Gu Shihui, Zhao Qian, Yao Jing, Zhang Li, Xu Lei, Chen Weiming, Gu Yudong, Xu Jianguang
Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.
Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China.
Ultrasound Med Biol. 2022 Jun;48(6):1122-1130. doi: 10.1016/j.ultrasmedbio.2022.02.013. Epub 2022 Mar 21.
Brachial plexus (BP) root injury often results in disability of the upper extremities. Improvements in high-frequency ultrasonography have enabled the visualization of BP nerve roots. This study was aimed at quantifying the diagnostic accuracy of ultrasonography in BP root injury at different stages post-trauma. A consecutive series of 170 patients with BP root injury between 2015 and 2019 were studied retrospectively and divided into three groups on the basis of time between injury and ultrasound examination (≤1 mo, 1-3 mo, >3 mo). Diagnosis of complete BP root injury under ultrasound was determined using a pre-defined criterion, including pseudomeningocele, retraction and rupture. Diagnostic accuracy was calculated based on surgical findings and intra-operative electrophysiological tests. Rates of detection of the cervical (C5-C8) and thoracic (T1) nerve roots under ultrasound were 99.4%, 99.4%, 99.4%, 95.9% and 79.4%, respectively. The sensitivity for complete BP root injury was 0.74, and the specificity was 0.91. No significant differences in sensitivity or specificity were observed across time stages. Ultrasound exhibited substantial consistency with surgical findings (κ = 0.70) for complete BP root injury at any stage post-injury. Ultrasound can be an optional method of diagnosis of complete BP root injury at an early stage post-injury.
臂丛神经（BP）根部损伤常导致上肢功能障碍。高频超声技术的进步使得BP神经根能够可视化。本研究旨在量化超声在创伤后不同阶段BP根部损伤中的诊断准确性。回顾性研究了2015年至2019年间连续的170例BP根部损伤患者，并根据损伤与超声检查之间的时间（≤1个月、1 - 3个月、>3个月）将其分为三组。超声下BP根部完全损伤的诊断采用预先定义的标准，包括假性脊膜膨出、回缩和破裂。根据手术结果和术中电生理检查计算诊断准确性。超声下颈（C5 - C8）神经根和胸（T1）神经根的检出率分别为99.4%、99.4%、99.4%、95.9%和79.4%。BP根部完全损伤的敏感性为0.74，特异性为0.91。不同时间阶段的敏感性或特异性未观察到显著差异。超声在损伤后任何阶段对BP根部完全损伤的诊断与手术结果具有高度一致性（κ = 0.70）。超声可作为损伤后早期BP根部完全损伤诊断的一种可选方法。
