高频超声在脑卒中偏瘫患者周围神经的形态学改变评估中的应用价值研究

摘要 目的：研究应用高频超声对脑卒中偏瘫患者周围神经的形态学改变进行评价。方法：纳入2019年3月-2021年2月脑卒中76例偏瘫患者作为研究对象（研究组），同时纳入76例健康志愿者作为对照（对照组）。通过高频超声对检测所有研究对象正中神经(MN)在横纹处（MN1）、豌豆骨水平（MN2）、钩骨水平（MN3）、腕横纹上方6 cm（MN4）、肱骨内上髁上4 cm（MN5）、肱骨中点（MN6）6个位点的宽度（W）、厚度（T）及横截面积（CSA），并检测尺神经（UN）在查肘管处（UN1）、肘管出口（UN2）、肘管入口（UN3）、肱骨内上髁上6 cm处（UN4）、肱骨中点（UN5）、肱骨内上髁下8 cm（UN6）、腕横纹上方6 cm（UN7）及Guyon管处（UN8）8个位点的W、T以及CAS值，并进行比较。结果：两组研究对象性别、年龄、体重、身高、BMI以及高频超声检测MN在不同位点的T值比较无显著差异（P>0.05）；研究组患者高频超声检测MN的6个位点的W值均显著低于对照组（P<0.05）；研究组患者MN在MN4、MN5和MN6 3处位点的CAS值均显著低于对照组（P<0.05）；研究组患者高频超声在UN1、UN3、UN4、UN5和UN6 5处位点的UN的W值显著低于对照组（P<0.05）；在UN1和UN6 2处位点的UN的T值显著低于对照组（P<0.05）；在UN3和UN52处位点的UN的CAS值显著低于对照组（P<0.05）。结论：通过高频超声评估可以准确获得脑卒中偏瘫患者正中神经和尺神经在不同检测位点的厚度、宽度和横截面积，以此可以用于评价脑卒中偏瘫患者周围神经形态学变化。

Application Value of High-frequency Ultrasound in the Evaluation of Peripheral Nerve Morphological Changes in Stroke Patients with Hemiplegia

ABSTRACT Objective: To study the use of high-frequency ultrasound on evaluating the morphological changes of peripheral nerves in stroke patients with hemiplegia. Methods: From March 2019 to February 2021, 76 stroke patients with hemiplegia were included as the research objects (research group), and 76 healthy volunteers were included as controls (control group). Detect the median nerve (MN) at the transverse striae (MN1), pea bone level (MN2), hook bone level (MN3), 6 cm above the wrist transverse striae (MN4), and internal epicondyle of the humerus by high-frequency ultrasound. The width (W), thickness (T) and cross-sectional area (CSA) of the upper 4 cm (MN5) and the midpoint of the humerus (MN6) at 6 sites, and the detection of the ulnar nerve (UN) at the cubital canal (UN1) , Cubital canal outlet (UN2), cubital canal inlet (UN3), 6 cm above the inner epicondyle of the humerus (UN4), mid-point of the humerus (UN5), 8 cm below the inner epicondyle of the humerus (UN6), 6 above the transverse crease of the wrist The W, T, and CAS values of 8 sites at cm (UN7) and Guyon tube (UN8) were compared. Results: There was no significant difference between the two groups of subjects in gender, age, weight, height, BMI, and T value of MN at different sites detected by high-frequency ultrasound(P>0.05); The W values of 6 sites of MN detected by high-frequency ultrasound in the study group were significantly lower than those in the control group (P<0.05); The CAS values of MN at MN4, MN5 and MN6 in the study group were significantly lower than those in the control group (P<0.05); The W value of UN in the study group of patients with high-frequency ultrasound at UN1, UN3, UN4, UN5 and UN65 was significantly lower than that in the control group (P<0.05); the T value of UN at UN1 and UN6 2 was significantly It was lower than the control group (P<0.05); the CAS value of UN at the sites of UN3 and UN52 was significantly lower than that of the control group (P<0.05). Conclusion: High-frequency ultrasound evaluation can accurately obtain the thickness, width and cross-sectional area of the median nerve and ulnar nerve at different detection sites in stroke patients with hemiplegia, which can be used to evaluate the morphological changes of peripheral nerves in stroke patients with hemiplegia.