永存正中动脉并正中神经双支变异的超声诊断特征分析

doi:10.3877/cma.j.issn.2095-655X.2023.04.006

目的

探讨永存正中动脉并正中神经双支变异的超声诊断特征。

方法

回顾性分析2018年1月1日至2022年12月31日就诊于济宁医学院附属医院超声科的7例永存正中动脉并正中神经双支变异患者的临床及超声图像特征，其中3例手术确诊，总结永存正中动脉并正中神经双支变异的超声诊断学特征。

结果

7例患者临床症状多表现为前臂或腕部疼痛不适，常伴有桡侧手指麻木。超声诊断特征为前臂可显示异常搏动的管状无回声，与正中神经伴行，正中神经变异为两支束状的低回声，有独立的高回声神经外膜，二者并行进入腕管，腕管可见正中神经卡压，卡压处前后径1.6 mm~1.9 mm，近端正中神经肿胀增粗，前后径增大至2.8 mm~3.5 mm。3例患者经手术证实，术中发现正中神经肿胀，前臂段分为两支，与永存正中动脉伴行进入腕管，腕管内正中神经可见不同程度卡压。

结论

超声检查永存正中动脉并正中神经双支变异有明确的诊断学特征，对临床诊断有重要的指导意义。

关键词: 超声检查, 永存正中动脉, 正中神经, 诊断

Objective

To investigate the ultrasonic diagnostic characteristics of persistent median artery and median nerve double branch variation.

Methods

Retrospective analysis of the clinical and ultrasound image characteristics of 7 patients with persistent median artery and median nerve double branch variation treated at Ultrasound Department of the Affiliated Hospital of Jining Medical University between January 1, 2018, and December 31, 2022 was performed. Three of them were found surgically. The ultrasonic diagnostic characteristics of the persistent median artery and median nerve double branch variation were summarized.

Results

The majority of the 7 patients′ clinical complaints were forearm or wrist pain and discomfort, frequently accompanied with radial finger numbness. The ultrasonic diagnostic characteristics were as follows: the forearm showed abnormal pulsating tubular anecho, accompanied by the median nerve, the median nerve changed into two bundles of hypoecho, and there was an independent hyperechoic outer nerve membrane, both of which entered the carpal tunnel in parallel, and the median nerve entrapment can be seen in the carpal tunnel, and the anteroposterior diameter of the compression site was 1.6 mm-1.9 mm, and the proximal middle nerve was swollen and enlarged, and the anteroposterior diameter increased to 2.8 mm-3.5 mm. Surgery on 3 patients revealed different degrees of median nerve entrapment in the carpal tunnel and confirmed that the median nerve had swollen during the procedure. The forearm segment was split into two branches that entered the carpal tunnel with the permanent median artery.

Conclusion

Ultrasound examination of the persistent median artery and double branches of the median nerve has clear diagnostic characteristics, which has important guiding significance for clinical diagnosis.

Key words: Ultrasonography, Persistent median artery, Median nerve, Diagnosis

图1 永存正中动脉并正中神经双支变异患者的超声图像注：a图为患者右腕部永存正中动脉彩色多普勒图像，示动脉管腔内有离心方向的搏动性血流信号，黄色箭头为永存正中动脉；b图为永存正中动脉并正中神经双支变异图像，黄色箭头为永存正中动脉，红色箭头为正中神经双支；c图为患者右腕管内正中神经长轴切面图像，正中神经外膜表面凹陷可见压迹(黄色箭头)

图2 永存正中动脉并正中神经双支变异患者的术中图像注：a图示患者右腕部可见两支正中神经(N1，N2)明显肿胀增粗(箭头所示)；b图示术中切除的永存正中动脉，长度约55.0 mm，最大径约1.2 mm

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Ultrasonic diagnosis features of persistent median artery and median nerve double branch variation

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Ultrasonic diagnosis features of persistent median artery and median nerve double branch variation