肌骨超声在周围神经病诊疗中的应用

doi:10.3877/cma.j.issn.2095-123X.2023.05.001

近年来，随着超声技术的发展，肌骨超声（MSKUS）在周围神经病中的应用越来越广泛。MSKUS可以应用于周围神经病的诊断、治疗、预后评估、随访等，具有便携、快捷、可双侧对比、动态观察以及可实现周围神经全程显像等优点。相较于MRI、CT等影像学辅助检查手段，MSKUS可以作为周围神经病诊疗的首选检查方法。本文主要围绕MSKUS在周围神经病诊疗中的应用作一述评，以期为MSKUS的临床应用提供理论依据。

关键词: 肌骨超声, 周围神经病, 高频超声

In recent years, with the development of ultrasound technology, the application of musculoskeletal ultrasound (MSKUS) in peripheral neuropathy (PN) has become increasingly widespread. MSKUS can be applied in various aspects of PN, including diagnosis, treatment, prognosis assessment, and follow-up. MSKUS offers the benefits of portability, speed, bilateral comparison, dynamic observation, and the ability to capture a complete imaging profile of peripheral nerves. In comparison to other imaging modalities like MRI and CT, MSKUS can be considered the preferred method. This paper reviews the application of MSKUS in the diagnosis and treatment of PN, aiming to contribute theoretical support to the clinical use of MSKUS.

Key words: Musculoskeletal ultrasound, Peripheral neuropathy, High-frequency ultrasound

图1 腕管综合征声像图正中神经在腕管内变细（实线箭头所示），回声减低，神经纤维结构不清，其近端神经水肿增粗（虚线箭头所示）

Fig.1 Ultrasound image of carpal tunnel syndrome

图2 右小腿创伤性神经瘤声像图A：右侧小腿比目鱼肌下方局限性肌腹回声增强紊乱，内部见实性低回声肿物；B：肿物内未见明显血流信号

Fig.2 Ultrasound image of traumatic neuroma in the right lower leg

图3 DPN患者腓总神经声像图右侧腓管处腓总神经内神经束明显增粗（箭头所示），神经内部回声减低，神经外膜回声模糊，与周围组织边界不清；DPN：糖尿病性周围神经病

Fig.3 Ultrasound image of the peroneal nerve in patients with DPN

[1]	华兴.肌骨超声的应用现状与发展趋势[J].第三军医大学学报, 2015, 37(20): 2005-2010. DOI: 10.16016/j.1000-5404.201507183.
[2]	Schreiber S, Vielhaber S, Schelle T. Peripheral Nerve Imaging - from a Neurological Perspective for Surgeons[J]. Zentralbl Chir, 2020, 145(6): 541-548. DOI: 10.1055/a-1189-3627.
[3]	Goedee HS, Brekelmans GJ, van Asseldonk JT, et al. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy--a review of the literature[J]. Eur J Neurol, 2013, 20(10): 1342-1351. DOI: 10.1111/ene.12182.
[4]	Carroll AS, Simon NG. Current and future applications of ultrasound imaging in peripheral nerve disorders[J]. World J Radiol, 2020, 12(6): 101-129. DOI: 10.4329/wjr.v12.i6.101.
[5]	Sconfienza LM, Adriaensen M, Albano D, et al. Clinical indications for image guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European society of musculoskeletal radiology (ESSR)-part III, nerves of the upper limb[J]. Eur Radiol, 2020, 30(3): 1498-1506. DOI: 10.1007/s00330-019-06479-z.
[6]	Descatha A, Huard L, Aubert F, et al. Meta-analysis on the performance of sonography for the diagnosis of carpal tunnel syndrome[J]. Semin Arthritis Rheum, 2012, 41(6): 914-922. DOI: 10.1016/j.semarthrit.2011.11.006.
[7]	Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis[J]. Clin Orthop Relat Res, 2011, 469(4): 1089-1094. DOI: 10.1007/s11999-010-1637-5.
[8]	Telleman JA, Herraets IJT, Goedee HS, et al. Nerve ultrasound: a reproducible diagnostic tool in peripheral neuropathy[J]. Neurology, 2018, Online ahead of print. DOI: 10.1212/WNL.0000000000006856.
[9]	安娜,郭玲,张丁丁,等.外周神经鞘瘤超声特征分析[J].北京医学, 2021, 43(3): 232-234. DOI: 10.15932/j.0253-9713.2021.03.010.
[10]	Simon NG, Talbott J, Chin CT, et al. Peripheral nerve imaging[J]. Handb Clin Neurol, 2016, 136: 811-826. DOI: 10.1016/B978-0-444-53486-6.00040-5.
[11]	宋英茜,陶冶,杨光.高频超声在周围神经源性肿瘤诊断中的应用现状[J].大连医科大学学报, 2014, 36(3): 291-294. DOI: 10.11724/jdmu.2014.03.22.
[12]	孙程宽,崔树森,孙鸿斌,等.高频超声对周围神经良性肿瘤诊断与鉴别诊断的作用[J].中国实验诊断学, 2019, 23(1): 91-93. DOI: 10.3969/j.issn.1007-4287.2019.01.037.
[13]	金珍珍,郭稳,陈涛,等.超声鉴别诊断恶性外周神经鞘瘤与神经纤维瘤[J].中国医学影像技术, 2021, 37(10): 1534-1538. DOI: 10.13929/j.issn.1003-3289.2021.10.024.
[14]	Taylor CA, Braza D, Rice JB, et al. The incidence of peripheral nerve injury in extremity trauma[J]. Am J Phys Med Rehabil, 2008, 87(5): 381-385. DOI: 10.1097/PHM.0b013e31815e6370.
[15]	Weyand B, Spies M. Functional reconstruction in traumatic paralysis[J]. Unfallchirurg, 2021, 124(10): 823-831. DOI: 10.1007/s00113-021-01078-4.
[16]	张申申,王磊,郭卫中.超声检查在外伤性腓总神经损伤诊断中的临床应用[J].中华手外科杂志, 2018, 34(6): 421-422. DOI: 10.3760/cma.j.issn.1005-054X.2018.06.008.
[17]	Bodner G, Buchberger W, Schocke M, et al. Radial nerve palsy associated with humeral shaft fracture: evaluation with US--initial experience[J]. Radiology, 2001, 219(3): 811-816. DOI: 10.1148/radiology.219.3.r01jn09811.
[18]	刘艾琳,陈为民,彭峰,等.高频超声诊断肱骨干骨折合并桡神经高位损伤的价值[J].中华创伤杂志, 2021, 37(7): 606-612. DOI: 10.3760/cma.j.cn501098-20210129-00085.
[19]	Wijntjes J, Borchert A, van Alfen N. Nerve ultrasound in traumatic and iatrogenic peripheral nerve injury[J]. Diagnostics (Basel), 2020, 11(1): 30. DOI: 10.3390/diagnostics11010030.
[20]	Peer S, Bodner G, Meirer R, et al. Examination of postoperative peripheral nerve lesions with high-resolution sonography[J]. AJR Am J Roentgenol, 2001, 177(2): 415-419. DOI: 10.2214/ajr.177.2.1770415.
[21]	郭永坤,谢井伟,单峤,等.神经电生理监测下神经显微减压术治疗糖尿病性下肢周围神经病[J].中华神经创伤外科电子杂志, 2020, 6(5): 319-320. DOI: 10.3877/cma.j.issn.2095-9141.2020.05.015.
[22]	Ma X, Li T, Du L, et al. Applicability of high-frequency ultrasound to the early diagnosis of diabetic peripheral neuropathy[J]. Biomed Res Int, 2021, 2021: 5529063. DOI: 10.1155/2021/5529063.
[23]	汤天津,于炎冰,杨文强,等.脊髓电刺激治疗糖尿病性周围神经病的研究进展[J].中华脑科疾病与康复杂志(电子版), 2021, 11(1): 35-37. DOI: 10.3877/cma.j.issn.2095-123X.2021.01.009.
[24]	Huang H, Wu S. Application of high-resolution ultrasound on diagnosing diabetic peripheral neuropathy[J]. Diabetes Metab Syndr Obes, 2021, 14: 139-152. DOI: 10.2147/DMSO.S292991.
[25]	Goyal K, Aggarwal P, Gupta M. Ultrasound evaluation of peripheral nerves of the lower limb in diabetic peripheral neuropathy[J]. Eur J Radiol, 2021, 145: 110058. DOI: 10.1016/j.ejrad.2021.110058.
[26]	Singh KP, Gupta K, Kataria N, et al. High-resolution ultrasonography of the sural nerve in diabetic peripheral neuropathy[J]. J Ultrason, 2020, 20(81): e83-e89. DOI: 10.15557/JoU.2020.0013.
[27]	Kelle B, Evran M, Ballı T, et al. Diabetic peripheral neuropathy: correlation between nerve cross-sectional area on ultrasound and clinical features[J]. J Back Musculoskelet Rehabil, 2016, 29(4): 717-722. DOI: 10.3233/BMR-160676.
[28]	Wei M, Ye X. Feasibility of point shear wave elastography for evaluating diabetic peripheral neuropathy[J]. J Ultrasound Med, 2020, 39(6): 1135-1141. DOI: 10.1002/jum.15198.
[29]	Jain S, Visser LH, Suneetha S. Imaging techniques in leprosy clinics[J]. Clin Dermatol, 2016, 34(1): 70-78. DOI: 10.1016/j.clindermatol.2015.10.014.
[30]	吴慧,盛秋敏,朱剑芳.剪切波弹性成像在类风湿关节炎周围神经病变中的诊断价值[J].中国医学影像学杂志, 2020, 28(6): 456-460. DOI: 10.3969/j.issn.1005-5185.2020.06.013.
[31]	Borire AA, Arnold R, Pussell BA, et al. Haemodialysis alters peripheral nerve morphology in end-stage kidney disease[J]. Clin Neurophysiol, 2017, 128(1): 281-286. DOI: 10.1016/j.clinph.2016.09.010.
[32]	Pitarokoili K, Gold R, Fisse AL. Nerve ultrasound for the diagnosis and follow-up of peripheral neuropathies[J]. Curr Opin Neurol, 2023, 36(5): 373-381. DOI: 10.1097/WCO.0000000000001183.
[33]	Jaeschke R, Thoirs K, Bain G, et al. Systematic review: hand activity and ultrasound of the median nerve[J]. Occup Med (Lond), 2017, 67(5): 389-393. DOI: 10.1093/occmed/kqx059.
[34]	Hassanien M, Elawamy A, Kamel EZ, et al. Perineural platelet-rich plasma for diabetic neuropathic pain, could it make a difference?[J]. Pain Med, 2020, 21(4): 757-765. DOI: 10.1093/pm/pnz140.
[35]	Sun J, Zou X, Fu Q, et al. Case report: ultrasound-guided needle knife technique for carpal ligament release in carpal tunnel syndrome treatment[J]. Front Neurol, 2023, 14: 1291702. DOI: 10.3389/fneur.2023.1291702.
[36]	Zhou Q, Shen Y, Zhu X, et al. Ultrasound-guided percutaneous release procedures in the transverse carpal ligament by acupotomy: a cadaveric study[J]. Front Surg, 2023, 9: 906109. DOI: 10.3389/fsurg.2022.906109.
[37]	王俊伟,曹娟,陈利锋,等.肌骨超声引导下针刀松解治疗枕大神经卡压综合症的临床研究[J].华南国防医学杂志, 2020, 34(8): 527-530. DOI: 10.13730/j.issn.1009-2595.2020.08.001.
[38]	徐晨婕,高献忠,管华,等.超声引导下射频消融治疗痛性神经瘤的疗效[J].临床麻醉学杂志, 2018, 34(12): 1180-1183. DOI: 10.12089/jca.2018.12.009.
[39]	Toia F, Gagliardo A, D'Arpa S, et al. Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?[J]. J Neurosurg, 2016, 125(3): 603-614. DOI: 10.3171/2015.6.JNS151001.
[40]	吴斌洪.高频超声在周围神经术后再生修复的应用[J].实用医学影像杂志, 2021, 22(5): 449-451. DOI: 10.16106/j.cnki.cn14-1281/r.2021.05.006.
[41]	Fantoni C, Erra C, Fernandez Marquez EM, et al. Ultrasound diagnosis of postoperative complications of nerve repair[J]. World Neurosurg, 2018, 115: 320-323. DOI: 10.1016/j.wneu.2018.04.179.
[42]	Aggarwal A, Jana M, Srivastava DN, et al. Magnetic resonance neurography and ultrasonogram findings in upper limb peripheral neuropathies[J]. Neurol India, 2019, 67(Supplement): S125-S134. DOI: 10.4103/0028-3886.250701.
[43]	Singh KP, Goindi AS, Gupta K. Reference values for the cross-sectional area of normal radial nerve at two levels using high-resolution ultrasonography[J]. J Ultrason, 2021, 21(85): e112-e126. DOI: 10.15557/JoU.2021.0020.
[44]	Ali ZS, Pisapia JM, Ma TS, et al. Ultrasonographic evaluation of peripheral nerves[J]. World Neurosurg, 2016, 85: 333-339. DOI: 10.1016/j.wneu.2015.10.005.
[45]	Hannaford A, Vucic S, Kiernan MC, et al. Review article "Spotlight on ultrasonography in the diagnosis of peripheral nerve disease: the evidence to date" [J]. Int J Gen Med, 2021, 14: 4579-4604. DOI: 10.2147/IJGM.S295851.

[1]	李敏, 邱逦. 健康人群指甲与邻近组织超声测值的初步研究[J]. 中华医学超声杂志（电子版）, 2023, 20(04): 449-454.
[2]	王慧芳, 胡守容, 郭蓉, 张丹丹, 曾娜君, 贺玉梅, 张蕾, 郄建英, 林燕秋, 蔡阿乔. 多途径超声联合检查在先天性阴道闭锁诊断中的应用价值[J]. 中华医学超声杂志（电子版）, 2022, 19(10): 1065-1070.
[3]	陈广兰, 王慧芳, 胡守容, 张丹丹, 贺玉梅, 郭蓉, 张蕾, 陈小清, 华琪, 张元吉, 林燕秋. MRKH综合征的超声影像学特征及其诊断价值[J]. 中华医学超声杂志（电子版）, 2022, 19(10): 1046-1051.
[4]	胡守容, 王玥, 陈广兰, 杨俊英, 蒋璐, 王慧芳. 经直肠双平面高频超声对正常女性阴道形态的评估[J]. 中华医学超声杂志（电子版）, 2021, 18(11): 1056-1060.
[5]	强坤坤, 罗红. 杜氏肌营养不良症患儿的高频超声与剪切波弹性成像诊断研究现状及前景[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 162-167.
[6]	凌振华, 张斌. 彩色多普勒血流显像及高频超声在腹股沟斜疝、直疝及股疝鉴别诊断中的应用价值[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 326-329.
[7]	李梦梅, 张春晓. 高频超声在不同类型腹股沟疝患者中的鉴别及与精索腹壁下动脉的关系研究[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(03): 313-316.
[8]	王成昊, 赵强, 潘吉祥, 陈震. 高频超声结合彩色多普勒超声在腹股沟斜疝和股疝中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(02): 224-226.
[9]	周珊珊, 王超. 高频超声在腹股沟疝修补术前诊断的准确性研究[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(02): 169-171.
[10]	于文江, 曹海伦, 岳志, 李剑桥, 段熊松, 王彬. 高频超声引导下造影定位内固定对多发肋骨骨折合并血气胸分析[J]. 中华肺部疾病杂志(电子版), 2021, 14(05): 635-637.
[11]	刘丽清, 杨菲, 路鑫铭, 赵紫钰. 肌骨高频超声在肘关节软组织损伤诊断中的应用价值[J]. 中华肩肘外科电子杂志, 2023, 11(01): 24-29.
[12]	井鹏, 宋九龙, 高红亮, 王超, 吴珊珊, 俞暖新, 赵添莹. 超声可视化注射对老年偏瘫肩痛炎性吸收的疗效[J]. 中华老年骨科与康复电子杂志, 2023, 09(03): 145-151.
[13]	李丽芬, 梁淑贤, 叶淑芬. 高频超声在跟腱断裂及断端被动运动状态的研究[J]. 中华消化病与影像杂志(电子版), 2022, 12(01): 38-40.
[14]	陈旭, 肖翼春, 项霞青. 肺部高频超声与CT扫描对儿童肺炎支原体肺炎的诊断效能对比研究[J]. 中华临床医师杂志(电子版), 2021, 15(12): 944-947.
[15]	帅宁安, 马悦, 强玉婷, 史晓岚, 佟莉, 董炜菁. 高压氧联合中医定向透药治疗老年糖尿病周围神经病变疗效分析[J]. 中华老年病研究电子杂志, 2022, 09(03): 29-32.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application of musculoskeletal ultrasound in the diagnosis and treatment of peripheral neuropathy

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application of musculoskeletal ultrasound in the diagnosis and treatment of peripheral neuropathy