肌骨超声测量正中神经横截面积与神经传导速度在腕管综合征严重程度分级中的相关性与诊断价值研究

doi:10.3969/j.issn.1009-976X.2026.04.006

摘要/Abstract

摘要： 目的探讨肌骨超声测量的正中神经横截面积（CSA）与神经传导速度（NCV）在腕管综合征（CTS）严重程度分级中的相关性及诊断价值。方法采用单中心、横断面诊断判别与相关性研究设计,选取2023年1月至2025年12月收治的120例（184腕）CTS患者作为研究对象,按神经电生理分级标准分为轻度组（56腕）、中度组（68腕）和重度组（60腕）。所有患者均接受高频肌骨超声检查（测量腕管入口处正中神经CSA）及神经电生理检查[远端运动潜伏期（DML）、感觉神经传导速度（SCV）及复合肌肉动作电位波幅（CMAP）]。分析CSA及NCV与CTS严重程度的相关性,并通过受试者工作特征曲线评估CSA对重度CTS的诊断效能。结果轻度、中度及重度CTS组正中神经CSA分别为12.35±2.11 mm²、15.68±2.43 mm²和20.57±3.02 mm²（P<0.001）。SCV分别为44.21±3.56 m/s、36.84±4.12 m/s和28.93±5.07 m/s（P<0.001）。DML分别为3.68±0.54 ms、5.21±0.78 ms和7.36±1.25 ms,CMAP分别为9.12±1.85 mV、6.85±1.63 mV和3.47±1.12 mV,三组间DML及CMAP比较,差异均有统计学意义（均P<0.001）。Spearman相关分析显示,CSA与CTS严重程度呈正相关（r=0.862,95%CI：0.812~0.900,P<0.001）,SCV与严重程度呈负相关（r=-0.841,95%CI：-0.884~-0.787,P<0.001）。CSA与DML呈正相关（r=0.794,95%CI：0.725~0.850,P<0.001）,与CMAP呈负相关（r=-0.756,95%CI：-0.820~-0.678,P<0.001）。以重度CTS为判断标准,CSA的ROC曲线下面积为0.932（95%CI：0.895~0.970,P<0.001）,最佳截断值为17.82 mm²,敏感度为90.00%,特异度为85.48%。在全部样本中,CSA与DML呈正相关（P<0.001）,与CMAP呈负相关（P<0.001）。结论肌骨超声测量的正中神经CSA与神经传导速度呈显著负相关,且CSA随CTS分级增加而显著增大。当CSA>17.82 mm²时,对重度CTS具有较高的区分效能。超声测量可作为神经电生理检查的有效补充方法,用于CTS的严重程度分级评估。

关键词: 腕管综合征, 肌骨超声, 正中神经, 横截面积, 神经传导速度, 疾病严重程度

Abstract: Objective To investigate the correlation and diagnostic value of median nerve cross-sectional area （CSA） measured by musculoskeletal ultrasound and nerve conduction velocity （NCV） for grading the severity of carpal tunnel syndrome （CTS）. Methods A single-center, cross-sectional study of diagnostic accuracy and correlation was conducted. A total of 120 patients （184 wrists） with clinically suspected CTS admitted between January 2023 and December 2025 were enrolled. All patients underwent high-frequency musculoskeletal ultrasound （measuring median nerve CSA at the carpal tunnel inlet） and nerve conduction studies [distal motor latency （DML）, sensory nerve conduction velocity （SCV）, and compound muscle action potential amplitude （CMAP）]. Using neuroelectrophysiological findings as the independent reference standard, the wrists with confirmed CTS were classified according to grading criteria into mild （56 wrists）, moderate （68 wrists）, and severe （60 wrists） groups. One-way analysis of variance and Spearman rank correlation analysis were used to analyze the correlations of CSA and NCV with CTS severity, and receiver operating characteristic curve analysis was used to evaluate the discriminative performance of CSA for severe CTS. Results The median nerve CSA values in the mild, moderate, and severe CTS groups were （12.35±2.11） mm², （15.68±2.43） mm², and （20.57±3.02） mm², respectively, with statistically significant differences among the three groups （P<0.001）. The SCV values were （44.21±3.56） m/s, （36.84±4.12） m/s, and （28.93±5.07） m/s, respectively, with statistically significant differences among groups （P<0.001）. The DML values were （3.68±0.54） ms, （5.21±0.78） ms, and （7.36±1.25） ms, and the CMAP values were （9.12±1.85） mV, （6.85±1.63） mV, and （3.47±1.12） mV, respectively, with statistically significant differences in both DML and CMAP among the three groups （all P<0.001）. Spearman correlation analysis showed that CSA was significantly positively correlated with CTS severity （r=0.862, 95%CI： 0.812 - 0.900, P<0.001）, while SCV was significantly negatively correlated with CTS severity （r=-0.841, 95%CI： -0.884 - -0.787, P<0.001）. CSA was significantly positively correlated with DML （r=0.794, 95%CI： 0.725 - 0.850, P<0.001） and significantly negatively correlated with CMAP （r=-0.756, 95%CI： -0.820 - -0.678, P<0.001）. Using severe CTS as the reference standard, the area under the ROC curve for CSA was 0.932 （95%CI： 0.895 - 0.970, P<0.001）. The optimal diagnostic cutoff was 17.82 mm², with a sensitivity of 90.00% and a specificity of 85.48%. Conclusion The median nerve CSA measured by musculoskeletal ultrasound is significantly negatively correlated with nerve conduction velocity, and CSA increases significantly with higher CTS severity grading. When CSA exceeds 17.82 mm², it demonstrates high discriminative efficacy for severe CTS. Ultrasound measurement can serve as an effective complement to neuroelectrophysiological testing for grading CTS severity.

Key words: carpal tunnel syndrome, musculoskeletal ultrasound, median nerve, cross-sectional area, nerve conduction velocity, disease severity

中图分类号:

赖少艳, 邓清泉, 曾莹, 邹龙华. 肌骨超声测量正中神经横截面积与神经传导速度在腕管综合征严重程度分级中的相关性与诊断价值研究[J]. 岭南现代临床外科, 2026, 25(04): 247-252.

LAI Shaoyan, DENG Qingquan, ZENG Ying, ZOU Longhua. Correlation and diagnostic value of median nerve cross-sectional area measured by musculoskeletal ultrasound and nerve conduction velocity in grading the severity of carpal tunnel syndrome[J]. Lingnan Modern Clinics In Surgery, 2026, 25(04): 247-252.

参考文献

[1] 隋佳星, 杨勇, 王振中, 等. 内窥镜辅助正中神经松解结合一期肌腱转位重建拇外展功能治疗重度腕管综合征[J]. 中国修复重建外科杂志, 2025, 39(12): 1510-1515.
[2] Prakash A, Vinutha H, Janardhan DC, et al.Diagnostic efficacy of high-frequency Grey-scale ultrasonography and Sono-elastography in grading the severity of carpal tunnel syndrome in comparison to nerve conduction studies[J]. Skeletal Radiol, 2024, 53(11): 2399-2408.
[3] 李金珠, 李红梅, 周涛, 等. 超声检查在腕管综合征诊断中的应用研究[J]. 中华劳动卫生职业病杂志, 2026, 44(01): 63-65.
[4] Jung DH, Lee SE, Park D, et al.A revised electrodiagnosis-based severity classification for carpal tunnel syndrome[J]. J Back Musculoskelet Rehabil, 2024, 37(5): 1205-1212.
[5] Milczarek C, Czyzewski B, Kozlowski K, et al.Carpal Tunnel Syndrome: A Comprehensive Review[J]. Cureus, 2025, 17(9): e93459.
[6] 张志, 王占业, 钱晓芹. 腕管综合征多模态超声诊断与引导治疗的应用进展[J]. 中华医学超声杂志(电子版), 2025, 22(3): 275-279.
[7] 柯淼, 黄粹业, 仇继任. 超声动态评估神经周围注射50 g/L葡萄糖治疗轻中度腕管综合征的疗效[J]. 广东医学, 2025, 46(3): 419-424.
[8] 朱玲, 刘凤欣, 穆雅群. 高频超声与肌电图在腕管综合征中的应用价值[J]. 河北医药, 2023, 45(10): 1519-1521.
[9] Onyeukwu C, Saggar R, Toncich RM, et al.Comparative Analysis of Methods for Obtaining Median Nerve Cross-Sectional Area Using Ultrasound[J]. HAND, 2026, 21(7): 1083-1088.
[10] Lin TY, Shen PC, Chang KV, et al.Assessment of the carpal tunnel and associated neural structures with superb microvascular imaging: a scoping review[J]. Expert Rev Med Devices, 2024, 21(1-2): 141-147.
[11] 汤样华, 洪芳, 母卓松, 等. 基于神经重塑机制的白脉软膏联合定向透药疗法对腕管综合征术后神经功能重建的临床疗效[J]. 中国医药导报, 2025, 22(31): 7-12.
[12] 翁泽鹏, 韩一栩, 冼小云. 基于“郁痹同病”探究加味补阳还五汤治疗腕管综合征合并焦虑抑郁患者的临床疗效及作用机制[J]. 世界中西医结合杂志, 2025, 20(12): 2477-2483.
[13] 沈素红, 耿丰勤, 付卓, 等. 腕管综合征正中神经病变多模态超声与神经电生理的对比研究[J]. 中国超声医学杂志, 2023, 39(6): 688-692.
[14] 张伟, 梁瑞歌, 义艳, 等. 超声引导下正中神经生理盐水“水分离”治疗腕管综合征疗效观察[J]. 现代中西医结合杂志, 2023, 32(19): 2704-2707.
[15] 王娆, 杨昀, 李文军. 神经肌电图检查联合高频超声应用于腕管综合征中的价值研究[J]. 安徽医学, 2025, 46(4): 426-430.
[16] Chen X, Zhang B, Yuan Y.Study of ultrasound and nerve electromyogram in diagnosis of carpal tunnel syndrome and its severity in the elderly[J]. Biotechnol Genet Eng Rev, 2024, 40(4): 4495-4511.
[17] Miller LE, Hammert WC, Rekant MS, et al.Diagnostic accuracy of neuromuscular ultrasound versus electrodiagnostic studies for carpal tunnel syndrome: systematic review and meta-analysis of paired accuracy studies[J]. HAND, 2025, 20(6): 1182-1189.
[18] Prakash A, Vinutha H, Janardhan DC, et al.Diagnostic efficacy of high-frequency Grey-scale ultrasonography and Sono-elastography in grading the severity of carpal tunnel syndrome in comparison to nerve conduction studies[J]. Skeletal Radiol, 2024, 53(11): 2399-2408.
[19] Martikkala L, Pemmari A, Himanen SL, et al.Median nerve shear wave elastography is associated with the neurophysiological severity of carpal tunnel syndrome[J]. J Ultrasound Med, 2024, 43(7): 1253-1263.
[20] Chen J, Chen L, Wu L, et al.Value of superb microvascular imaging ultrasonography in the diagnosis of carpal tunnel syndrome: Compared with color Doppler and power Doppler[J]. Medicine, 2017, 96(21): e6862.