Roll Shawn C, Takata Sandy C, Yao Buwen, Kysh Lynn, Mack Wendy J
Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA.
J Diagn Med Sonogr. 2023 Sep;39(5):492-506. doi: 10.1177/87564793231176009. Epub 2023 Jun 6.
Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds.
Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality.
The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm [6.09-6.84], 8.68mm [8.22-9.13], and 8.60mm [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β=0.03mm, p=0.047). Men (9.42mm, [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm, [7.01-8.42]). No difference was noted in laterality.
A reference value for median nerve CSA in the carpal tunnel is 8.60mm. Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.
建立正中神经横截面积（CSA）参考值，并确定影响诊断阈值的患者层面因素。
通过对多个数据库进行全面检索来识别研究，并使用美国国立卫生研究院观察性队列和横断面研究质量评估工具的修改版进行质量评估。进行荟萃分析以确定按解剖位置分层的规范值。进行荟萃回归以检查年龄、性别和侧别的异质性影响。
荟萃分析纳入73项研究；41项（56.2%）为高质量研究。在前臂近端、腕管入口和近端腕管处，正中神经CSA[95%置信区间]分别为6.46mm[6.09 - 6.84]、8.68mm[8.22 - 9.13]和8.60mm[8.23 - 8.97]。年龄与近端腕管水平的CSA呈正相关（β = 0.03mm，p = 0.047）。与女性（7.71mm，[7.01 - 8.42]）相比，男性（9.42mm，[8.06 - 10.78]）的近端腕管CSA在统计学上更大（p = 0.03）。左右侧未发现差异。
腕管内正中神经CSA的参考值为8.60mm。儿科或老年人可能需要进行调整。男性患者10.0mm的诊断阈值应谨慎应用，因为规范平均值的上限超过了该阈值。
