| Objectives The accuracy of ultrasonic examination in the diagnosis of carpal tunnel syndrome with neuroelectomyoguaphy as the gold standard.Ultrasound parameters of clinical mild,moderate and severe carpal tunnel syndrome were measured by real-time dynamic ultrasonography before and after flexion of the fingers,and severity of the patients was judged according to the result;preliminary exploration of the role of real-time dynamic ultrasonography in detecting the morphological changes and activity of the median nerve during the movement of the fingers before and after flexion in the diagnosis of carpal tunnel syndrome;the ROC curve of the ultrasonic parameters of MN were analyzed with the extended position,and the best diagnostic threshold for diagnosing the severity of CTS was found.Methods 134 cases of patients with clinical and EMG diagnosis of carpal tunnel syndrome(46 cases of mild group,moderate group of 43 cases,45 cases of severe group)as the case group,health examiner of 103 cases as the control group were examined by ultrasonography.The thickness of the median nerve entrapment and the most extensive and transverse carpal ligament(TCL)thickness were measured on the longitudinal section,and the thickness ratio was calculated.The transverse diameter(D),anteroposterior diameter(d),cross-sectional area(CSA),flat rate(FR),transverse displacement of median nerve and carpal tunnel anteroposterior distance(CTAPD)were measured at middle section of wrist,proximal section,midpoint section and diatal section of carpal tunnel at natural extension position and complete flexion of fingers(hold the position of table tennis).Statistical analysis was used by SPSS22.0,the measurement data of different groups are represented by mean standard deviation.According to the data type and distribution characteristics,the gender and occupation differences between groups were compared by chi square test,the data among groups were compared by one-way ANOVA,SNK and the paired t-test.The Pearson correlation analysis was used to test the correlation between MNCSA and DML and SCV.The diagnostic value was determined by ROC curve,and the sensitivity and specificity of each index were calculated.The level of test was P < 0.05 and the difference was statistically significant.Results 1 Longitudinal ultrasonic can visually display the morphology changes of MN: nerve entrapment became flat,most sites in hamate hook level and nerve were swollen thickening,in the control group,mild group,moderate group and severe group the TCL increases,the thickness ratio decreases,the differences were compared among the groups(P<0.05).2 The ultrasound parameters in the control group,the mild group,the moderate group and the severe group were increased in different sections at natural extension of fingers.The differences of the D,CSA of MN and CTAPD were compared among the groups(P<0.05).(1)The FR in severe group and the contrast group at the middle cross section of the wrist was statistically significant(P < 0.05).The FR was significant difference among groups of the proximal section of carpal tunnel(the control group and the mild group,the mild group and the moderate group were exclued)(P<0.05).The FRwas statistically significant difference among the control group and the moderate group,the control group and the severe group,the mild group and the severe group in the distal secton of carpal tunnel(P<0.05).(2)The d in the control group,mild group,moderate group and severe group was increased at the middle section of wrist,proximal and distal section of carpal tunnel,the statistically significant were among groups(P<0.05).The d was decreased at the midpoint section of carpal tunnel,there was no statistical difference among groups(P>0.05).3 The ultrasound parameters were increased in control group,mild group,moderate group and severe group at complete flexion of the fingers,the D was statistical difference among groups(P<0.05).(1)The FR was significant difference among groups at the middle section of wrist and the proximal section of the carpal tunnel(except the control group and the mild group)(P < 0.05).The FR was significant difference in the control group and the moderate group,the control group and the severe group,the mild group and the severe group at the midpoint and distal of carpal tunnel(P<0.05).(2)The d was increased at the middle section of wrist,the proximal and distal section of carpal tunnel and the difference was statistically significant among groups(P<0.05).The d was no statistical difference among groups at the midpoint of carpal(P>0.05).(3)There was significant difference of CSA in the midpoint section of the carpal tunnel(except the control group and the mild group)(P<0.05).4 In the control group,the mild group,the moderate group and the severe group the D and FR were decresed,d and CTAPD were increased in before and after flexion of the fingers at the different sections,there were statistically significant among groups(P < 0.05).The CSAwas significant difference in before and after flexion of fingers at the proximal section of carpal tunnel(P<0.05).5 The transverse displacement of MN in the control group,the mild group,the moderate group and the severe group was decreased in turn,and the difference was statistically significant among groups(P<0.05).6 There was a positive correlation between MNCSA and DML in each section of the natural extension position of the fingers,and negative correlation with SCV.7 The ROC curves of all parameters were analyzed.The value of the diagnosis was better for the MNCSA of the proximal section of the carpal tunnel,and the area under curve were more than 0.800.The diagnostic critical value was 10.10mm2 in mild group,the sensitivity was 0.848,the specificity was 0.816,the diagnostic critical value was 12.50mm2 in moderate group,the sensitivity was 0.860,the specificity was 0.804,the diagnostic critical value was 14.75mm2 in severe group,the sensitivity was 0.933,the specificity was 0.721,the sensitivity and specificity of other ultrasound parameters in the rest of the different sections were low.Conclusions 1 The correlation between the results of ultrasonic testing and neural electromyography is good,which indicates that ultrasound has a certain value in the diagnosis of CTS.2 Real-time dynamic ultrasound can observe the morphological changes of the MN before and after flexion of the fingers,the D decreases and the d increases.3 The more restrictive the activity of the MN before and after fingers flexion is,the smaller the transverse displacement is,and the more severe the lesion is.4 Through ROC analysis,the diagnostic value of the MNCSA of the proximal carpal tunnel is large,and diagnostic cut-off values of the mild,moderate,and severe CTS are 10.10mm2,12.50mm2,14.75mm2,respectively. |
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