Dietrich Léna G, Juon Bettina, Wirtz Christian, Vögelin Esther
Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
Department of Surgery, Hand Surgery, Kantonsspital Graubünden, Chur, Switzerland.
Ultrasound Int Open. 2024 Sep 6;10:a23786902. doi: 10.1055/a-2378-6902. eCollection 2024.
Ultrasound (US) has gained in importance for the visualization of morphological changes of injured nerves. After surgical repair, changes in neural structures are seen over time. The correlation of morphologic changes in US with the corresponding nerve function is uncertain. The aim of this study is to determine a correlation of post-traumatic morphological nerve changes with US and with nerve function after surgery. This dual-center, prospective cohort study was conducted between 2017 and 2022 and included 20 mixed sensory motor nerve lesions. Patients were followed up clinically (sensitivity, pain, and motor function) with US and electroneuromyography. We determined the US changes of the nerves including the interaction of the tissue after nerve repair and any correlation with nerve function. With US nerve cross-sectional area (CSA), the number of traversing fascicles, hypo-echogenicity, and presence of perineural scar were analyzed. 20 lesions (12 median and 8 ulnar nerves) of 18 patients with intraoperatively confirmed nerve injury of at least 50% in the forearm were included. The average CSA was over 20 mm throughout the follow-up period, corresponding to a neuroma in continuity compared to the opposite side (10.75 mm ). Sensibility and motor function at 12 months were 6xS3/4 and 10xM3-5. There was a statistically significant correlation between continuous fascicles on US at 6 months and sensitivity at 12 months. This study supports the presence of post-traumatic morphological changes in nerve fibers with US after traumatic injury. Morphological changes in nerve structure after trauma can be detected with US indicating a correlation between continuity of nerve fascicles and development of sensitivity and motor function.
超声（US）在显示受损神经的形态学变化方面的重要性日益增加。手术修复后，神经结构会随时间发生变化。超声形态学变化与相应神经功能之间的相关性尚不确定。本研究的目的是确定创伤后神经形态学变化与超声以及术后神经功能之间的相关性。 这项双中心前瞻性队列研究于2017年至2022年进行，纳入了20例混合性感觉运动神经损伤患者。对患者进行临床随访（感觉、疼痛和运动功能），同时进行超声检查和神经电生理检查。我们确定了神经的超声变化，包括神经修复后组织的相互作用以及与神经功能的任何相关性。通过超声分析神经横截面积（CSA）、穿行束的数量、低回声性和神经周围瘢痕的存在情况。 纳入了18例患者的20处损伤（12例正中神经和8例尺神经），术中证实前臂神经损伤至少50%。在整个随访期间，平均CSA超过20mm²，与对侧相比相当于连续性神经瘤（10.75mm²）。12个月时的感觉和运动功能分别为6×S3/4和10×M3-5。6个月时超声显示的连续束与12个月时的感觉之间存在统计学显著相关性。 本研究支持创伤后超声显示神经纤维存在创伤后形态学变化。创伤后神经结构的形态学变化可以通过超声检测到，表明神经束的连续性与感觉和运动功能的发展之间存在相关性。
