横切面超声评估手腕运动时人腕管正中神经的变形和位移。
Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements.
机构信息
Tendon and Soft Tissue Biology Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
Ultrasound Med Biol. 2014 Jan;40(1):53-61. doi: 10.1016/j.ultrasmedbio.2013.09.009. Epub 2013 Nov 7.
The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. To better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images during different wrist movements, to have a baseline for comparison with abnormal movements. Dynamic ultrasound images of both wrists of 10 asymptomatic volunteers were obtained during wrist maximal flexion, extension and ulnar deviation. To simplify the analysis, the initial and final shape and position of the median nerve were measured and analyzed. The circularity of the median nerve was significantly increased and the aspect ratio and perimeter were significantly decreased in the final image compared with the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (p < 0.01). There were significant differences in median nerve displacement vector between finger flexion, wrist flexion with finger extension and wrist ulnar deviation with finger extension (all p's < 0.001). The mean amplitudes of median nerve motion in wrist flexion with finger extension (2.36 ± 0.79 normalized units [NU]), wrist flexion with finger flexion (2.46 ± 0.84 NU) and wrist ulnar deviation with finger extension (2.86 ± 0.51 NU) were higher than those in finger flexion (0.82 ± 0.33 NU), wrist extension with finger extension (0.77 ± 0.46 NU) and wrist extension with finger flexion (0.81 ± 0.58 NU) (p < 0.0001). In the normal carpal tunnel, wrist flexion and ulnar deviation could induce significant transverse displacement and deformation of the median nerve.
腕管综合征是正中神经在腕部受压引起的一种神经卡压综合征，其症状会因腕部运动而加重，但这些运动对正中神经运动的影响尚不清楚。为了更好地了解异常神经的生物力学特性，首先需要了解正常神经的运动。本研究的目的是评估不同腕部运动时近端腕管水平正中神经在横切超声图像上的变形和位移，以便与异常运动进行比较。对 10 名无症状志愿者的双侧腕部进行了最大腕关节屈曲、伸展和尺偏运动的动态超声检查。为了简化分析，测量并分析了正中神经的初始和最终形状和位置。与初始图像相比，手指伸展时的腕关节屈曲、手指屈曲时的腕关节屈曲和手指伸展时的腕关节尺偏时，正中神经的圆形度显著增加，纵横比和周长显著减小（p<0.01）。手指屈曲、腕关节伸展伴手指伸展和腕关节尺偏伴手指伸展时，正中神经位移向量有显著差异（均 p<0.001）。手指伸展时的腕关节屈曲（2.36±0.79 归一化单位 [NU]）、手指伸展时的腕关节屈曲（2.46±0.84 NU）和手指伸展时的腕关节尺偏（2.86±0.51 NU）的正中神经运动幅度均值高于手指屈曲（0.82±0.33 NU）、手指伸展时的腕关节伸展（0.77±0.46 NU）和手指伸展时的腕关节伸展（0.81±0.58 NU）（p<0.0001）。在正常腕管中，腕关节屈曲和尺偏可引起正中神经明显的横向位移和变形。
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