Department of Ultrasonography, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, People's Republic of China.
Department of Orthopaedics, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, People's Republic of China.
World Neurosurg. 2020 Feb;134:e103-e111. doi: 10.1016/j.wneu.2019.09.111. Epub 2019 Sep 27.
To investigate the ultrasonographic characteristics in hourglasslike constriction of peripheral nerve in the upper extremity and to evaluate the value of ultrasonography in the diagnosis.
Nineteen patients with hourglasslike constriction of peripheral nerve in the upper extremity underwent ultrasonography and the results were compared with surgery. The ultrasonographic characteristics, the accurate rate, and the relation between the ultrasonography and surgery were analyzed.
There were 22 affected nerves involved in 19 patients, including 17 radial neuropathies, 4 median neuropathies, and 1 musculocutaneous neuropathy. The accuracy rate of ultrasonography in diagnosing hourglasslike constriction of upper limb nerve was 87.93%. Ultrasonography showed that the constriction sites were completely consistent with the operation. The ultrasonography characteristics of hourglasslike constriction of upper limb nerves were hourglasslike nerve incompleteness or complete constriction, and the nerves at both ends were thickened, and no compression structure was seen around. All lesions with complete constriction diagnosed by ultrasonography were treated with resection of the lesion with or without graft. In addition, 71.43% with incomplete constriction were treated with neurolysis, and 28.57% with resection of the lesion with direct repair.
Ultrasonography could be used as a routine noninvasive examination for hourglasslike constriction of upper limb nerves. Ultrasonography suggests that resection of the lesion rather than neurolysis should be considered in the treatment of complete constriction. For patients with clinical symptoms, ultrasonography showed local nerve enlargement but no constriction; clinicians should be prompted to explore carefully during operation to avoid missing nerve hourglasslike constriction.
探讨上肢周围神经沙漏样狭窄的超声特征，评估超声在诊断中的价值。
对 19 例上肢沙漏样周围神经狭窄患者进行超声检查，并与手术结果进行比较。分析超声特征、准确率及与手术的关系。
19 例患者共 22 条受累神经，其中桡神经 17 条，正中神经 4 条，肌皮神经 1 条。超声诊断上肢神经沙漏样狭窄的准确率为 87.93%。超声显示狭窄部位与手术完全一致。上肢神经沙漏样狭窄的超声特征为不完全或完全神经缺失性狭窄，两端神经增粗，周围未见压迫结构。超声诊断完全狭窄的所有病变均行病变切除加或不加移植治疗。此外，71.43%的不完全狭窄患者行神经松解术，28.57%的不完全狭窄患者行病变切除直接修复术。
超声可作为上肢神经沙漏样狭窄的常规无创检查。超声提示完全狭窄者应行病变切除，而非神经松解术。对于有临床症状、超声显示局部神经肿大但无狭窄的患者，手术时应仔细探查，避免漏诊神经沙漏样狭窄。
