Meric Gokhan, Başdelioğlu Koray, Yanık Bahar, Sargin Serdar, Ulusal Ali Engin
Orthopaedics and Traumatology, Yeditepe University, Istanbul, TUR.
Orthopaedics and Traumatology, Istanbul Oncology Hospital, Istanbul, TUR.
Cureus. 2020 Oct 18;12(10):e11010. doi: 10.7759/cureus.11010.
Purpose The purpose of this study was to define posterior border distance (PBD), which represents an ultrasonographic diagnosing method of carpal tunnel syndrome (CTS), and to determine the reliability of PBD in comparison with electromyography (EMG) results. Methods Thirty-three patients (mean age: 51.8 ± 9.5 years; 27 females and six males) with CTS were included in this study. Ultrasonography (US) and EMG were performed under blinded conditions. PBD was evaluated by measuring the length of the perpendicular line between the posterior border of the median nerve and the line between the hook of the hamate and trapezoid tubercle. The cross-sectional area, anteroposterior (AP), and transverse diameter of the median nerve were measured. Control US was performed in 20 patients who were available at the first year postoperative follow-up and the results compared with preoperative US values. Correlation analyzes were performed to determine the relationship between electrodiagnostic results and ultrasonographic measurements. Results According to the results of preoperative and postoperative first-year US, there were statistically significant differences in the results of PBD (preoperative: 3.309±1.7472 mm, postoperative: 2.290±0.7867 mm p: 0.013) and AP diameter of the median nerve (preoperative: 3.012±0.7865 mm, postoperative: 2.680±0,5578 mm p: 0.017). There was no statistically significant difference in transverse diameter (preoperative: 6.585±1.9505 mm, postoperative: 6.955±2.2128 mm) and cross-sectional area (preoperative: 14.33±6.513 mm, postoperative: 11.20±5.830 mm) results (p>0.05). The cut-off value of PBD was ≥3.6 mm, it yielded 81.48% specificity and 83.33% sensitivity in the diagnosis of CTS. PBD was correlated with motor and sensory latency, anteromedial, and transverse diameter of the median nerve (p<0.05). There was no correlation between EMG values and the results of the cross-sectional area, transverse diameter, and AP diameter of the median nerve (p>0.05). Conclusion PBD is suggested as a reliable ultrasonographic measurement method for the diagnosis of CTS.
目的 本研究旨在定义代表腕管综合征（CTS）超声诊断方法的后缘距离（PBD），并与肌电图（EMG）结果比较以确定PBD的可靠性。方法 本研究纳入33例CTS患者（平均年龄：51.8±9.5岁；女性27例，男性6例）。在盲法条件下进行超声检查（US）和肌电图检查。通过测量正中神经后缘与钩骨钩和梯形结节之间连线的垂直线长度来评估PBD。测量正中神经的横截面积、前后径（AP）和横径。对20例在术后第一年随访时可进行检查的患者进行对照超声检查，并将结果与术前超声值进行比较。进行相关性分析以确定电诊断结果与超声测量之间的关系。结果 根据术前和术后第一年超声检查结果，PBD结果（术前：3.309±1.7472mm，术后：2.290±0.7867mm，p：0.013）和正中神经AP直径（术前：3.012±0.7865mm，术后：2.680±0.5578mm，p：0.017）存在统计学显著差异。横径（术前：6.585±1.9505mm，术后：6.955±2.2128mm）和横截面积（术前：14.33±6.513mm，术后：11.20±5.830mm）结果无统计学显著差异（p>0.05）。PBD的截断值为≥3.6mm，在CTS诊断中特异性为81.48%，敏感性为83.33%。PBD与正中神经的运动和感觉潜伏期、前后径及横径相关（p<0.05）。肌电图值与正中神经的横截面积、横径和AP直径结果之间无相关性（p>0.05）。结论 PBD被认为是一种可靠的用于诊断CTS的超声测量方法。
