Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Ultraschall Med. 2022 Apr;43(2):186-193. doi: 10.1055/a-1140-5717. Epub 2020 Jun 30.
Permanent nerve damage after corticosteroid injection has been suggested when symptoms of median nerve injury (MNI) are irreversible. We assess the outcomes of MNI and their association with ultrasonography (US)-guided hydrodissection and the following corticosteroid injection for symptomatic carpal tunnel syndrome (CTS).
US-guided hydrodissection and the following corticosteroid injections were administered to 126 CTS patients. Occurrence of MNI, clinical data, and post-hydrodissection findings were evaluated. Post-hydrodissection findings included vascular injury during hydrodissection, altered echogenicity, reduced flattening ratio, and increased cross-sectional area of the MN at the inlet of the carpal tunnel (MN-CSA-Inlet) on ultrasonography after hydrodissection. The relevance of MNI with respect to these clinical data and findings was determined. The outcome was rated using Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores.
Nine patients suffered MNI (incidence, 7.1 %) but improved significantly at follow-up. Clinical data and vascular injury during hydrodissection, altered echogenicity, and reduced flattening ratio after hydrodissection were unrelated to prolonged transient MNI (p > 0.05). MNI was significantly associated with increased CSA (p = 0.005). A CSA increase > 2 mm after hydrodissection yielded the greatest performance (0.979) for MNI in the receiver operating characteristic analysis. Decreases in BCTQ scores after injection did not differ significantly between groups with and without MNI (p > 0.05).
MNI during hydrodissection may be reversible. MNI is indicated by an increase in MN-CSA-inlet immediately after hydrodissection.
当正中神经损伤（MNI）的症状不可逆转时，已经有人提出皮质类固醇注射后会造成永久性神经损伤。我们评估了 MNI 的结果及其与超声引导下液压分离术和随后用于治疗症状性腕管综合征（CTS）的皮质类固醇注射的关系。
对 126 例 CTS 患者进行了超声引导下液压分离术和随后的皮质类固醇注射。评估了 MNI 的发生、临床资料和液压分离后的发现。液压分离后的发现包括液压分离过程中的血管损伤、回声改变、变平率降低以及 MN 在腕管入口处的横截面积（MN-CSA-入口）增加。确定 MNI 与这些临床数据和发现的相关性。使用波士顿腕管综合征问卷（BCTQ）评分来评估结果。
9 例患者发生 MNI（发生率为 7.1%），但随访时明显改善。临床资料和液压分离过程中的血管损伤、液压分离后的回声改变和变平率与短暂性 MNI 延长无关（p＞0.05）。MNI 与 CSA 增加显著相关（p=0.005）。液压分离后 CSA 增加>2mm 对 MNI 的诊断性能最佳（0.979）。注射后 BCTQ 评分的降低在有和没有 MNI 的组之间没有显著差异（p＞0.05）。
液压分离过程中的 MNI 可能是可逆的。MN-CSA-入口处的 MN-CSA 立即增加表明发生了 MNI。
