Lanteri M, Ptasznik R, Constable L, Dawborn J K
Austin and Repatriation Medical Center, Heidelberg, Australia.
Clin Nephrol. 1997 Dec;48(6):375-80.
Dialysis related amyloidosis (DRA) is a common complication of chronic dialysis, but diagnosis can be difficult. Hand involvement, as carpal tunnel syndrome (CTS) or particularly amyloid hand, can affect dexterity. To investigate the prevalence and extent of hand involvement, ultrasound evaluation of the carpal tunnel and tendons of the hand was performed in 25 chronic hemodialysis patients. Clinical symptoms of CTS were present in 18/50 wrists (36%); symptomatic patients had undergone hemodialysis for a significantly longer period than those without symptoms (16 +/- 2.9 years vs 5.3 +/- 3.0 years). The ultrasound indicators suggestive of DRA in the wrist which correlated with CTS were 1) increased carpal tunnel depth (15 +/- 2.3 mm vs 11 +/- 1.5 mm), 2) increased displacement of flexor tendons from the radius (3.4 +/- 2.4 mm vs 11 +/- 0.6 mm), and 3) presence of hypoechoic masses, erosions and fluid collections (16% of wrists). There was no relationship between symptoms and either flexor retinaculum thickness or median nerve surface area index. Five patients (20%) had severe stiffness of their fingers; ultrasound revealed thickening of the tendons of the hand in all these cases. Ultrasound technology allows the non-invasive examination of the wrist and hand for DRA and may be valuable in diagnosis and planning surgery.
透析相关淀粉样变性（DRA）是慢性透析的常见并发症，但诊断可能困难。手部受累，如腕管综合征（CTS）或特别是淀粉样变手，会影响灵活性。为了调查手部受累的患病率和程度，对25例慢性血液透析患者的腕管和手部肌腱进行了超声评估。50个腕关节中有18个（36%）存在CTS的临床症状；有症状的患者接受血液透析的时间明显长于无症状患者（16±2.9年 vs 5.3±3.0年）。与CTS相关的腕部提示DRA的超声指标为：1）腕管深度增加（15±2.3 mm vs 11±1.5 mm），2）屈肌腱相对于桡骨的移位增加（3.4±2.4 mm vs 1±0.6 mm），3）存在低回声团块、侵蚀和液体积聚（16%的腕关节）。症状与屈肌支持带厚度或正中神经表面积指数之间均无关联。5例患者（20%）手指严重僵硬；超声显示所有这些病例中手部肌腱均增厚。超声技术可对手腕和手部进行无创检查以诊断DRA，在诊断和手术规划中可能具有重要价值。
