Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Ultraschall Med. 2018 Jun;39(3):334-342. doi: 10.1055/s-0043-120109. Epub 2017 Dec 28.
To identify the ultrasound (US) findings of intra-epineurial corticosteroid injection during US-guided hydrodissection in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes.
We performed 101 US-guided hydrodissections and corticosteroid injections in 101 patients with CTS, and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the occurrence of intra-epineurial injection. We also recorded clinical data including sex, age, side of injection, BMI, and the duration of pre-injection CTS-related discomfort. The outcomes were measured using the Likert satisfaction scale and Boston Carpal Tunnel Questionnaire (BCTQ) scores. The clinical data, cross-sectional area of the median nerve (CSA-MN) at the inlet of the carpal tunnel measured on US images, and the symptom relief for the patients receiving intra-epineurial and extra-epineurial injection were compared.
The intra-epineurial injection rate was 38.6 % in the 101 US-guided injections. The clinical data, pre-injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). The group with intra-epineurial injections had significantly decreased CSA-MN (difference in means, 2.5 mm; p < 0.0001), greater patient satisfaction (p = 0.002), and lower BCTQ scores (p < 0.05) than the group with extra-epineurial injections.
We characterized the US findings of intra-epineurial corticosteroid injection during US-guided hydrodissection. Intra-epineurial injection provided a more meaningfully reduction in edema of the MN, greater patient satisfaction, and greater symptom relief than extra-epineurial injection.
在超声引导下水分离术中识别腕管综合征（CTS）患者的神经内膜内皮质类固醇注射的超声（US）表现，并确定其与治疗结果相关的临床意义。
我们对 101 例 CTS 患者进行了 101 次超声引导下水分离和皮质类固醇注射，并评估了他们注射前后的 US 发现。我们根据是否发生神经内膜内注射将这些注射分为两组。我们还记录了包括性别、年龄、注射侧、BMI 和注射前 CTS 相关不适持续时间在内的临床数据。结果采用 Likert 满意度量表和波士顿腕管问卷（BCTQ）评分进行测量。比较了接受神经内膜内和神经外膜内注射的患者的临床数据、US 图像上测量的腕管入口处正中神经的横截面积（CSA-MN）和症状缓解情况。
101 次超声引导注射中，神经内膜内注射率为 38.6%。两组间的临床数据、腕管入口处正中神经的注射前 CSA-MN 和注射前 BCTQ 评分无显著差异（p>0.05）。神经内膜内注射组的 CSA-MN 明显减小（平均差异为 2.5mm；p<0.0001），患者满意度更高（p=0.002），BCTQ 评分更低（p<0.05），与神经外膜内注射组相比。
我们描述了超声引导下水分离术中神经内膜内皮质类固醇注射的超声表现。与神经外膜内注射相比，神经内膜内注射可更有效地减轻 MN 水肿，提高患者满意度，缓解症状。
