超音波檢查於腕隧道症候群之診斷及正中神經滑動之量測

Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and Measurement of Gliding of the Median Nerve

張益維(Yi-Wei Chang) ； 連一潔(Yi-Chieh Lien) ； 洪怡珣(Yi-Shiung Horng)

《台灣復健醫學雜誌》 42卷4期 (2014/12) Pp. 179-187+189

https://doi.org/10.6315/2014.42(4)01

摘要

臨床上超音波於診斷腕隧道症候群之研究，主要之目的為彌補理學檢查及神經傳導檢查之不足，期望因此減少診斷偽陰性之發生。目前在靜態超音波檢查中，正中神經截面積、扁平係數、腫脹係數，以及出口處屈肌支持帶彎曲位移皆曾被提出做為診斷標準，並有學者以彩色杜卜勒超音波測量正中神經血流量之變化。除此之外，近年來亦有學者嘗試以動態超音波測量正中神經及屈指肌腱的滑動位移，包括以杜卜勒超音波或是利用互相關演算法（cross-correlation algorithm）分析正中神經的位移量，希望藉由評估腕隧道內正中神經以及結締組織的沾黏程度，有助於未來發展出更有效的運動治療方式。目前以超音波診斷腕隧道症候群的大部份研究，皆嘗試訂出一絕對值來做為診斷標準，但此方法可能忽視了不同族群、性別、年齡層、體重等個體差異，未來可以朝向依照不同人種、性別、年齡、體重和身體質量指數訂出各自適合的臨界值，以建全腕隧道症候群之超音波診斷標準。因此，本篇文章擬回顧近年來應用超音波於腕隧道症候群之診斷及評估等文獻，並針對目前臨床應用可能遭遇之問題進行探討及建議，以期超音波檢查於腕隧道症候群的應用能更加普遍。

關鍵字

正中神經 ； 腕隧道症候群 ； 超音波 ； 杜卜勒超音波

並列摘要

The main purpose of the diagnostic ultrasound examination for carpal tunnel syndrome (CTS) is to compensate for the inadequacies of physical examinations and nerve conduction studies and thereby reduce the false negative rate of CTS diagnosis. The cross-sectional area of the median nerve, swelling ratio, flattening ratio, and palmar bowing of the flexor retinaculum have been reported as the diagnostic criteria for CTS in ultrasonographic examinations. In addition, Doppler ultrasound has been applied to measure the blood flow of the median nerve, and dynamic ultrasound combined with a cross-correlation algorithm has been developed to measure the gliding of the median nerve and flexor digitorum tendons inside the carpal tunnel. Assessing the adhesion between the median nerve and the connective tissue inside the carpal tunnel by using ultrasound may contribute to the development of a therapeutic exercise program for patients with CTS in the future. Most studies have attempted to establish a single diagnostic standard for all patients with CTS. However, using this standard might lead to underestimation of the variation in nerve size among patients with differences in ethnic group, sex, age, body weight, and height. Therefore, future studies should be devoted to establishing a series of diagnostic standards that account for these variations to improve the ultrasound diagnosis of CTS. In summary, this study was conducted to review the ultrasonographic criteria used in diagnosing CTS and the innovative approaches used to evaluate the gliding of the median nerve and flexor tendons inside the carpal tunnel. In addition, this study demonstrated the difficulties of clinically applying methods involving ultrasound in diagnosing CTS, and this paper proposes suggestions for managing these difficulties.

並列關鍵字

median nerve ； carpal tunnel syndrome ； ultrasound ； Doppler ultrasound

參考文獻

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