Abdullah Shalimar, Azhar Muhammad Shafiq, Mokhtar Sabarul Afian, Hua Lim Chia, Fan Elaine Soh Zi, Maktar Juliana Fairuz, Aziz Suraya, Mohammed Rusli Emilia Rosniza, Hisham Aina Shamira Noor, Rajaratnam Vaikunthan
Orthopaedics and Traumatology Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
Musculoskeletal Unit, Department of Radiology, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
Surg Radiol Anat. 2025 Feb 28;47(1):85. doi: 10.1007/s00276-025-03596-x.
Ultrasound is a primary imaging modality for diagnosing and managing nerve-related injuries, particularly for identifying peripheral nerve locations. However, its accuracy and reliability in surgical applications remain insufficiently explored, potentially limiting its utility in nerve surgery.
This study aims to assess the precision of ultrasound in identifying upper limb peripheral nerves by comparing ultrasonographic findings with direct human cadaveric dissection.
Fourteen fresh-frozen upper limb specimens were examined in February 2023. Ultrasound assessments were performed by two experienced musculoskeletal radiologists using three linear probes (15 MHz, 24 MHz, and a 22 MHz hockey stick probe). Seven peripheral nerves were identified and marked using dye injections. Subsequent dissections were conducted under loupe magnification by hand surgeons.
The recurrent motor branch of the median nerve exhibited the lowest discrepancy (mean 1.014 ± 1.459 mm) and the highest accuracy (64.29% of specimens). The greatest discrepancy was observed in the branch of the musculocutaneous nerve to the brachialis (mean 5.114 ± 3.758 mm). The interrater correlation coefficient (ICC) varied across nerve sites, ranging from - 6.298 to 0.795, with the highest ICC observed in the superficial branch of the ulnar nerve (0.795, 0.066).
These findings suggest that ultrasound is a valid and effective tool for identifying peripheral nerve branches in the upper limb, particularly for superficial nerves. Improved accuracy in ultrasound-guided nerve identification may enhance surgical precision and reduce complications in nerve-related procedures.
超声是诊断和处理神经相关损伤的主要成像方式，尤其用于识别周围神经的位置。然而，其在外科手术应用中的准确性和可靠性仍未得到充分探索，这可能限制了其在神经外科手术中的效用。
本研究旨在通过将超声检查结果与人体尸体直接解剖结果进行比较，评估超声在识别上肢周围神经方面的准确性。
2023年2月对14个新鲜冷冻的上肢标本进行了检查。由两名经验丰富的肌肉骨骼放射科医生使用三种线性探头（15兆赫、24兆赫和22兆赫的曲棍球棒探头）进行超声评估。通过染料注射识别并标记了七条周围神经。随后由手外科医生在放大镜下进行解剖。
正中神经的返支运动支差异最小（平均1.014±1.459毫米），准确性最高（64.29%的标本）。在肌皮神经至肱肌的分支中观察到最大差异（平均5.114±3.758毫米）。不同神经部位的组内相关系数（ICC）有所不同，范围从-6.298至0.795，尺神经浅支的ICC最高（0.795，0.066）。
这些发现表明，超声是识别上肢周围神经分支的有效工具，尤其是对于浅表神经。提高超声引导下神经识别的准确性可能会提高手术精度并减少神经相关手术中的并发症。
