The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study
The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study
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DOI：
10.1371/journal.pone.0162288
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发表时间：
2016-09-23
期刊：
影响因子：
3.7
通讯作者：
Dejaco, Christian
中科院分区：
文献类型：
--
作者：
Marschall, Alexander;Ficjian, Anja;Dejaco, Christian
ObjectivesTo探讨正中神经B超和能量多普勒（PD）超声对腕管综合征（CTS）患者近期和远期临床预后的预测价值。方法前瞻性研究135例疑似CTS患者，分别于基线、短期（3个月）和长期（15-36个月）随访3次。在基线时，正中神经的横截面积（CSA）在前臂和手腕上的4个水平用超声测量。对PD信号进行半定量分级（0-3）。在每次访视时使用波士顿问卷（BQ）和DASH问卷以及患者疼痛评估（painVAS）和医生总体评估（physVAS）的视觉模拟量表评价临床结局。基线CSA和PD的临床outcomes.ResultsShort-term和长期随访数据的预测值与多变量logistic回归models.Results111（82.2%）和105（77.8%）例患者，分别确定。84例患者（125个腕关节）最终诊断为CTS。回归分析显示，在腕管入口处测量的CSA预测了接受腕管手术的CTS患者的BQ短期临床改善（OR 1.8，p = 0.05），但保守治疗的患者则不然。CSA和PD评估均未预测疼痛VAS，physVAS或DASH的短期改善，也没有任何的超声参数用于预测长期临床outcome.ConclusionsUltrasound正中神经在腕管入口的评估可以预测短期临床改善CTS患者进行腕管释放，但长期的结果是无关的超声结果。
ObjectivesTo investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short-and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS).MethodsProspective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15-36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0-3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient's assessment of pain (painVAS) and physician's global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.ResultsShort-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.ConclusionsUltrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long- term outcomes are unrelated to ultrasound findings.