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患儿女,25 个月,阴道分娩时出现肩难产,暴力牵引出生后,患儿右侧锁骨骨折,保守治疗一般情况平稳后出院.患儿 2 岁时手指及屈肘肌力较弱,临床初步诊断为:右侧臂丛神经损伤.

We describe an unusual case of infant obstetric brachial plexus injury located in the cervical (C)5–C6 brachial plexus nerve, which was preoperatively diagnosed using high-frequency ultrasonography (US) at 2 years of age. The girl was diagnosed with a right clavicular fracture because of shoulder dystocia. She had been showing movement limitations of her entire right upper limb after fracture healing and was then referred to our hospital at 2 years of age. High-frequency US showed that the roots of the right brachial plexus ran continuously, but the diameter of C6 was thinner on the affected side than on the contralateral side (right 0.12 cm vs. left 0.20 cm). A traumatic neuroma had formed at the upper trunk, which was thicker (diameter: right 0.35 cm vs. left 0.23 cm; cross-sectional area: right 0.65 cm2 vs. left 0.31 cm2) at the level of the supraclavicular fossa. Intraoperative findings were consistent with ultrasound findings. Postoperative pathology confirmed brachial plexus traumatic neuroma.

目的 探讨高频超声在诊断周围神经内、外囊肿致神经卡压中的临床价值.方法 选取我院经手术病理证实的周围神经囊肿患者27例,术前应用高频超声观察周围神经内、外囊肿致神经卡压情况,肌电图分析其运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)、复合肌肉动作电位(CMAP)、感觉神经动作电位(SNAP),比较周围神经内、外囊肿上述高频超声及肌电图检查结果的差异.绘制受试者工作特征(ROC)曲线分析高频超声周围神经内、外囊肿的诊断效能;分析高频超声与肌电图指标的相关性.结果 27例患者中,高频超声准确诊断24例,其中周围神经内囊肿11例,周围神经外囊肿13例,诊断准确率为88.89%.周围神经内、外囊肿病变神经缩窄率比较差异有统计学意义(P<0.05);其余检查结果比较差异均无统计学意义.肌电图检查结果显示23例出现神经卡压,诊断准确率为85.18%;表现为病变神经MNCV和SNCV减慢,动作电位波幅减低;周围神经内、外囊肿MNCV、SNCV、CMAP、SNAP比较差异均无统计学意义.高频超声所测病变神经缩窄率的截断值为0.682,诊断周围神经内、外囊肿的曲线下面积为0.755(95%可信区间:0.557～0.954,P=0.034),灵敏度、特异度分别为46.2%、95.7%,且其与MNCV、SNCV、CMAP、SNAP均呈正相关(r=0.589、0.560、0.645、0.525,均P<0.01).结论 高频超声在诊断周围神经内、外囊肿致神经卡压中有一定的临床价值.

Background Thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus (BP) is difficult to diagnosis. This study aimed to summarize the features of thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus observed on high-frequency ultrasonography (HFUS). Methods The ultrasound data of 27 patients who had TOS with the lower trunk compression of brachial plexus were collected and eventually confirmed by surgery. The imaging data were compared, and the pathogenesis of TOS was analyzed on the basis of surgical data. Results TOS occurred predominantly in females (70.4%). Most cases had unilateral involvement (92.6%), mainly on the right side (66.7%). The HFUS features of TOS can be summarized as follows: (1) Lower trunk compression. HFUS revealed focal thinning that reflected compression at the level of the lower trunk; furthermore, the distal part of the nerve was thickened for edema (Affected side: 0.49 ± 0.12 cm vs. Healthy side: 0.38 ± 0.06, P = 0.009), and the cross-sectional area of brachial plexus cords was markedly greater on the injured side than on the healthy side (0.95 ± 0.08 cm² vs. 0.65 ± 0.11 cm², P = 0.004). (2) Hyperechoic fibromuscular bands behind the compressed nerve (mostly the scalenus minimus muscle). (3) Abnormal bony structures : cervical ribs or elongated transverse processes of the 7th cervical vertebra (C7). Surgical results showed that the etiological factors contributing to TOS were (1) muscle hypertrophy and/or fibrosis (100%) and (2) cervical ribs/elongated C7 transverse processes (20.7%). Conclusion TOS with the lower trunk compression of brachial plexus can be diagnosed accurately and reliably by high-frequency ultrasound.

目的 分析比较高频超声(high-frequency ultrasound,HFUS)、超声造影(contrast-enhanced ultrasound,CEUS)以及磁共振成像(magnetic resonance imaging,MRI)在军事训练所致肩袖撕裂中的诊断效能.方法 选取68例临床怀疑肩袖损伤的军事训练伤患者资料,以关节镜术中诊断为金标准,对HFUS、CEUS和MRI 3种检查手段对肩袖撕裂的诊断价值予以分析和比较.结果 68例患者中,关节镜确诊肩袖撕裂62例,无肩袖撕裂伤6例.对于判断有无肩袖撕裂,HFUS的灵敏度、特异度和准确率分别为96.77％、50.00％和92.56％,CEUS的分别为95.16％、50.00％和91.18％,MRI的分别为98.39％、66.67％和95.59％,3种方法对诊断有无肩袖撕裂均有统计学意义(P＜0.05),3种方法之间差异无统计学意义(P＞0.05).HFUS诊断肩袖撕裂程度的灵敏度、特异度和准确率分别为87.50％、94.44％和91.67％,CEUS 的分别为 88.46％、93.94％、91.53％,MRI 的分别为 91.67％、94.59％、93.44％,3 种检查方法对诊断肩袖撕裂程度均有统计学意义(P＜0.05),但3种检查方法之间的差异无统计学意义(P＞0.05).结论 HFUS、CEUS和MRI对肩袖撕裂准确率的诊断准确率均较高,3种影像学方法可作为相互补充,其中HFUS因检查简单便捷可推广应用于军事训练所引起的肩袖损伤筛查中.

Melanotic nerve sheath tumor (MNST) is a rare variant of schwannoma. Here, we report an unusual case of multiple MNST lesions located in the upper limb nerves. The patient presented with a mass on the left wrist in 2016 and another mass on the left thumb in 2017. In both instances, magnetic resonance imaging scans confirmed multiple giant-cell tumors of the tendon sheath. Persistent pain in the left upper limb and numbness in the ring finger and little finger recurred in 2021. High-frequency ultrasound (HFUS) showed that the left brachial plexus nerves (C5-8) were widened compared with those on the contralateral side; the neuroma formed at the lateral cord, and the median nerve was markedly thickened. The surgical findings were consistent with the ultrasound results. Pathology confirmed that the tumors were malignant MNSTs. HFUS is important for preoperative diagnosis and lesion localization, even identifying some lesions that are unrecognized on magnetic resonance imaging; thus, HFUS is crucial for improving surgical strategy and decision-making.

目的:探讨下肢神经剪切波弹性成像(SWE)对不同程度糖尿病周围神经病变(DPN)的诊断效能.方法:收集DPN患者65例,按下肢病变程度分为无溃疡组(49例,轻症)与溃疡组(16例,重症).纳入同期体检健康者32例为对照组.应用SWE技术对双侧下肢神经(胫神经、腓总神经及腓肠神经)进行成像,测量参数包括弹性模量峰值(Emax)、平均弹性模量(Emean)、最大剪切波传导速度(Vmax)、平均剪切波传导速度(Vmean).比较三组胫神经、腓总神经及腓肠神经SWE参数并评价对不同程度糖尿病周围神经病变的诊断效能.结果:溃疡组胫神经Emean、Emax、Vmean和Vmax高于无溃疡组和对照组(均P<0.05).溃疡组和无溃疡组腓总神经Emean、Emax、Vmean和Vmax高于对照组,且溃疡组高于无溃疡组(均P<0.05).ROC曲线分析显示,胫神经和腓总神经SWE参数对不同程度DPN具有中等诊断效能,而腓肠神经诊断效能较低.结论:DPN患者下肢神经损害程度不一,其中胫神经和腓总神经SWE参数对不同程度DPN具有一定的诊断效能.

目的 通过剪切波弹性成像(Shear Wave Elastography,SWE)技术评估大鼠糖尿病周围神经病变(Diabetic Peripheral Neuropathy,DPN),探讨DPN组织学与SWE的相关性,为深入了解DPN基础、临床早诊及干预提供影像学依据.方法 腹腔注射链脲菌素溶液(左下腹单次55 mg/kg)建立糖尿病大鼠模型(11只)为DPN组,另10只作为对照组,建模成功2周后记录比较2组大鼠的坐骨神经SWE各参数;坐骨神经组织HE染色及透射电镜观察其病理改变.Image J软件对电镜图片进行定量分析(每组随机选取4只),比较2组间神经髓鞘的外周周长、内周周长、横截面积及平均厚度.结果 与对照组比较,DPN组建模2周后即出现SWE参数增高(P<0.05);ROC曲线分析提示病变的预警值:Emean为14.90 kPa、Emax为16.55 kPa、Vmean为2.15 m/s.光镜观察DPN组大鼠神经髓鞘明显肿胀,透射电镜示DPN组髓鞘板层崩解,分离明显,结构紊乱;对照组与DPN组定量分析相比,髓鞘外周周长、横截面积、平均厚度间均存在显著差异(P<0.05).结论 糖尿病大鼠发病2周时SWE即可提示神经早期病变,组织学亦有变化,SWE参数改变与其病理学基础变化具有一定相关性,SWE有望为临床及时发现DPN、稳定控制DPN并发症提供早期影像学依据.

目的 探讨多发性大动脉炎(Takayasu Arteritis,TA)轻症患者疾病活动性与脑血流动力学和认知功能的变化关系及临床意义.方法 选取2017年8月至2020年8月于我院就诊的轻症TA患者67例(TA组)与健康体检者60名(对照组).所有受试者均采用经颅彩色多普勒测量颅内大血管的收缩期峰值血流速度(Peak Systolic Velocity,PSV)、舒张末期血流速度(End Diastolic Velocity,EDV)、搏动指数(Pulsatility Index,PI)、阻力指数(Resistance Index,RI).采用简易精神状态评价量表(Mini-Mental State Examination,MMSE)评估MMSE总分.依据Kerr评分评估TA组疾病活动性,分析TA活动性与脑血流及认知的关系.结果 轻症TA患者右侧大脑中动脉(Middle Cerebral Artery,MCA)和基底动脉的PSV、RI、PI,双侧椎动脉的PSV、EDV、RI、PI,左侧MCA的PSV,左侧大脑后动脉的PI值均高于对照组(P<0.05);另外,轻症TA患者的MMSE总分明显低于对照组(P<0.05),且与Kerr评分呈负相关(r=-0.665,P<0.05),而Kerr评分与脑血流动力学各参数无显著相关性;轻症TA患者脑血流异常参数综合与MMSE总分呈显著性相关(r=0.539,P<0.05).结论 轻症TA患者未出现明显血管狭窄时,脑血流动力学参数及认知功能已出现异常,且随着疾病活动性的加重,认知功能损害也加重,提示临床需尽早关注轻症TA患者脑血流动力学和认知功能改变,及时干预以改善患者预后.

Abstract Background Cervical plexus (CP) tumours are difficult to diagnose because of atypical symptoms. This study aimed to summarize the features of a normal CP and CP tumours observed on high-frequency ultrasonography. Methods The ultrasound data of 11 CP tumour patients and 22 normal volunteers were collected. All 11 patients underwent magnetic resonance imaging (MRI), and 4 patients also underwent computed tomography (CT). The imaging data were compared with surgery and pathology data. Results The C7 vertebra and bifurcation of the carotid common artery (CCA) were useful anatomic markers for identifying the CP. In contrast to the C1 nerve (22.7%), the C2-4 nerves were well displayed and thinner than the brachial plexus (P < 0.05). CP tumours were more common in females (72.7%) and generally located at C4 (72.7%) on the right side (81.8%). Additionally, the nerve trunk in tumour patients was obviously wider than that in normal controls (7.49 ± 1.03 mm vs 2.67 ± 0.36 mm, P < 0.01). Compared with pathology, the diagnostic rates of CP tumours by MRI, CT and high-frequency ultrasound were 72.7% (8/11), 25% (1/4) and 90.9% (10/11), respectively. Conclusions The diagnosis of CP neuropathy is accurate and reliable by high-frequency ultrasound, and the C7 vertebra and bifurcation of the CCA are useful anatomic markers in CP ultrasonography.

目的 观察多灶性运动神经病(MMN)患者周围神经的超声特征.方法 纳入8例MMN患者(MMN组)及18名健康志愿者(对照组),观察MMN超声特征,并与肌电图诊断结果对比,比较组间周围神经横截面积(CSA)的差异.结果 超声与肌电图共检查8例MMN患者的96条周围神经,诊断周围神经异常率分别为32.29％(31/96)及31.25％(30/96),均以正中神经(68.75％ vs 56.25％)及尺神经(50.00％ vs 56.25％)异常为主.超声及肌电图对其中73条(73/96,76.04％)的诊断结果一致,超声表现包括神经增粗、回声减低、束状结构消失及外膜回声增强.MMN组双侧正中神经、双侧尺神经及左侧腓总神经CSA明显大于对照组(P均＜0.05),其余神经CSA组间差异均无统计学意义(P均＞0.05).结论 MMN超声异常多见于上肢正中神经及尺神经,与肌电图检查结果结合可为临床诊断MMN提供更多信息.

目的 评价超声在诊断军事训练软组织损伤、超声引导下介入治疗及术后监测随访中的应用价值.方法 选取2015年6月至2018年6月于空军军医大学第一附属医院检查的军事训练伤官兵患者198例,所有患者均对损伤部位进行超声检查,结合患者病情及意愿,选择保守治疗或行超声引导下介入治疗,所有患者均于治疗后1～3个月进行随访,依据超声检查结果及临床症状改善情况分为治愈、好转和无明显变化.总有效率=治愈率+好转率.比较2种治疗方法的疗效,分析军事训练伤超声表现及随访结果.结果 198例确诊为军事训练伤软组织损伤的患者中,131例接受超声引导下介入治疗,67例采取保守治疗.131例接受超声引导下介入治疗的患者中治愈99例,好转30例,无明显变化2例,总有效率为98.5％;67例接受保守治疗的患者中治愈26例,好转24例,无明显变化17例,总有效率为74.6％,2者总有效率比较差异有统计学意义(χ2=29.05,P<0.05).在治疗有效的各种类型软组织损伤患者中,超声随访均表现为厚度、回声、血流等较治疗前情况好转或恢复正常.结论 高频超声能够准确诊断军事训练软组织损伤,精准定位实时引导微创治疗,并可动态监测康复情况,值得临床推广应用.

Objective To explore the effect of single level lumbar disc herniation on the morphology and diameter of sciatic nerve,and to identify the correlation between the diameter change in sciatic nerve and severity of clinical symptoms,as well as the prognosis of surgical treatment in patients with lumbar disc herniation.Methods From January 1,2017 to December 31,2017,Seventy lumbar disc herniation (LDH) patients who underwent single-level posterior lumbar spine surgery were recruited in this retrospective analysis study.Specific data including age,gender,the level of a disc herniation,the type of disc herniation,symptomatic side,surgical procedure were recorded respectively.In addition the morphological changes and the diameter of bilateral sciatic nerve were recorded preoperatively and postoperatively by B-mode ultrasound.Furthermore,the pain in patients and neurological function were evaluated by visual analogue scale (VAS,back pain and leg pain),Japanese orthopaedic association scores-lumbar (JOA) and Oswestry disability index (ODI).The correlation between the diameter of sciatic nerve and clinical features,as well as clinical prognosis of patients were identified in the present study.Results For patients with acute lumbar disc herniation,the diameter of sciatic nerve in affected side was 5.19±1.03 ram,which is significantly higher than that in the unaffected side (4.57±0.64 mm,t=6.735,P=0.000).In addition,preoperative ratio of the affected side to the healthy side of the sciatic nerve showed strong correlation with the VAS of leg pain (r=0.838,P=0.001),JOA (r=-0.857,P=0.001),and ODI score(r=0.881,P=0.000),but not with the VAS of back pain (r=-0.061,P=0.614).Three months after surgery,the diameter of sciatic nerve in the affected side decreased to 4.58±0.63 mm (t=6.865,P=0.000),while the unaffected side showed no significant change(t=0.300,P=0.765).Clinical improvement was observed in all the patients postoperatively.The changes in the diameter of sciatic nerve postoperatively in affected side showed strong correlation to the rate of improvement in VAS of leg (r=0.624,P=0.003),JOA(r=0.615,P=0.003) and ODI scores (r=0.722,P=0.002),but not to the rate of improvement in VAS of back (r=-0.025,P=0.836).Conclusion Single root compression in patients with single level disc herniation might cause morphological changes such as thickening and edema in sciatic nerve,which were closely related to the severity of clinical symptoms and the prognosis of surgical treatment.

Background:Computer-aided diagnosis (CAD) systems are being applied to the ultrasonographic diagnosis of malignant thyroid nodules, but it remains controversial whether the systems add any accuracy for radiologists.Objective:To determine the accuracy of CAD systems in diagnosing malignant thyroid nodules.Methods:PubMed, EMBASE, and the Cochrane Library were searched for studies on the diagnostic performance of CAD systems. The diagnostic performance was assessed by pooled sensitivity and specificity, and their accuracy was compared with that of radiologists. The present systematic review was registered in PROSPERO (CRD42019134460).Results:Nineteen studies with 4,781 thyroid nodules were included. Both the classic machine learning- and the deep learning-based CAD system had good performance in diagnosing malignant thyroid nodules (classic machine learning: sensitivity 0.86 [95% CI 0.79-0.92], specificity 0.85 [95% CI 0.77-0.91], diagnostic odds ratio (DOR) 37.41 [95% CI 24.91-56.20]; deep learning: sensitivity 0.89 [95% CI 0.81-0.93], specificity 0.84 [95% CI 0.75-0.90], DOR 40.87 [95% CI 18.13-92.13]). The diagnostic performance of the deep learning-based CAD system was comparable to that of the radiologists (sensitivity 0.87 [95% CI 0.78-0.93] vs. 0.87 [95% CI 0.85-0.89], specificity 0.85 [95% CI 0.76-0.91] vs. 0.87 [95% CI 0.81-0.91], DOR 40.12 [95% CI 15.58-103.33] vs. DOR 44.88 [95% CI 30.71-65.57]).Conclusions:The CAD systems demonstrated good performance in diagnosing malignant thyroid nodules. However, experienced radiologists may still have an advantage over CAD systems during real-time diagnosis.