Ettema Anke M, Belohlavek Marek, Zhao Chunfeng, Oh Sang Ho, Amadio Peter C, An Kai-Nan
Biomechanics Laboratory, Division of Orthopedic Research, 200 First Street SW, Mayo Clinic College of Medicine, Rochester, Minnesota 55902, USA.
J Orthop Res. 2006 Oct;24(10):2011-20. doi: 10.1002/jor.20252.
The carpal tunnel contains the median nerve, nine flexor tendons, two synovial bursae, and peritendinous subsynovial connective tissue (SSCT). Fibrosis of the SSCT is the most consistent pathological finding in patients with carpal tunnel syndrome. We investigated the anatomy and gliding characteristics of the flexor digitorum superficialis tendon and its adjacent SSCT with high-resolution ultrasound (15 MHz). Our hypotheses were that tendon and SSCT are distinguishable by ultrasound and that their velocities during tendon excursion are different. Qualitative ultrasound analysis of a flexor tendon and its SSCT was performed on five cadaver wrists and correlated to respective findings after anatomical study of the same cadavers. Quantitative Doppler velocity analysis of eight cadaver wrists was done to assess the sliding movement of the tendon and its SSCT within the carpal tunnel. No significant difference was found between the thickness of SSCT measured by ultrasound and that measured directly after dissection. The SSCT moved slower than its flexor tendon. The SSCT velocities were statistically different from the tendon velocities (t-test, p>0.001). High-resolution ultrasound is a very precise method to display the anatomy of the tendon and SSCT within the carpal tunnel, and their different velocities can be detected with Doppler. Noninvasive assessment of the thickness and velocity of the tenosynovium in carpal tunnel syndrome by high-resolution sonography might be a new diagnostic tool for disorders affecting the SSCT, especially carpal tunnel syndrome.
腕管内包含正中神经、九条屈肌腱、两个滑膜囊以及腱周滑膜下结缔组织（SSCT）。SSCT的纤维化是腕管综合征患者最一致的病理表现。我们使用高分辨率超声（15兆赫）研究了指浅屈肌腱及其相邻SSCT的解剖结构和滑动特性。我们的假设是，肌腱和SSCT可通过超声区分，且它们在肌腱移动过程中的速度不同。对五具尸体手腕进行了屈肌腱及其SSCT的定性超声分析，并与对同一尸体进行解剖研究后的相应结果进行了关联。对八具尸体手腕进行了定量多普勒速度分析，以评估肌腱及其SSCT在腕管内的滑动情况。超声测量的SSCT厚度与解剖后直接测量的厚度之间未发现显著差异。SSCT的移动速度比其屈肌腱慢。SSCT的速度与肌腱速度在统计学上存在差异（t检验，p>0.001）。高分辨率超声是一种非常精确的方法，可用于显示腕管内肌腱和SSCT的解剖结构，并且可以用多普勒检测到它们不同的速度。通过高分辨率超声对腕管综合征中腱鞘厚度和速度进行无创评估，可能是一种用于诊断影响SSCT的疾病，尤其是腕管综合征的新诊断工具。
