Ikegaya N, Hishida A, Sawada K, Furuhashi M, Maruyama Y, Kumagai H, Kobayashi S, Yamamoto T, Yamazaki K
Shinpukai Maruyama Hospital, Hamamatsu, Japan.
Clin Nephrol. 1995 Oct;44(4):231-7.
The carpal tunnel syndrome (CTS) is the most frequent clinical symptom of dialysis-related amyloidosis. We examined CTS by ultrasound imaging and correlation between CTS and bone amyloidosis was sought. One hundred and forty-two wrists of 71 hemodialysis (HD) patients and 28 of 14 normal volunteers (group 1) were studied. Patients on HD were divided into 4 groups based on HD duration: Group 2, less than 5 years; group 3, 5-10 years; group 4, 10-15 years; and group 5, more than 15 years. The frequency of CTS increased gradually with HD duration: 0% in group 2, 35.3% in group 3, 36.4% in group 4 and 74.1% in group 5. The thickness of the palmar radiocarpal ligament (PRL), corresponding to the posterior wall of the carpal tunnel was significantly greater in groups 4 (p < 0.05), and 5 (p < 0.05) than in group 1 (2.25 +/- 1.30 and 3.11 +/- 1.02 in group 4 and 5 vs 1.15 +/- 0.34 mm in group 1); and the width of the carpal tunnel (CT) was significantly larger in group 5 than in group 1 (6.92 +/- 1.78 in group 5 vs 5.53 +/- 1.48 mm in group 1, p < 0.05). Wrists operated on for CTS had significantly increased PRL and CT compared to the control group and patients without CTS. Patients with CTS had wider PRL than the control and HD patients without CTS. Cystic radiolucent lesions (CRL) of carpal bones characteristic of bone amyloidosis were noted in 15 of 71 HD patients. The thickness of PRL and width of CT in HD patients with CRL exceeded those in patients without CRL. These data indicated that ultrasonographic findings of wrists were closely correlated with the degree of CTS and CRL. The usefulness of ultrasonographic evaluation of PRL thickness and CT width in the evaluation of dialysis-related amyloidosis should be evaluated.
腕管综合征（CTS）是透析相关淀粉样变性最常见的临床症状。我们通过超声成像检查了CTS，并探寻了CTS与骨淀粉样变性之间的相关性。研究了71例血液透析（HD）患者的142只手腕以及14名正常志愿者中的28只手腕（第1组）。HD患者根据透析时间分为4组：第2组，透析时间少于5年；第3组，透析时间5至10年；第4组，透析时间10至15年；第5组，透析时间超过15年。CTS的发生率随透析时间逐渐增加：第2组为0%，第3组为35.3%，第4组为36.4%，第5组为74.1%。对应腕管后壁的掌侧桡腕韧带（PRL）厚度在第4组（p < 0.05）和第5组（p < 0.05）中显著大于第1组（第4组和第5组分别为2.25 +/- 1.30和3.11 +/- 1.02，而第1组为1.15 +/- 0.34 mm）；腕管（CT）宽度在第5组中显著大于第1组（第5组为6.92 +/- 1.78，第1组为5.53 +/- 1.48 mm，p < 0.05）。接受CTS手术的手腕与对照组及无CTS的患者相比，PRL和CT显著增加。患有CTS的患者PRL比对照组及无CTS的HD患者更宽。71例HD患者中有15例出现了骨淀粉样变性特有的腕骨囊性透光性病变（CRL）。有CRL的HD患者的PRL厚度和CT宽度超过了无CRL的患者。这些数据表明手腕的超声检查结果与CTS和CRL的程度密切相关。应评估超声评估PRL厚度和CT宽度在透析相关淀粉样变性评估中的实用性。
