超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 43(6): 683-691 (2018)
doi:10.11272/jss.43.683

研究Research Paper

当院における特発性前骨間神経麻痺の超音波検査経験Ultrasound Evaluation of Anterior Interosseous Nerve Paralysis in Our Hospital

1北海道大学病院検査・輸血部Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital

2北海道大学病院超音波センターDiagnostic Center for Sonography, Hokkaido University Hospital

3北海道大学大学院医学研究院整形外科学教室Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University

4北海道大学病院放射線部Department of Radiological Technology, Hokkaido University Hospital

受付日:2018年2月22日Received: February 22, 2018
受理日:2018年6月22日Accepted: June 22, 2018
発行日:2018年12月1日Published: December 1, 2018
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目的:特発性前骨間神経麻痺(sAINP)はまれな疾患であり,誘因なく母指指節間関節および示指遠位指節間関節が屈曲不能となる.自然回復する症例が多く,発症早期には保存的に経過観察される場合が多いが,発症後3~6か月で回復しない場合は保存療法に加え手術療法が考慮される.本疾患では,正中神経の神経束に“砂時計様くびれ”(“くびれ”)が存在することが注目されているが,術前画像診断は困難であった.しかし,近年の装置分解能向上の結果,超音波検査(US)による“くびれ”評価が可能となり,USのsAINP診断への貢献が期待されている.そこで,sAINP診断と治療効果判定におけるUSの有用性を当院での経験症例から後方視的に検討した.

対象と方法:2015年7月~2017年10月に,当院で臨床的にsAINPと診断されUSを施行した4例.被検者を検者と向かい合わせに座位とし,上肢を肘伸展位,屈側を上にした状態で,肘屈曲皮線より近位10 cm以内の正中神経本幹の神経束を高周波プローブ(18~24 MHz)にて評価した.

結果と考察:全例の神経束に短軸走査で径変化と長軸走査で“くびれ”を1~2カ所認め,そのくびれ率は42%~71%であった.4例中3例に手術が施行され,USで指摘した位置に最大“くびれ”が確認された.また,手術例では,その後のUSで“くびれ”の改善が確認されたが,軽度の“くびれ”の指摘は困難であった.

結論:USはsAINPの診断,治療方針決定,経過観察に寄与する可能性が示唆された.

Purpose: Spontaneous anterior interosseous nerve paralysis (sAINP) is a rare disease with sudden onset that causes difficulty in flexing the interphalangeal joint of the thumb and index finger. Improvement in most cases is achieved with conservative treatment and subsequently with surgery, such as interfascicular neurolysis, 3–6 months after onset if no improvement is observed. Although sAINP often presents with hourglass-like constrictions in some fascicles of a median nerve trunk, these findings are rarely detected with an imaging modality and are only identified during surgery. Recently, the development of ultrasonography (US) has facilitated detection of these constrictions on ultrasonography. The aim of this study was to evaluate the usefulness of US for sAINP.

Subjects and Methods: Four patients clinically diagnosed with sAINP underwent US at our institution between July 2015 and October 2017. US was performed to observe nerve fascicles in the median nerve trunk within 10 cm proximal from elbow flexion level and to identify fascicular constriction with an 18 to 24 MHz linear probe.

Results and Discussion: US revealed hourglass-like constrictions in all cases at one to two positions in one or two fascicles. In three of four cases, surgery was performed and the constrictions were confirmed at two positions in one fascicle. US revealed maximum constriction at the US marked position in all three cases and follow-up US revealed an improvement in constrictions, following surgery. However, one minor constriction in one patient was not detected.

Conclusion: Thus, this study suggests that US is useful for diagnosing sAINP and can therefore aid in determining the treatment strategy, and follow-up observation required.

Key words: anterior interosseous nerve paralysis; median nerve; nerve fascicle; hourglass-like constriction; ultrasonography

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This page was last modified on 2018-11-30T17:47:20.101+09:00


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