and posterior diameters,left and right diameters（Diameter,D）of the median nerve in hook bone hook,left and right diameters（D1）and posterior diameters（D2）;（2）Thickness of transverse carpal ligament of hook bone hook（Transverse carpal ligament Thickness,TT）;（3）Cross sectional area（CSA）,median nerve cross-sectional area（CSA1）,ulnar nerve cross-sectional area（csa2）of pea bone;（4）At the same time,the flat ratio（FR）of the median nerve in the horizontal plane of the hook was calculated according to the formula;（5）Median/ulnar nerve area difference（Median/ulnar nerve area difference,MUD）in pea bone horizontal plane;（6）Median/ulnar nerve ratio（Median/ulnar nerve area ratio,MUR）in pea bone horizontal plane;（7）Using Color Doppler ultrasound（CDUS）detect the blood flow signal of median nerve in the longitudinal section of pea bone.All data are processed by statistical methods.According to the data type,using 2-test or independent sample t-test to judge the difference between different test indexes.By drawing the receiver operational characters（ROC）,analyzing the area under the curve,AUC),throughing calculation to determine the best indicators,and determine the sensitivity,specificity and the best diagnostic threshold of different detection indicators.Results:1.There is no significant difference between CTS group and control group in age,gender,height,dominant hand,education level,marital status and smoking（P>0.05）,and there was significant difference in weight,BMI and carpal loading（P<0.05）.2.Compared with the control group,the blood flow of CTS group is significantly different under D1,FR,TT,CSA1,MUD,MUR and CDUS（P<0.05）.3.From the ROC curve analysis,it can be concluded that MUD,CSA1 and MUR have high diagnostic value.The area under the curve of CSA1 is the largest（AUC=0.964）.When the best cut-off value is 0.119cm2,the sensitivity is 97.8%,and the specificity is 86.4%.4.HFUS can clearly showed the median nerve.In CTS patients,the median nerve was jammed,and there are pressure marks at the entrapment site.The distal median nerve at the entrapment site expanded and thickened,and the echo of the median nerve decreased.5.Under HFUS scanning found 2 cases of persistent middle artery（PMA）.Conclusion:1.CSA1 is the best detection index,the best diagnostic threshold is 0.119cm~2,the sensitivity is 97.8%,and the specificity is 86.4%.2.CDUS can be used as an assistant to improve the diagnosis of CTS.3.HFUS can observe the soft tissue of the wrist and find the entrapment site of the median nerve.Dynamic observation of the echo and blood flow in the entrapment site of the nerve has a high diagnostic value in the diagnosis of wrist diseases.4.Weight,BMI and repeated use of wrist are independent risk factors for predicting CTS.5.HFUS can identify the variation of median nerve in CTS,provide anatomic relationship for surgery and make reasonable operation plan. |
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