Uehara Kosuke, Miura Toshiki, Morizaki Yutaka, Miyamoto Hideaki, Ohe Takashi, Tanaka Sakae
Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Hand Surg Am. 2013 Jan;38(1):23-8. doi: 10.1016/j.jhsa.2012.09.013. Epub 2012 Dec 4.
Neurovascular injury is a serious complication after surgery for Dupuytren disease. The purpose of this study was to evaluate the relationship between the cord and the neurovascular bundle ultrasonographically.
We included 22 healthy volunteers and 14 Dupuytren disease patients (25 fingers) in this study. We evaluated the cord and the digital artery with high-resolution ultrasound. We first investigated the effect of the angle of metacarpophalangeal joint on the position of the radial and ulnar digital arteries in volunteers without evidence of Dupuytren disease. We compared 3 parameters of the radial and ulnar digital arteries, including differences in depth, differences in lateral shift, and the shape of the cross-section of the artery, between volunteers and patients with Dupuytren disease.
None of these parameters changed with flexion of the metacarpophalangeal joint of 0°, 30°, and 60°. Digital arteries and cords could be identified ultrasonographically in all patients, and we confirmed ultrasonographic findings by operative findings in 13 fingers. We classified the fingers into 3 subgroups based on the ultrasonographic findings: type A (n = 13), in which the cord was above the artery; type B (n = 5), in which the cord was below the artery; and type C (n = 7), in which the cord was located between the radial and ulnar digital arteries. Types A, B, and C corresponded to natatory cord/abductor digiti minimi cord, spiral cord, and central cord, respectively. Comparisons among volunteers and patient subgroups showed that the difference in depth in type B patients was significantly larger than that of the other groups. When we set the cutoff point of the difference in depth to 3 mm, sensitivity and specificity to detect the spiral cord were 80% and 76%, respectively.
The relationship between the neurovascular bundle and the type of Dupuytren disease cord can be evaluated by high-resolution ultrasound.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.
神经血管损伤是Dupuytren病手术后的一种严重并发症。本研究的目的是通过超声评估条索与神经血管束之间的关系。
本研究纳入了22名健康志愿者和14例Dupuytren病患者（25根手指）。我们用高分辨率超声评估了条索和指动脉。我们首先在无Dupuytren病证据的志愿者中研究掌指关节角度对桡侧和尺侧指动脉位置的影响。我们比较了志愿者和Dupuytren病患者之间桡侧和尺侧指动脉的3个参数，包括深度差异、横向移位差异和动脉横截面形状。
这些参数在掌指关节屈曲0°、30°和60°时均无变化。所有患者均能通过超声识别指动脉和条索，我们在13根手指中通过手术结果证实了超声检查结果。根据超声检查结果，我们将手指分为3个亚组：A型（n = 13），条索位于动脉上方；B型（n = 5），条索位于动脉下方；C型（n = 7），条索位于桡侧和尺侧指动脉之间。A型、B型和C型分别对应蹼状条索/小指展肌条索、螺旋条索和中央条索。志愿者与患者亚组之间的比较显示，B型患者的深度差异明显大于其他组。当我们将深度差异的截断点设定为3 mm时，检测螺旋条索的敏感性和特异性分别为80%和76%。
高分辨率超声可评估神经血管束与Dupuytren病条索类型之间的关系。
研究类型/证据水平：诊断性III级。
