腕管综合征患者正中神经的解剖学变化

摘要

目的：观察腕管综合征患者正中神经的解剖学变化。方法选取腕管综合征患者15例（30侧）作为观察组，其中轻度10侧、中度12侧、重度8侧，另选择同期匹配的15例健康者作为对照组。对两组患者进行彩色多普勒超声检查，计算正中神经在桡尺关节、豌豆骨、钩骨钩3个平面的横截面积，计算不同病情程度腕管综合征患者在豌豆骨、钩骨钩平面腕横韧带厚度、正中神经扁平率。结果观察组与对照组桡尺关节平面的正中神经横截面积分别为（0．10±0．02）、（0．06±0．01）cm2，豌豆骨平面的正中神经横截面积分别为（0．15±0．03）、（0．08±0．02）cm2，钩骨钩平面的正中神经横截面积分别为（0．12±0．02）、（0．06±0．02）cm2，两组比较，P均＜0．01。轻、中、重度腕管综合征患者钩骨钩截面腕横韧带厚度分别为（0．40±0．02）、（0．43±0．03）、（0．46±0．03）cm，正中神经扁平率分别为3．32％±0．43％、3．47％±0．23％、3．69％±0．12％，轻、中、重度间比较，P均＜0．05；轻、中、重度腕管综合征患者豌豆骨截面腕横韧带厚度分别为（0．30±0．02）、（0．36±0．06）、（0．40±0．03）cm，正中神经扁平率分别为2．87％±0．34％、3．12％±0．43％、3．33％±0．11％，轻、中、重度间比较，P均＜0．05。结论腕管综合征患者正中神经解剖学变化表现为在桡尺关节、豌豆骨、钩骨钩3个平面的横截面积均明显增大；随着病情加重，正中神经在钩骨钩截面、豌豆骨截面腕横韧带厚度及正中神经扁平率均明显增加。%Objective To observe the anatomical changes of the median nerve ( MN) in patients with carpal tunnel syndrome(CTS).Methods 15 patients with CTS (observation group), including 10 mild cases, 12 moderate cases and 8 severe cases, and 15 healthy persons (control group) were selected.Color Doppler ultrasonography was performed on two groups.The cross section areas(CSAs)of MN at three cross sections of articulatio radioulnaris , pisiform bone and hook of hamate bone were calculated .Results The thickness of ligament carpi transversum at cross section of pisiform bone and hook of hamate bone , the MN flattening ratio ( MNFR) in patients with different state of illness were calculated .In observa-tion group and control group, CSAs of MN were (0.10 ±0.02)and(0.06 ±0.01)cm2, (0.15 ±0.03)and(0.08 ±0.02) cm2, (0.12 ±0.02) and(0.06 ±0.02)cm2 at cross sections of articulatio radioulnaris, pisiform bone, hook of hamate bone respectively, compared the two groups , P<0.01.In mild cases, moderate cases and severe cases , the thickness of ligament carpi transversum at cross section of hook of hamate bone was (0.40 ±0.02), (0.43 ±0.03), (0.46 ±0.03)cm respectively, the MNFR was 3.32%±0.43%, 3.47%±0.23%, 3.69%±0.12% respectively, compared the mild, moderate and severe cases , P<0.05.In mild cases, moderate cases and severe cases , the thickness of ligament carpi transversum at cross section of pisiform bone was (0.30 ±0.02), (0.36 ±0.06), (0.40 ±0.03)cm respectively.the MNFR was 2.87%±0.34%, 3.12%±0.43%, 3.33%±0.11%respectively,compared the mild, moderate and severe cases, P<0.05.Conclusions The anatomical changes of the MN in patients with CTS are CSAs obviously increasing at three cross sections of articulatio radioulnaris , pisiform bone and hook of hamate bone .With the aggravation of state of ill-ness, the thickness of ligament carpi transversum at cross section of pisiform bone and hook of hamate bone , and the MNFR are obviously increasing .