CARPAL-TUNNEL SYNDROME - CORRELATION OF MAGNETIC-RESONANCE-IMAGING, CLINICAL, ELECTRODIAGNOSTIC, AND INTRAOPERATIVE FINDINGS
CARPAL-TUNNEL SYNDROME - CORRELATION OF MAGNETIC-RESONANCE-IMAGING, CLINICAL, ELECTRODIAGNOSTIC, AND INTRAOPERATIVE FINDINGS
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DOI：
10.1227/00006123-199512000-00009
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发表时间：
1995-12-01
期刊：
影响因子：
4.8
通讯作者：
KLIOT, M
中科院分区：
文献类型：
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作者：
BRITZ, GW;HAYNOR, DR;KLIOT, M
我们进行了一项前瞻性研究，研究对象为32例临床诊断为腕管综合征的患者（研究组）的43个腕关节和5个无症状患者（对照组）的腕关节，将临床、电诊断、术中和磁共振成像（MRI）结果相关联。采用冠状位和轴位T1和T2加权、质子密度和短tau反转恢复序列对腕管和鱼际隆起进行MRI检查。MRI显示，研究组43/43（100%）例腕关节出现正中神经切断，对照组0/5（0%）例腕关节出现正中神经切断。正中神经信号增强41/43例（95%），屈肌腱鞘信号增强41/43例（95%），屈肌腱支持带掌侧弯曲39/43例（91%），屈肌腱间距增大37/43例（86%），神经形态异常28/43例（65%）。肌电图显示，43个腕关节中有5个（12%）腕关节的鱼际肌短tau蛋白反转恢复信号增加，所有这些腕关节都发生了严重的去神经变化。对43例腕关节中的27例（63%）进行了手术松解，对43例腕关节中的42例（98%）进行了随访。20/27例（74%）患者术后结局良好或极佳，2/27例（7%）结局一般，4/27例（15%）结局较差，1/27例（4%）患者失访。对于接受腕管松解术且MRI显示神经配置异常的患者，结局有所改善，18名患者中有15名（83%）获得良好或优秀的结果。正中神经或屈肌腱信号改变、屈肌腱间隙增加或屈肌支持带弯曲与预后无关。我们的研究结果表明，MRI是一种敏感的诊断方式，可以显示信号和配置异常的正中神经患者诊断为腕管综合征。鱼际肌肉的信号增加，如MRI所揭示的，使用短的tau反转恢复序列，仅发生在经历了严重的去神经变化的肌肉中，如肌电图所揭示的。
WE UNDERTOOK A prospective study of 43 wrists in 32 patients who had been clinically diagnosed as having carpal tunnel syndrome (study group) and 5 wrists in people who had no symptoms (control group), correlating the clinical, electrodiagnostic, intraoperative, and magnetic resonance imaging (MRI) findings. MRI of the carpal tunnel and thenar eminence was performed, using coronal and axial T1- and T2-weighted, proton density, and short tau inversion recovery sequences. Abnormalities of the median nerve, as revealed by MRI, were found in 43 of 43 (100%) wrists in the study group and in 0 of 5 (0%) wrists in the control group. Increased signal of the median nerve was seen in 41 of 43 (95%) wrists, increased signal of the flexor tendon sheath in 41 of 43 (95%), volar bowing of the flexor retinaculum in 39 of 43 (91%), increased distance between the flexor tendons in 37 of 43 (86%), and abnormal nerve configuration in 28 of 43 (65%). Increased short tau inversion recovery signal of the thenar muscles was found in 5 of 43 (12%) wrists, all of which had undergone severe denervation changes, as revealed by electromyography. Operative release was performed for 27 of 43 (63%) wrists, and follow-up was obtained for 42 of 43 (98%). A good or excellent postoperative outcome resulted for 20 of 27 (74%) patients, a fair outcome for 2 of 27 (7%), and a poor outcome for 4 of 27 (15%), and 1 of 27 (4%) patients was lost to follow-up. For patients undergoing carpal tunnel release whose MRI revealed an abnormal nerve configuration, the outcome was improved, with good or excellent results in 15 of 18 (83%) patients. No association with outcome was seen with median nerve or flexor tendon signal changes, increased interspace between the flexor tendons, or flexor retinaculum bowing. Our results indicate that MRI is a sensitive diagnostic modality that can demonstrate signal and configurational abnormalities of the median nerve in patients diagnosed with carpal tunnel syndrome. Increased signal of the thenar muscles, as revealed by MRI, using short tau inversion recovery sequences, occurs only in muscles that have undergone severe denervation changes, as revealed by electromyography.