Lee Sungche, Kwak Jinmyong, Lee Sanghoon, Cho Hyuncheol, Oh Eunsun, Park Ji Woong
Department of Physical Medicine and Rehabilitation.
Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2019 Sep;98(36):e17066. doi: 10.1097/MD.0000000000017066.
Despite the high prevalence and clinical importance of soft-tissue disorders, objective methods for evaluation of the biomechanical properties of soft tissues are lacking. This study aimed to quantitatively evaluate stiffness, an important biomechanical characteristic of soft tissue, using acoustic radiation force impulse (ARFI) elastography. The shear wave velocity (SWV, m/s) values of soft tissue structures within the carpal tunnel (CT) were measured in various combinations of wrist and finger positions.Twenty-six healthy adults were enrolled in this study. We measured the cross-sectional area of the median nerve (MN) and the SWV values of several structures within the CT at the CT inlet level. Measurement of SWV of the MN, flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and transverse carpal ligament (TCL) were conducted in six wrist/finger motion combinations.When the wrist and fingers were in neutral positions (position A), the mean SWV was lowest for the MN (mean ± standard deviation, 2.3 ± 0.5 m/s), followed by the FDS (2.9 ± 0.2), FDP (3.2 ± 0.3), and TCL (3.3 ± 0.4). The SWV was significantly different among the six different wrist/finger positions for all structures (P < .001). However, the MN cross-sectional area was not significantly different (P = .527). The SWV values for the MN, FDS, and FDP increased significantly as the wrist/finger positions the stress on the tendons increased (from position B to F) compared with a neutral position, while the SWV of the TCL was significantly higher for in all positions compared with neutral, except for wrist neutral, finger extension. The SWV values for the MN, FDS, and TCL gradually increased as stress increased.The intra-CT structures are under increased stress during wrist and finger motions than when the hand is in a neutral position. We have used ARFI elastography to gain insight into the pathophysiology of CTS.
尽管软组织疾病的患病率很高且具有临床重要性，但目前仍缺乏评估软组织生物力学特性的客观方法。本研究旨在使用声辐射力脉冲（ARFI）弹性成像技术定量评估软组织的重要生物力学特性——硬度。在腕部和手指的不同位置组合下，测量腕管（CT）内软组织结构的剪切波速度（SWV，m/s）值。本研究纳入了26名健康成年人。我们在CT入口水平测量了正中神经（MN）的横截面积以及CT内几个结构的SWV值。在六种腕部/手指运动组合中测量了MN、指浅屈肌（FDS）、指深屈肌（FDP）和腕横韧带（TCL）的SWV。当腕部和手指处于中立位置（位置A）时，MN的平均SWV最低（平均值±标准差，2.3±0.5 m/s），其次是FDS（2.9±0.2）、FDP（3.2±0.3）和TCL（3.3±0.4）。所有结构在六种不同的腕部/手指位置的SWV均存在显著差异（P<0.001）。然而，MN的横截面积没有显著差异（P = 0.527）。与中立位置相比，随着腕部/手指位置使肌腱上的应力增加（从位置B到F），MN、FDS和FDP的SWV值显著增加，而TCL的SWV在除腕部中立、手指伸展外的所有位置均显著高于中立位置。随着应力增加，MN、FDS和TCL的SWV值逐渐升高。与手部处于中立位置时相比，腕部和手指运动期间CT内的结构承受的应力增加。我们使用ARFI弹性成像技术来深入了解腕管综合征（CTS）的病理生理学。
