高频超声在外周神经疾病诊断中的应用
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摘要
目的：探讨非创伤性上肢神经束扭转的高频超声诊断价值。
材料与方法：收集15例上肢神经扭转的患者进行检查,所有患者均行高频超声检查,5例患者同时行磁共振检查。其中,男11例,女4例,年龄18-42岁,15例患者均无明显外伤史,均为单侧上肢发病。将高频探头(9-14MHz)置于上肢体表由近心侧向远心侧直接扫查,二维超声连续扫查臂丛神经、上肢的桡神经、正中神经及尺神经,着重观察上臂中段以远及肘关节水平神经束的走行,特别是桡神经主干及桡神经深支的近心段,观察神经的内径及其回声改变,双侧对比观察,测量并记录患侧神经束及对侧相应位置正常神经束的内径。同时注意神经周围的解剖结构,神经有无卡压等。当发现神经病变,均准确定位病变的位置及病变累及的范围,并体表标记扭转的位置,用“×”表示。其中5例患者行3.0T磁共振检查,对患者主要采用T1加权成像、T2加权成像、T1压脂成像、T2压脂成像及弥散背景抑制成像等序列进行检查,观察神经束的走行、内径及其信号的改变,并观察神经束周围有无异常解剖结构。分析非创伤性上肢神经扭转的高频超声声像图及磁共振影像特征,并与临床外科手术所见进行对照。对扭转神经束的内径与对侧正常肢体相应位置神经束内径进行配对t检验,应用SPSS13.0软件进行统计分析,以p<0.05认为有统计学意义。
结果：高频超声均可清晰显示各神经束的走行及其内部的束膜结构。本组15例神经束扭转患者高频超声及5例磁共振神经检查均做出准确诊断,诊断符合率为100%。15例非创伤性神经束扭转的患者中,13例为单纯桡神经扭转,1例尺神经扭转,另1例为正中神经合并桡神经扭转。13例单纯桡神经扭转中仅累及桡神经深支的有2例,余11例均累及上臂桡神经主干。15例神经束扭转中单发神经扭转5例,多发神经扭转10例。上肢非创伤性神经束扭转声像图表现为单发或者多节段性沙漏样改变,沙漏样改变两端神经束增粗,回声减低,内部筛网状束膜结构显示不清。扭转的神经束内径约0.284±0.05cm,而对侧健康肢体相应位置神经束宽约0.23+0.04cm,行配对t检验得出t值为9.542(p<0.01)。
结论：高频超声可作为诊断上肢外周神经非创伤性扭转的首选影像学检查方法,可对临床外周神经手术术前评估及术式的选择具有重要的意义。
目的：探讨高频超声对外周神经肿瘤的诊断价值。
方法：收集46例外周神经肿瘤患者进行高频超声检查,其中男性28例,女性18例,年龄2-76岁,平均年龄37.8岁。46例患者中36例因单一肿物就诊,另10例为多发肿物。对肿物采用高频探头(9～14MHz)连续扫查,注意与病变部位相连的神经形态、回声及其内部结构等,并与血管、肌腱、韧带等的回声相鉴别。发现病变后,均准确定位病变的位置及病变累及的范围,并作体表标记。其中11例患者行磁共振检查,对患肢主要采用T1加权成像、T2加权成像、T1压脂成像、T2压脂成像等序列进行检查,观察肿瘤的形态、内部信号改变及其与周围的解剖关系等。
结果：46例外周神经肿瘤患者中,超声及磁共振检查均发现肿物并准确定位,其中神经鞘瘤29例,神经纤维瘤8例,脂肪纤维错构瘤9例。其中10例多发肿物,均为神经鞘瘤。46例患者中,肿瘤位于正中神经17例,尺神经13例,桡神经5例,腓总神经6例,胫神经5例,皮神经4例,臂丛神经2例。
正常外周神经声像图在其长轴表现为条索状相互平行的低回声束,短轴表现为筛网状结构。实时观察外周神经位置相对恒定,不随肌肉、肌腱和韧带而运动。
神经鞘瘤纵切面表现为低回声实性肿块,边界清晰,形态规则,呈纺锤形,其两端与神经相连,呈鼠尾样改变,内部回声欠均匀,内部多见囊变及出血等无回声区,彩色多普勒显像显示其内可见较丰富的血流信号显示,部分多发神经鞘瘤声像图为沿神经分布的串珠样结节,边界清晰。
神经纤维瘤声像图表现分为三型：结节型、丛状及弥漫型,其中结节型神经纤维瘤瘤最为常见,其声像图与神经鞘瘤类似；丛状及弥漫型神经纤维瘤较为少见,其中丛状表现为皮下多发低回声结节,呈串珠样改变,无明显边界；弥漫型可见皮下浅筋膜层弥漫型增厚,结构紊乱,弥漫分布丛状及类圆形的低回声结节,呈类淋巴水肿样改变。
脂肪纤维错构瘤声像图表现为：神经明显增粗,呈膨胀性生长,纵切面神经内可见分布不均的条状低回声神经纤维和高回声脂肪组织相间的结构,呈“电缆状”；横断面表现为点状低回声和强回声相间,呈“莲藕状”。彩色多普勒显示,增粗的神经内未见血流信号显示。
结论：高频超声可作为诊断外周神经肿瘤首选的影像学检查方法,可对临床外周神经肿瘤术前评估及术式的选择具有重要的意义。
Objective:To evaluate the role of high frequency ultrasonography in the diagnosis of non-traumatic nerve fascicle torsion of the upper extremity.
Materials and Methods:15patients (age range18-42years,4female,11male) who underwent surgical treatment for nerve fascicle torsion were included in the study. There were no traumatic histories in all patients, who were affected unilaterally. Nerve fascicles of the upper extremity (brachial plexus, radial nerve, median nerve and ulnar nerve) were examined from shoulder joint to wrist joint, focusing on the distal segment of the upper arm and elbow joint. The radial nerve trunk and the proximal segment of deep branch of radial nerve were observed intensively. The location, diameter, echoic change, and peripheral anatomy structures of the nerve fascicles were observed. The location of the nerve torsion was marked by cross "x". The contralateral upper extremity was also observed as control, when necessary. In addition, five patients were examined using a commercially available clinical3.0T MRI system. The T1-weighted imaging and T2-weighted imaging, fat suppressed T1-weighted imaging, fat suppressed T2-weighted imaging and diffusion weighted MR neurography (DW-MRN) were performed. The location, diameter, signal change, and peripheral anatomy structures of the nerve fascicles were observed. The imaging characterization of non-traumatic nerve fascicle torsion in high frequency ultrasonography and MR were analyzed, and was compared with the surgical findings. The SPSS program (version13.0, SPSS, Chicago, IL, USA) was used for statistical analysis. Analysis of the paired t-test was adopted. There were significant differences between the nerve fascicle torsion and the normal nerve fascicle of contralateral upper extremity (p<0.05).
Results:Both high frequency ultrasonography and MRI clearly showed nerve fascicles and peripheral soft-tissue structures.15patients were accurately diagnosed as nerve fascicle torsion preoperatively using ultrasonography and MRI. Among15 patients, there were13patients of radial nerve torsion,1patient of ulnar nerve torsion,1patient of radial nerve and median nerve torsion. In13patients of radial nerve torsion, there were deep branch of radial nerve torsion in2patients and the radial nerve trunk torsion in11patients. In15patients, there were single-segmental torsion in5patients and multi-segmental torsion in10patients.
The hourglass-shaped appearance was a characteristic feature of nerve fascicle torsion, the affected segmental nerve fascicles were hypoechoic with increased diameters at ultrasonography, and had long T1and long T2signals at MRI. The mean diameter of nerve fascicle torsion at ultrasonography was0.28±0.05cm in15patients, and the mean diameter of that of the contralateral upper extremity was0.23±0.04cm. The SPSS program (version13.0, SPSS, Chicago, IL, USA) was used for statistical analysis. Analysis of the paired t-test was adopted. There were significant differences between the nerve fascicle torsion and the normal nerve fascicle of contralateral upper extremity (t=9.698,p<0.05).
Conclusion:High frequency ultrasonography may be valuable in the diagnosis of non-traumatic nerve fascicle torsion of the upper extremity, there was important value in clinical preoperative evaluation and surgical intervention.
Objective:To evaluate the role of high frequency ultrasonography in the diagnosis of peripheral nerve tumor.
Materials and Methods:46patients (age range2-76years, mean age37.8years) of peripheral nerve were retrospectively studied, including18females and28males. There were single tumor in36patients and multiple tumors in10patients. The tumors were examined by high frequency ultrasonography. The tumor location, diameter, echoic change, and peripheral anatomy structures of the tumors were observed. The contralateral extremity was also observed as control, when necessary. In addition,11patients were examined using a commercially available clinical3.0T MRI system. The T1-weighted imaging and T2-weighted imaging, fat suppressed T1-weighted imaging and fat suppressed T2-weighted imaging were performed. The location, diameter, signal change, and peripheral anatomy structures of tumors were observed.
Results:Both high frequency ultrasonography and MRI clearly showed tumors and peripheral soft-tissue structures. There were29schwannomas,8neurofibromas and9fibrolipomatous hamartomas. In10cases of multiple tumors, they were all schwannoma. Concerning tumor location, there were17cases of median nerve,13cases ulnar nerve,6cases common peroneal nerve,5cases tibial nerve,4cases cutaneous nerve and2cases brachial plexus.
Normal peripheral nerves on ultrasonography appeared as hypoechoic nerve fascicles and hyperechoic connective tissue. In the transverse plane, the peripheral nerve was relatively hyperechoic compared with surrounding muscle tissue. In the longitudinal plane, the peripheral nerve had a linear fascicular appearance. The peripheral nerve location was relative constant by real-time observation, not with muscles, tendons and ligaments movement.
Schwannoma on ultrasonography appeared as low echo mass with clear boundary, the tumors of the upper edge and lower edge were associated with nerve, like a rat-tail appearance. There were multiple cystic and hemorrhagic no-echo area in tumors, there were rich blood flow signals in Schwannoma. The sonography of multiple schwannomas appeared as beaded nodular along the nerve.
The features of neurofibroma sonography were divided into three types: localized type, plexiform type and diffuse type. The localized type was the most common, which sonography was similar to Schwannoma. The plexiform type and diffuse type was relatively rare. The plexiform type of neurofibroma appeared as multiple hypoechoic nodules, which was bead-like change and without obvious boundary. The diffuse type appeared as subcutaneous fascia layer diffuse thickening, structure disorder, diffuse distribution of plexiform hypoechoic nodules, which was similar to lymphedema.
The fibrolipomatous hamartoma of peripheral nerve was showed expansive growth. The hyperechoic fat tissue and hypoechoic nerve fibers were alternated with one and another, the peripheral nerve was lotus-like appearance in the transverse plane, and cable-like appearance in the longitudinal plane. There were no blood flow signals in nerves.
Conclusions:High frequency ultrasonography may be valuable in the diagnosis of peripheral nerve tumors, thus helpful in clinical preoperative evaluation and surgical intervention.
材料与方法：收集15例上肢神经扭转的患者进行检查,所有患者均行高频超声检查,5例患者同时行磁共振检查。其中,男11例,女4例,年龄18-42岁,15例患者均无明显外伤史,均为单侧上肢发病。将高频探头(9-14MHz)置于上肢体表由近心侧向远心侧直接扫查,二维超声连续扫查臂丛神经、上肢的桡神经、正中神经及尺神经,着重观察上臂中段以远及肘关节水平神经束的走行,特别是桡神经主干及桡神经深支的近心段,观察神经的内径及其回声改变,双侧对比观察,测量并记录患侧神经束及对侧相应位置正常神经束的内径。同时注意神经周围的解剖结构,神经有无卡压等。当发现神经病变,均准确定位病变的位置及病变累及的范围,并体表标记扭转的位置,用“×”表示。其中5例患者行3.0T磁共振检查,对患者主要采用T1加权成像、T2加权成像、T1压脂成像、T2压脂成像及弥散背景抑制成像等序列进行检查,观察神经束的走行、内径及其信号的改变,并观察神经束周围有无异常解剖结构。分析非创伤性上肢神经扭转的高频超声声像图及磁共振影像特征,并与临床外科手术所见进行对照。对扭转神经束的内径与对侧正常肢体相应位置神经束内径进行配对t检验,应用SPSS13.0软件进行统计分析,以p<0.05认为有统计学意义。
结果：高频超声均可清晰显示各神经束的走行及其内部的束膜结构。本组15例神经束扭转患者高频超声及5例磁共振神经检查均做出准确诊断,诊断符合率为100%。15例非创伤性神经束扭转的患者中,13例为单纯桡神经扭转,1例尺神经扭转,另1例为正中神经合并桡神经扭转。13例单纯桡神经扭转中仅累及桡神经深支的有2例,余11例均累及上臂桡神经主干。15例神经束扭转中单发神经扭转5例,多发神经扭转10例。上肢非创伤性神经束扭转声像图表现为单发或者多节段性沙漏样改变,沙漏样改变两端神经束增粗,回声减低,内部筛网状束膜结构显示不清。扭转的神经束内径约0.284±0.05cm,而对侧健康肢体相应位置神经束宽约0.23+0.04cm,行配对t检验得出t值为9.542(p<0.01)。
结论：高频超声可作为诊断上肢外周神经非创伤性扭转的首选影像学检查方法,可对临床外周神经手术术前评估及术式的选择具有重要的意义。
目的：探讨高频超声对外周神经肿瘤的诊断价值。
方法：收集46例外周神经肿瘤患者进行高频超声检查,其中男性28例,女性18例,年龄2-76岁,平均年龄37.8岁。46例患者中36例因单一肿物就诊,另10例为多发肿物。对肿物采用高频探头(9～14MHz)连续扫查,注意与病变部位相连的神经形态、回声及其内部结构等,并与血管、肌腱、韧带等的回声相鉴别。发现病变后,均准确定位病变的位置及病变累及的范围,并作体表标记。其中11例患者行磁共振检查,对患肢主要采用T1加权成像、T2加权成像、T1压脂成像、T2压脂成像等序列进行检查,观察肿瘤的形态、内部信号改变及其与周围的解剖关系等。
结果：46例外周神经肿瘤患者中,超声及磁共振检查均发现肿物并准确定位,其中神经鞘瘤29例,神经纤维瘤8例,脂肪纤维错构瘤9例。其中10例多发肿物,均为神经鞘瘤。46例患者中,肿瘤位于正中神经17例,尺神经13例,桡神经5例,腓总神经6例,胫神经5例,皮神经4例,臂丛神经2例。
正常外周神经声像图在其长轴表现为条索状相互平行的低回声束,短轴表现为筛网状结构。实时观察外周神经位置相对恒定,不随肌肉、肌腱和韧带而运动。
神经鞘瘤纵切面表现为低回声实性肿块,边界清晰,形态规则,呈纺锤形,其两端与神经相连,呈鼠尾样改变,内部回声欠均匀,内部多见囊变及出血等无回声区,彩色多普勒显像显示其内可见较丰富的血流信号显示,部分多发神经鞘瘤声像图为沿神经分布的串珠样结节,边界清晰。
神经纤维瘤声像图表现分为三型：结节型、丛状及弥漫型,其中结节型神经纤维瘤瘤最为常见,其声像图与神经鞘瘤类似；丛状及弥漫型神经纤维瘤较为少见,其中丛状表现为皮下多发低回声结节,呈串珠样改变,无明显边界；弥漫型可见皮下浅筋膜层弥漫型增厚,结构紊乱,弥漫分布丛状及类圆形的低回声结节,呈类淋巴水肿样改变。
脂肪纤维错构瘤声像图表现为：神经明显增粗,呈膨胀性生长,纵切面神经内可见分布不均的条状低回声神经纤维和高回声脂肪组织相间的结构,呈“电缆状”；横断面表现为点状低回声和强回声相间,呈“莲藕状”。彩色多普勒显示,增粗的神经内未见血流信号显示。
结论：高频超声可作为诊断外周神经肿瘤首选的影像学检查方法,可对临床外周神经肿瘤术前评估及术式的选择具有重要的意义。
Objective:To evaluate the role of high frequency ultrasonography in the diagnosis of non-traumatic nerve fascicle torsion of the upper extremity.
Materials and Methods:15patients (age range18-42years,4female,11male) who underwent surgical treatment for nerve fascicle torsion were included in the study. There were no traumatic histories in all patients, who were affected unilaterally. Nerve fascicles of the upper extremity (brachial plexus, radial nerve, median nerve and ulnar nerve) were examined from shoulder joint to wrist joint, focusing on the distal segment of the upper arm and elbow joint. The radial nerve trunk and the proximal segment of deep branch of radial nerve were observed intensively. The location, diameter, echoic change, and peripheral anatomy structures of the nerve fascicles were observed. The location of the nerve torsion was marked by cross "x". The contralateral upper extremity was also observed as control, when necessary. In addition, five patients were examined using a commercially available clinical3.0T MRI system. The T1-weighted imaging and T2-weighted imaging, fat suppressed T1-weighted imaging, fat suppressed T2-weighted imaging and diffusion weighted MR neurography (DW-MRN) were performed. The location, diameter, signal change, and peripheral anatomy structures of the nerve fascicles were observed. The imaging characterization of non-traumatic nerve fascicle torsion in high frequency ultrasonography and MR were analyzed, and was compared with the surgical findings. The SPSS program (version13.0, SPSS, Chicago, IL, USA) was used for statistical analysis. Analysis of the paired t-test was adopted. There were significant differences between the nerve fascicle torsion and the normal nerve fascicle of contralateral upper extremity (p<0.05).
Results:Both high frequency ultrasonography and MRI clearly showed nerve fascicles and peripheral soft-tissue structures.15patients were accurately diagnosed as nerve fascicle torsion preoperatively using ultrasonography and MRI. Among15 patients, there were13patients of radial nerve torsion,1patient of ulnar nerve torsion,1patient of radial nerve and median nerve torsion. In13patients of radial nerve torsion, there were deep branch of radial nerve torsion in2patients and the radial nerve trunk torsion in11patients. In15patients, there were single-segmental torsion in5patients and multi-segmental torsion in10patients.
The hourglass-shaped appearance was a characteristic feature of nerve fascicle torsion, the affected segmental nerve fascicles were hypoechoic with increased diameters at ultrasonography, and had long T1and long T2signals at MRI. The mean diameter of nerve fascicle torsion at ultrasonography was0.28±0.05cm in15patients, and the mean diameter of that of the contralateral upper extremity was0.23±0.04cm. The SPSS program (version13.0, SPSS, Chicago, IL, USA) was used for statistical analysis. Analysis of the paired t-test was adopted. There were significant differences between the nerve fascicle torsion and the normal nerve fascicle of contralateral upper extremity (t=9.698,p<0.05).
Conclusion:High frequency ultrasonography may be valuable in the diagnosis of non-traumatic nerve fascicle torsion of the upper extremity, there was important value in clinical preoperative evaluation and surgical intervention.
Objective:To evaluate the role of high frequency ultrasonography in the diagnosis of peripheral nerve tumor.
Materials and Methods:46patients (age range2-76years, mean age37.8years) of peripheral nerve were retrospectively studied, including18females and28males. There were single tumor in36patients and multiple tumors in10patients. The tumors were examined by high frequency ultrasonography. The tumor location, diameter, echoic change, and peripheral anatomy structures of the tumors were observed. The contralateral extremity was also observed as control, when necessary. In addition,11patients were examined using a commercially available clinical3.0T MRI system. The T1-weighted imaging and T2-weighted imaging, fat suppressed T1-weighted imaging and fat suppressed T2-weighted imaging were performed. The location, diameter, signal change, and peripheral anatomy structures of tumors were observed.
Results:Both high frequency ultrasonography and MRI clearly showed tumors and peripheral soft-tissue structures. There were29schwannomas,8neurofibromas and9fibrolipomatous hamartomas. In10cases of multiple tumors, they were all schwannoma. Concerning tumor location, there were17cases of median nerve,13cases ulnar nerve,6cases common peroneal nerve,5cases tibial nerve,4cases cutaneous nerve and2cases brachial plexus.
Normal peripheral nerves on ultrasonography appeared as hypoechoic nerve fascicles and hyperechoic connective tissue. In the transverse plane, the peripheral nerve was relatively hyperechoic compared with surrounding muscle tissue. In the longitudinal plane, the peripheral nerve had a linear fascicular appearance. The peripheral nerve location was relative constant by real-time observation, not with muscles, tendons and ligaments movement.
Schwannoma on ultrasonography appeared as low echo mass with clear boundary, the tumors of the upper edge and lower edge were associated with nerve, like a rat-tail appearance. There were multiple cystic and hemorrhagic no-echo area in tumors, there were rich blood flow signals in Schwannoma. The sonography of multiple schwannomas appeared as beaded nodular along the nerve.
The features of neurofibroma sonography were divided into three types: localized type, plexiform type and diffuse type. The localized type was the most common, which sonography was similar to Schwannoma. The plexiform type and diffuse type was relatively rare. The plexiform type of neurofibroma appeared as multiple hypoechoic nodules, which was bead-like change and without obvious boundary. The diffuse type appeared as subcutaneous fascia layer diffuse thickening, structure disorder, diffuse distribution of plexiform hypoechoic nodules, which was similar to lymphedema.
The fibrolipomatous hamartoma of peripheral nerve was showed expansive growth. The hyperechoic fat tissue and hypoechoic nerve fibers were alternated with one and another, the peripheral nerve was lotus-like appearance in the transverse plane, and cable-like appearance in the longitudinal plane. There were no blood flow signals in nerves.
Conclusions:High frequency ultrasonography may be valuable in the diagnosis of peripheral nerve tumors, thus helpful in clinical preoperative evaluation and surgical intervention.
引文
1 潘勇卫,王澎寰,韦加宁.非创伤性桡神经麻痹伴神经多段束带样病变.中华外科杂志,2001；39：285-287..
2 Fernandez E, Di Rienzo A, Marchese E, et al. Radial nerve palsy caused by spontaneously occurring nerve torsion:case report. J Neurosurg 2001; 94: 627-629.
3 Rossey-Marec D, Simonet J, Beccari R, et al. Ultrasonographic appearance of idiopathic radial nerve constriction proximal to the elbow. J Ultrasound Med 2004; 23:1003-1007.
4吴可晚,陈为民,陈德松,等.超声检查在桡神经自发性多段缩窄病变中的应用.中华手外科杂志.2010,26：261-263.
5孙倩,张聪建,李自力,等.高频超声在外周神经损伤中的应用.中华超声影像学杂志.2012,21：178-179.
6陈定章,周晓东,朱永胜,等.超声诊断外周神经病变的临床价值.中华超声影像学杂志.2006,15：514-516.
7 Abe T, Hoshiko M, Shinohara N, et al. Isolated paralysis of the deep branch of the radial nerve thought to be the entrapment neuropathy [in Japanese]. Rinsho Seikei Geka 1966; 1:617-216.
8 Voiculescu V, Popescu F. Progressive non-traumatic paralysis of the deep branch of the radial nerve. Rom Med Rev.1969; 13(4):48-51.
9 Stellbrink G. Diskussions bemerkung zu Englert HM:partielle faszikulare Medianus-Atrophie ungeklarter Genese. Handchirurgie 1976; 8:62.
10 Yasunaga H, Shiroishi T, Ohta K, et al. Fascicular torsion in the median nerve within the distal third of the upper arm:three cases of nontraumatic anterior interosseous nerve palsy. J Hand Surg (Am) 2003; 28:206-211.
11 Hosi K, Ochiai N, Shinoda H, et al. Median nerve paresis with hourglass deformed funiculi:a case report [in Japanese]. Rinsho Useikeigeka 1993; 28:1171-1174
12 Nagano A, Shibata K, Tokimura H, et al. Spontaneous anterior interosseous nerve palsy with hourglass-like fascicular constriction within the main trunk of the median nerve. J Hand Surg (Am) 1996; 21:266-270.
13 Yasunaga H, Shiroishi T, Ohta K, et al. Fascicular torsion in the median nerve within the distal third of the upper arm:three cases of nontraumatic anterior interosseous nerve palsy. J Hand Surg (Am) 2003; 28:206-211
14 Lundborg G. Commentary:hourglass-like fascicular nerve compressions. J Hand Surg 2003; 28:212-214.
15 Dellon AL, Mackinnon SE. Musculoaponeurotic variations along the course of the median nerve in the proximal forearm. J Hand Surg Br 1987; 12:359-363.
16顾玉东.沙漏样腊肠样非创伤性神经扭转病变的新认识——压迫易感性遗传性神经病.中华手外科杂志,2010；26(3)：129
17张成.遗传性周围神经病//王维治.神经病学.北京：人民卫生出版社.2006：419-423.
18 Qi HT, Wang XM, Li SY, et al. The role of ultrasonography and MRI in patients with non-traumatic nerve fascicle torsion of the upper extremity. Clinical Radiology,2013; 68(9):e479-e483.
19亓恒涛,王增涛,王德华,等.非创伤性上肢神经扭转的超声诊断价值探讨,中华超声影像学杂志,2013；22(6)：69-71.
20 Guerra WK, Schroeder HW. Peripheral nerve palsy by torsional nerve injury. Neurosurgery 2011; 68:1018-1024.
21吴可晚,陈德松,陈琳,等。桡神经自发性缩窄病变的诊断与治疗.中华外科杂志,2012；50(3)：283-284.
22曹洪艳,陈定章,丛锐,等.高频超声在肘管综合征诊断中的应用。中国超声医学杂志,2008；24(6)：546-548.
23 Kodama Y, Seo K, Hayashi T, et al. Orofacial pain related to traumatic neuroma in a patient with multiple TMJ operations. Cranio.2012; 30(3):183-187.
24 Zhu J, Liu F, Li D, et al. Preliminary study of the types of traumatic peripheral nerve injuries by ultrasound. Eur Radiol.201; 21(5):1097-1101.
25尹维田,李庆霖,张君,等.神经疏导与重建神经连续性预防及治疗神经瘤性残端痛。中华手外科杂志,2007；23：19-21.
26 Chiou HJ, Chou YH, Chiou SY, et al. Peripheral nerve lesions:role of high resolution US, Radiographic,2003; 20:e15.
27 Scheidl E, Bohm J, Farbaky Z, et al. The significance of high-resolution ultrasonography in the diagnosis of peripheral nerve disorders. Ideggyogy Sz. 2013;66(1-2):4-13.
28 Nair V, Nair RV, Mookambika RV, et al. Additional muscle fibers of brachioradialis with anomalous high origin and entrapment of radial nerve in an osseomuscular canal. Bratisl Lek Listy 2012; 113:622-623.
29王德华,王增涛,朱小雷,等.桡神经非创伤性神经束扭转的临床研究.实用骨科杂志,2009,15：745-746.
30 Karabay N, Toros T, Ademoglu Y, et al. Ultrasonogaphic evaluation of the iatrogenic peripheral nerve injuries in upper extremity. Eur J Radiol,2010; 73: 234-240.
31 Kotani H, Miki T., Senoku F, et al. Posterior interosseous nerve paralysis with multiple constrictions. J Hand Surg. Am,1995; 20:15-17.
1 Chiou HJ, Chou YH, Chiou SY, et al. Peripheral nerve lesions:role of high resolution US, Radiographic,2003; 20:e15.
2 Ricci S, Moro L, Antonelli Incalzi R. Ultrasound imaging of the sural nerve: ultrasound anatomy and rationale for investigation. Eur J Vasc Endovasc Surg. 2010; 39:636-641.
3 Stoll G, Wilder-Smith E, Bendszus M. Imaging of the peripheral nervous system. Handb Clin Neurol.2013; 115:137-153.
4 Kara M, Ozcakar L, De Muynck M, et al. Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med.2012; 48:665-674
5 Wu S, Liu G, Tu R. Value of ultrasonography in neurilemmoma diagnosis:the role of round shape morphology. Med Ultrason.2012; 14:192-196.
6 Hughes DG, Wilson DJ. Ultrasound appearances of peripheral nerve tumours. Br J Radiol.1986; 59(706):1041-1043.
7 Riccardi VM. Von Rechlinghausen neurofibromatosis. N Engl J Med.1981; 305: 1617-1627.
8陈定章,周晓东,朱永胜,等.超声诊断外周神经病变的临床价值.中华超声影像学杂志.2006；15：514-516.
9柏宁野,戴光华,郑辉.外周神经源肿瘤的声像图诊断与鉴别诊断分析.中国超声医学杂志.2001；17：309-311.
10 Kara M, Yilmaz A, Ozel S, et al. Sonographic imaging of the peripheral nerves in a patient with neurofibromatosis type 1. Muscle Nerve.2010; 41:887-888.
11陈文,贾建文,张华斌,等.高频超声对外周神经纤维瘤的诊断价值.中国超声医学杂志,2008；24：86-89.
12 Kara M, Ozcakar L, De Muynck M, et al. Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med.2012; 48:665-674.
13 Schaefer IM, Strobel P, Thiha A, et al. Soft tissue perineurioma and other unusual tumors in a patient with neurofibromatosis type 1. Int J Clin Exp Pathol.2013; 6(12):3003-3008
14 Ferner RE, Gutmann DH. Neurofibromatosis type 1 (NF1):diagnosis and management. Handb Clin Neurol.2013; 115:939-955
15 Riccardi VM. Von Rechlinghausen neurofibromatosis. N Engl J Med.1981; 305: 1617-1627.
16 Park SJ, Sawitzki B, Kluwe L, et al. Serum biomarkers for neurofibromatosis type I and early detection of malignant peripheral nerve-sheath tumors. BMC Med. 2013; 11:109
17田立杰.周围神经纤维脂肪瘤的命名、诊断与治疗.实用手外科杂志,2002,16：70-72.
18侯明钟.神经脂肪纤维错构瘤的命名.实用手外科杂志,2002,16：133.
19 Nielsen GP. Lipomatosis of nerve. In:Fletcher CD, Unni KK, Mertens F, editors. World Health Organization classification of tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon:IARC Press; 2002.
20 Cherqui A, Sulaiman WA, Kline DG Resection and nerve grafting of a lipofibrohamartoma of the median nerve:case report. Neurosurgery.2009,65: A229-235.
21 Ulrich D, Ulrich F, Schroeder M, et al. Lipofibromatous hamartoma of the median nerve in patients with macrodactyly:diagnosis and treatment of a rare disease causing carpal tunnel syndrome. Arch Orthop Trauma Surg.2009; 129: 1219-1224.
22 Ogose A, Hotta T, Higuchi T, et al. Fibrolipomatous hamartoma in the foot: magnetic resonance imaging and surgical treatment:a report of two cases. J Bone Joint Surg Am.2002; 84-A(3):432-436.
23 Toms AP, Anastakis D, Bleakney RR, et al. Lipofibromatous hamartoma of the upper extremity:a review of the radiologic findings for 15 patients. Am J Roentgenol.2006; 186(3):805-811.
24 Ardakani AS, Nematolahi P, Mohammadizadeh F, et al. A case of fibrolipomatous hamartoma of nerve arising from superficial peroneal nerve. J Res Med Sci.2007, 12:271-274.
25 Paltiel HL, Burrows PE, Mulliken JB. Color Doppler ultrasound of soft tissue vascular anomalies. Radiology.1994; 193:292-295.
26 Scalvenzi M, Francia MG, Raimondo A, et al. Ultrasonography in the management of a recurrent and eruptive lobular capillary hemangioma and resolution with intense pulsed light. Cutis.2013; 92(4):E5-8.
1 Martinoli C, Bianchi S, Dahmane M, et al. Ultrasound of tendons and nerves. Eur Radiol.2002; 12:44-55.
2 Chiou HJ, Chou YH, Chiou SY, et al. Peripheral nerve lesions:role of high resolution US, Radiographic,2003; 20:e15.
3 Kara M, Ozcakar L, De Muynck M, et al. Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med.2012; 48:665-674.
4 Kara M, Ozcakar L, Tiftik T, et al. Sonographic evaluation of sciatic nerves in patients with unilateral sciatica. Arch Phys Med Rehabil.2012; 93:1598-1602.
5 Kara M, Tiftik T, Yestisgin A, et al. Ultrasound in the diagnosis and treatment of posterior interosseous nerve entrapment:a case report. Muscle Nerve.2012; 45: 299-300.
6 Bianchi S, Martinoli C. Wrist. In:Bianchi S, Martinoli C, editors. Ultrasound of the Musculoskeletal system. Berlin, Germany:Springer-Verlag; 2007. P.425-492.
7 Aleman L, Berna J, Reus M, et al. Reliability of sonographic measurement of the median nerve. J Ultrasound Med.2008; 27:193-197.
8 Walker FO. Imaging nerve and muscle with ultrasound. SupplcClin Neurophysiol. 2004; 57:243-254.
9 Hammer HB, Hovden IAH, Haavardsholm EA, et al. Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpel tunnel syndrome. Rheumatology.2006; 45:584-588.
10 Lee D, Van Holsbeeck MT, Janevsdki PK, et al. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Radiol Clin North Am.1999; 37: 859-872.
11 Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome:a meta-analysis. Clin Orthop Relat Res. 2011; 469:1089-1094.
12 Beekman R, Schiemarker MC, Van Der Plas JP, et al. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology.2004; 62: 767-773.
13 Karatas A, Apaydin N, Uz A, et al. Regional anatomic atructures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg.2009; 18: 627-631.
14 Chiou HJ, Chou YH, Cheng SP, et al. Cubital tunnel syndrome:diagnosis by high-resolution ultrasonography. J Ultrasound Med.1998; 17:643-648.
15 Jacob D, Createur V, Courthaliac C, et al. Sonoanatomy of the ulnar nerve in the cubital tunnel:a multicentre study by the GEL. Eur Radiol.2004; 14:1770-1773.
16 Yoon JS, Walker FO, Cartwright MS, et al. Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve,2008; 38:1231-1235.
17 Kim BJ, Date ES, Lee SH, et al. Distance measure error induced by displacement of the ulnar nerve when the elbow is flexed. Arch Phys Med Rehabil.2005; 86: 809-812.
18 Bodner G, Buchberger W, Schocke M, et al. Radial nerve palsy associated with humeral shaft fracture:evaluation with US-initial experience. Radiology.2001; 219:811.
19 Beltran LS, Bencardino J, Ghazikhanian V, et al. Entrapment neuropathies III: lower limb. Semin Musculoskelet Radiol.2010; 14:501-511.
20赵新宇,鄂占森,徐文忠.高频超声检查肘部桡神经.中国医学影像技术.2010；26：778-779.
21 Fessell DP, Van Holsbeeck MT. Foot and ankle sonography. Radiol Clin North Am.1999; 37:831-858.
22 Chiou HJ, Chou YH, Choiu SY, et al. Peripheral nerve lesions:role of high-resolution US. Radiographics.2003; 23:e15.
23 Cokluk C, Aydin K. Ultrasound examination in the surgical treatment for upper extremity peripheral nerve injuries:part I. Turk Neurosurg.2007; 17:277-282.
24 Cokluk C, Aydin K, Senel A. Presurgical ultrasound assisted neuro-examination in the surgical repair of peripheral nerve injury. Minim Invasive Neurosurg.2004; 47: 169-172.
25 Kopf H, Loizides A, Mostbeck GH, et al. Diagnostic sonography of peripheral nerves:indications, examination techniques and pathological findings. Ultraschall Med.2011; 32:242-263.
26 Reynolds DL Jr, Jacobson JA, Inampudi P, et al. Sonographic characteristics of peripheral nerve sheath tumors. Am J Roentgenol.2004; 182:741-744.
27 Riccardi VM. Von Rechlinghausen neurofibromatosis. N Engl J Med.1981; 305: 1617-1627.
28殷春霞,邓荷萍,张哲民,等.正中神经脂肪纤维错构瘤超声表现2例.中华超声影像学杂志,2011,20：1058-1059.
29 Yamauchi T, Yoshii T, Sempuku T. Whether to excise a lipofibroma of the median nerve. Scand J Plast Reconstr Surg Hand Surg.2009,43:346-349.
30 Zeng R, Frederick-Dyer K, Ferguson NL, et al. Fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve). Skeletal Radiol.2012; 41:1323-1326.
31亓恒涛,王增涛,张先东,等.外周神经脂肪纤维错构瘤超声诊断价值的探讨,中华超声影像学杂志,2014,23(1)：58-60.
32 Cherqui A, Sulaiman WA, Kline DG. Resection and nerve grafting of a lipofibrohamartoma of the median nerve:case report. Neurosurgery.2009,65: A229-235.
33 Ly JQ, Bui-Mansfield LT, SanDiego JW, et al. Neural fibrolipoma of the foot. J Comput Assit Tomogr,2003,27:639-640.
2 Fernandez E, Di Rienzo A, Marchese E, et al. Radial nerve palsy caused by spontaneously occurring nerve torsion:case report. J Neurosurg 2001; 94: 627-629.
3 Rossey-Marec D, Simonet J, Beccari R, et al. Ultrasonographic appearance of idiopathic radial nerve constriction proximal to the elbow. J Ultrasound Med 2004; 23:1003-1007.
4吴可晚,陈为民,陈德松,等.超声检查在桡神经自发性多段缩窄病变中的应用.中华手外科杂志.2010,26：261-263.
5孙倩,张聪建,李自力,等.高频超声在外周神经损伤中的应用.中华超声影像学杂志.2012,21：178-179.
6陈定章,周晓东,朱永胜,等.超声诊断外周神经病变的临床价值.中华超声影像学杂志.2006,15：514-516.
7 Abe T, Hoshiko M, Shinohara N, et al. Isolated paralysis of the deep branch of the radial nerve thought to be the entrapment neuropathy [in Japanese]. Rinsho Seikei Geka 1966; 1:617-216.
8 Voiculescu V, Popescu F. Progressive non-traumatic paralysis of the deep branch of the radial nerve. Rom Med Rev.1969; 13(4):48-51.
9 Stellbrink G. Diskussions bemerkung zu Englert HM:partielle faszikulare Medianus-Atrophie ungeklarter Genese. Handchirurgie 1976; 8:62.
10 Yasunaga H, Shiroishi T, Ohta K, et al. Fascicular torsion in the median nerve within the distal third of the upper arm:three cases of nontraumatic anterior interosseous nerve palsy. J Hand Surg (Am) 2003; 28:206-211.
11 Hosi K, Ochiai N, Shinoda H, et al. Median nerve paresis with hourglass deformed funiculi:a case report [in Japanese]. Rinsho Useikeigeka 1993; 28:1171-1174
12 Nagano A, Shibata K, Tokimura H, et al. Spontaneous anterior interosseous nerve palsy with hourglass-like fascicular constriction within the main trunk of the median nerve. J Hand Surg (Am) 1996; 21:266-270.
13 Yasunaga H, Shiroishi T, Ohta K, et al. Fascicular torsion in the median nerve within the distal third of the upper arm:three cases of nontraumatic anterior interosseous nerve palsy. J Hand Surg (Am) 2003; 28:206-211
14 Lundborg G. Commentary:hourglass-like fascicular nerve compressions. J Hand Surg 2003; 28:212-214.
15 Dellon AL, Mackinnon SE. Musculoaponeurotic variations along the course of the median nerve in the proximal forearm. J Hand Surg Br 1987; 12:359-363.
16顾玉东.沙漏样腊肠样非创伤性神经扭转病变的新认识——压迫易感性遗传性神经病.中华手外科杂志,2010；26(3)：129
17张成.遗传性周围神经病//王维治.神经病学.北京：人民卫生出版社.2006：419-423.
18 Qi HT, Wang XM, Li SY, et al. The role of ultrasonography and MRI in patients with non-traumatic nerve fascicle torsion of the upper extremity. Clinical Radiology,2013; 68(9):e479-e483.
19亓恒涛,王增涛,王德华,等.非创伤性上肢神经扭转的超声诊断价值探讨,中华超声影像学杂志,2013；22(6)：69-71.
20 Guerra WK, Schroeder HW. Peripheral nerve palsy by torsional nerve injury. Neurosurgery 2011; 68:1018-1024.
21吴可晚,陈德松,陈琳,等。桡神经自发性缩窄病变的诊断与治疗.中华外科杂志,2012；50(3)：283-284.
22曹洪艳,陈定章,丛锐,等.高频超声在肘管综合征诊断中的应用。中国超声医学杂志,2008；24(6)：546-548.
23 Kodama Y, Seo K, Hayashi T, et al. Orofacial pain related to traumatic neuroma in a patient with multiple TMJ operations. Cranio.2012; 30(3):183-187.
24 Zhu J, Liu F, Li D, et al. Preliminary study of the types of traumatic peripheral nerve injuries by ultrasound. Eur Radiol.201; 21(5):1097-1101.
25尹维田,李庆霖,张君,等.神经疏导与重建神经连续性预防及治疗神经瘤性残端痛。中华手外科杂志,2007；23：19-21.
26 Chiou HJ, Chou YH, Chiou SY, et al. Peripheral nerve lesions:role of high resolution US, Radiographic,2003; 20:e15.
27 Scheidl E, Bohm J, Farbaky Z, et al. The significance of high-resolution ultrasonography in the diagnosis of peripheral nerve disorders. Ideggyogy Sz. 2013;66(1-2):4-13.
28 Nair V, Nair RV, Mookambika RV, et al. Additional muscle fibers of brachioradialis with anomalous high origin and entrapment of radial nerve in an osseomuscular canal. Bratisl Lek Listy 2012; 113:622-623.
29王德华,王增涛,朱小雷,等.桡神经非创伤性神经束扭转的临床研究.实用骨科杂志,2009,15：745-746.
30 Karabay N, Toros T, Ademoglu Y, et al. Ultrasonogaphic evaluation of the iatrogenic peripheral nerve injuries in upper extremity. Eur J Radiol,2010; 73: 234-240.
31 Kotani H, Miki T., Senoku F, et al. Posterior interosseous nerve paralysis with multiple constrictions. J Hand Surg. Am,1995; 20:15-17.
1 Chiou HJ, Chou YH, Chiou SY, et al. Peripheral nerve lesions:role of high resolution US, Radiographic,2003; 20:e15.
2 Ricci S, Moro L, Antonelli Incalzi R. Ultrasound imaging of the sural nerve: ultrasound anatomy and rationale for investigation. Eur J Vasc Endovasc Surg. 2010; 39:636-641.
3 Stoll G, Wilder-Smith E, Bendszus M. Imaging of the peripheral nervous system. Handb Clin Neurol.2013; 115:137-153.
4 Kara M, Ozcakar L, De Muynck M, et al. Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med.2012; 48:665-674
5 Wu S, Liu G, Tu R. Value of ultrasonography in neurilemmoma diagnosis:the role of round shape morphology. Med Ultrason.2012; 14:192-196.
6 Hughes DG, Wilson DJ. Ultrasound appearances of peripheral nerve tumours. Br J Radiol.1986; 59(706):1041-1043.
7 Riccardi VM. Von Rechlinghausen neurofibromatosis. N Engl J Med.1981; 305: 1617-1627.
8陈定章,周晓东,朱永胜,等.超声诊断外周神经病变的临床价值.中华超声影像学杂志.2006；15：514-516.
9柏宁野,戴光华,郑辉.外周神经源肿瘤的声像图诊断与鉴别诊断分析.中国超声医学杂志.2001；17：309-311.
10 Kara M, Yilmaz A, Ozel S, et al. Sonographic imaging of the peripheral nerves in a patient with neurofibromatosis type 1. Muscle Nerve.2010; 41:887-888.
11陈文,贾建文,张华斌,等.高频超声对外周神经纤维瘤的诊断价值.中国超声医学杂志,2008；24：86-89.
12 Kara M, Ozcakar L, De Muynck M, et al. Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med.2012; 48:665-674.
13 Schaefer IM, Strobel P, Thiha A, et al. Soft tissue perineurioma and other unusual tumors in a patient with neurofibromatosis type 1. Int J Clin Exp Pathol.2013; 6(12):3003-3008
14 Ferner RE, Gutmann DH. Neurofibromatosis type 1 (NF1):diagnosis and management. Handb Clin Neurol.2013; 115:939-955
15 Riccardi VM. Von Rechlinghausen neurofibromatosis. N Engl J Med.1981; 305: 1617-1627.
16 Park SJ, Sawitzki B, Kluwe L, et al. Serum biomarkers for neurofibromatosis type I and early detection of malignant peripheral nerve-sheath tumors. BMC Med. 2013; 11:109
17田立杰.周围神经纤维脂肪瘤的命名、诊断与治疗.实用手外科杂志,2002,16：70-72.
18侯明钟.神经脂肪纤维错构瘤的命名.实用手外科杂志,2002,16：133.
19 Nielsen GP. Lipomatosis of nerve. In:Fletcher CD, Unni KK, Mertens F, editors. World Health Organization classification of tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon:IARC Press; 2002.
20 Cherqui A, Sulaiman WA, Kline DG Resection and nerve grafting of a lipofibrohamartoma of the median nerve:case report. Neurosurgery.2009,65: A229-235.
21 Ulrich D, Ulrich F, Schroeder M, et al. Lipofibromatous hamartoma of the median nerve in patients with macrodactyly:diagnosis and treatment of a rare disease causing carpal tunnel syndrome. Arch Orthop Trauma Surg.2009; 129: 1219-1224.
22 Ogose A, Hotta T, Higuchi T, et al. Fibrolipomatous hamartoma in the foot: magnetic resonance imaging and surgical treatment:a report of two cases. J Bone Joint Surg Am.2002; 84-A(3):432-436.
23 Toms AP, Anastakis D, Bleakney RR, et al. Lipofibromatous hamartoma of the upper extremity:a review of the radiologic findings for 15 patients. Am J Roentgenol.2006; 186(3):805-811.
24 Ardakani AS, Nematolahi P, Mohammadizadeh F, et al. A case of fibrolipomatous hamartoma of nerve arising from superficial peroneal nerve. J Res Med Sci.2007, 12:271-274.
25 Paltiel HL, Burrows PE, Mulliken JB. Color Doppler ultrasound of soft tissue vascular anomalies. Radiology.1994; 193:292-295.
26 Scalvenzi M, Francia MG, Raimondo A, et al. Ultrasonography in the management of a recurrent and eruptive lobular capillary hemangioma and resolution with intense pulsed light. Cutis.2013; 92(4):E5-8.
1 Martinoli C, Bianchi S, Dahmane M, et al. Ultrasound of tendons and nerves. Eur Radiol.2002; 12:44-55.
2 Chiou HJ, Chou YH, Chiou SY, et al. Peripheral nerve lesions:role of high resolution US, Radiographic,2003; 20:e15.
3 Kara M, Ozcakar L, De Muynck M, et al. Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med.2012; 48:665-674.
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