Name: screening of axonal degeneration in carpal tunnel syndrome using ultrasonography and nerve conduction studies
Uploaded: 2019-01-11T14:30:00
Description: Watch this Scientific Journal Video about Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies at JoVE.com

薛登先生、胡勇博士和叶永玉博士致力于研究设计、选题、手稿起草和修改的概念。周丽香女士及赵淑仪女士专心致志于联络、收集资料及操纵非华语。梁国培博士致力于电生理诊断、临床指导和超声波操作。

所有程序均获香港大学/医院当局批准, 香港西机构检讨委员会 (hkuseha hkw irb, 编号: uw17-129)。
该方案适用于在手的神经支配的中位区域出现麻木、刺痛或疼痛等临床症状的患者, 在 tiinel 的体征和 phalen 的测试中, 结果呈阳性。那些合群的受试者, 如糖尿病、癌症、类风湿性关节炎和其他周围神经病, 不符合这一协议的条件。
1. 神经传导研究的测量
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<ol>
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S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discriminatory+sonographic+criteria+for+the+diagnosis+of+carpal+tunnel+syndrome.">Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome.</a> Arthritis &amp; Rheumatology. 46 (7), 1914-1921 (2002).</li><li>Mondelli, M., Filippou, G., Gallo, A., Frediani, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+utility+of+ultrasonography+versus.+nerve+conduction+studies+in+mild+carpal+tunnel+syndrome.">Diagnostic utility of ultrasonography versus. nerve conduction studies in mild carpal tunnel syndrome.</a> Arthritis &amp; Rheumatology. 59 (3), 357-366 (2008).</li><li>Wong, S. 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由于年龄、性别、种族、体重等人口因素和身体因素的影响, 建立衡量非传染性疾病的通用标准具有挑战性. 14. 关于 snap 振幅, 正畸 (货币向身体的方向) 和反流体 (货币的方向远离身体) 技术之间存在差异, 因为 snap 振幅是测量的用正交法比反抑郁方法15小。在我们的实验室中, 正畸刺激通常在临床上应用, 因此我们将10μv 设置为确定轴突损伤的临界值。如?...

cts 是一种病理上的疾病与节段性脱髓鞘, 而继发性轴突变性, 这是指示手术减压, 可能共存的疾病进展1。然而, 目前的诊断和严重等级表 (从轻度到非常严重的等级) cts 不能清楚地表明任何共存的轴突变性, 导致混乱时选择适当的治疗。传统的确认轴突变性的方法, 如肌电图和神经活检, 可以是敏感和准确的, 但它们都受到限制, 在临床实践中由于其侵入性2。
为了克服这些缺点, 引入了超声波, 以协助诊断3, 4, 5 和评级的严重程度的 cts6,7,8。此外, 先前的研究成功地确定了其与 cts 相关的鉴别轴突变性的临界值, 总体上具有令人满意的灵敏度和特异性9。本研究旨在将这一高效、非侵入性的治疗方案引入到临床背景下的实践中。该方案的基本原理是结合 ncs 和超声波提供的神经生理和结构信息, 以指示病理进展1,10。它被认为是更准确地描述病理进展比目前的严重等级系统, 帮助临床医生更好地制定一个护理计划。与其他传统的神经成像技术 (如扩散张量成像 (dti)) 相比, 这种基于证据的方法可以更容易地应用于临床环境,成本更低11。

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screening of axonal degeneration in carpal tunnel syndrome using ultrasonography and nerve conduction studies

轴索变性, 指示手术减压, 可能共存的腕管综合征 (cts) 的疾病的进展。然而, 目前的诊断和严重等级制度不能清楚地表明其共存, 导致混乱的适当治疗处方。传统的差异化方法也存在制约因素。本研究旨在引入一种创新、高效、快速的筛选方案, 利用超声和神经传导研究 (ncs) 来区分与 cts 相关的轴突变性变性。它开始使用 ncs 在手腕上进行正畸刺激, 分别获得中位神经和尺神经的感觉传导。同时, 通过刺激手掌、手腕和肘部, 然后刺激肘部下方和上方的腕部尺神经, 来收集中位神经的运动传导。然后, 使用线性阵列传感器进行超声评估, 手腕上有横截面面积 (csa) 和周长 (p), 前臂远端卡钳为三分之一。比率 (r-csa、r-p) 和从手腕到三分之一远端前臂 (csa 和 p) 的变化是按照标准格式计算的。将根据 ncs 标准和先前研究中确定的超声测量的截止值进行筛选, 以筛选 cts 中共存的潜在轴突变性。从其不侵入性、低成本、方便性、高效性等方面来看, 在临床实践中很容易将超声辅助应用于潜在的共存在轴索变性患者。然而, 超声成像不能直接反映轴突变性。它仍然依赖于传统的, 但侵入性的方法, 如肌电图 (emg) 和活检确认, 如果需要。

如表 1所示, 如果受试者符合 ncs 标准, 则主要筛选出相关的轴突变性: (1) 中位神经的感觉传导速度小于 42ms, 或 (2) 远端的感觉。潜伏期大于4.6 毫秒, 或远端运动潜伏期大于 3.2 ms;(3) 手腕的 snap 振幅小于 10μv, cmap 振幅下降不超过20%。将排除那些具有时间色散 (cmap 振幅下降 gt;20%) 和/或传导阻滞 (cmap 振幅下降 gt;50%) 的患者。关于 ncs 参数的标准, 包括传导速度、远?...

Watch this Scientific Journal Video about Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies at JoVE.com

Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies

超声和神经传导研究对腕管综合征轴突变性的筛查

在这里, 我们提出了一个协议, 使用神经传导研究和超声筛选潜在的轴突变性相关的腕管综合征。确定了区分的标准。与传统方法相比, 该方法具有无创、方便、高效等优点, 具有整体满意的准确性、灵敏度和特异性。

Axonal degeneration, indicative of surgical decompression, may coexist in carpal tunnel syndrome (CTS) as the disease progresses. However, the current ...

这种使用神经传导研究和超声波的非侵入性方法用于具体和敏感地评估腕管综合征患者的斧道退化。这种方法可由临床医生直接评估疾病的病理阶段，并可轻松应用于更好的治疗区域规划。演示手术的将是注册护士周菲比和医生梁国普，他们都是来自我的实验室。要测量中枢感觉神经的传导，首先让患者用温水洗手。干燥后，将记录环电极放在近边关节处，将参考环电极放在近边环接头上。将其他记录电极放在手腕上，在屈肌腕肌肌腱和棕榈长肌之间。12cm 近到记录环电极，理想情况下近到远侧手腕折痕。在确保接地电极位于刺激和记录位点之间后，通过食指上连接的电极对中位神经施加超最大值刺激 10 次。要测量乌尔纳感觉神经中的传导，请将记录环电极放在第 5 位近邻的半路上，将参考环电极 4cm 到记录环电极。将其他记录电极靠近屈曲器卡皮乌尔纳里斯的肌腱，12cm 接近记录环电极，确保接地电极位于刺激和记录点之间。然后通过第 5 指上的附加电极对 ulnar 神经施加 10 次超最大值刺激。要测量中位运动神经中的传导，请将记录环的电极放在诱拐者轮虫器的马达点最显眼的极点，并将参考环电极放在拇指的近位法兰上。然后使用电子刺激器刺激中掌，三到四厘米的半距离手腕折痕，和6.5厘米近到记录环电极在手腕，肌腱之间的屈肌卡皮径向和棕榈长。在肘部前部空间的中侧，只是侧向胸动脉。要测量乌尔纳运动神经中的传导，请将记录环电极放在绑架者数字小神经的腹部上。刺激点与记录位之间的第 5 位数字和接地电极的参考环电极。然后在手腕上刺激，7cm近到记录环电极，只是侧向或中向屈曲卡皮肌腱。肘部下方和上方，5cm 的近侧和近向的 ulnar 槽。对于超声波测量，将患者放在一个脚上，双手放在水平上，手指半伸。在传感器、手腕位置和近臂 1/3 前臂的探头上放置一些超声波凝胶。接下来，使用 13 到 14 兆赫的线性阵列传感器在腕管入口执行横向扫描。冻结实时成像，并持续校准腕管入口中位神经的超分道。然后沿着中枢神经的内侧区域近侧扫描到1/3近前臂的位点。冻结实时成像，并在1/3近前臂的中位神经的超分细胞性检查。在筛查相关斧颈退化后，任何超声波参数值高于相应截止值的患者将被视为患有电弓变性的潜在共存。或者，如果主体不满足神经传导研究标准，超声波读数可视为潜在斧神手退化的指标。例如，在这项具有代表性的研究中，发现脱叶化患者和相关斧颈退化之间的显著差异，表明该协议可以是筛查与腕管综合征相关的斧颈变性的有效工具。此外，在这群人中，这些患者没有达到神经传导标准，并且被录下超声波测量，超声波测量数据表明，所有这些患者都可能仅根据超声波测量结果与共处的电导变性有关。在神经传导研究中，消毒化学过程和侧对侧比较都很重要，因为它们可以提高评估的可靠性。虽然断层扫描是确认斧神手退化的黄金标准，但可以使用进一步的验证研究来评估断层扫描和我们的评估包之间的可靠性和有效性。在超声波评估期间，确保超声波参数一致，并选择适当的频率和探头尺寸。该技术路径是研究人员探索超声诊断腕管综合征的创新用途，并有可能用于预测治疗效果。

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Cerebellar granule neurons (CGNs) are a commonly used neuronal model, forming an abundant homogeneous population in the cerebellum. In light of their ...

In Vivo Electrophysiological Measurement of the Rat Ulnar Nerve with Axonal Excitability Testing

In Vivo Electrophysiological Measurement of the Rat Ulnar Nerve with Axonal Excitability Testing

在体内轴突兴奋性试验对大鼠尺神经的电生理测量

Electrophysiology enables the objective assessment of peripheral nerve function in vivo. Traditional nerve conduction measures such as amplitude and ...

Partial Optic Nerve Transection in Rats: A Model Established with a New Operative Approach to Assess Secondary Degeneration of Retinal Ganglion Cells

大鼠部分视神经切断术: 建立一种新的手术方法评价视网膜神经节细胞二次变性的模型

Previous studies have shown that the secondary degeneration of retinal ganglion cells (RGCs) occurs commonly in glaucoma. Partial optic nerve transection ...

Ablation of a Neuronal Population Using a Two-photon Laser and Its Assessment Using Calcium Imaging and Behavioral Recording in Zebrafish Larvae

用双光子激光消融神经种群及其对斑马鱼幼虫钙成像和行为记录的评价

To identify the role of a subpopulation of neurons in behavior, it is essential to test the consequences of blocking its activity in living animals. Laser ...

Facial Nerve Surgery in the Rat Model to Study Axonal Inhibition and Regeneration

大鼠模型中的面部神经外科研究同氧抑制与再生

This protocol describes consistent and reproducible methods to study axonal regeneration and inhibition in a rat facial nerve injury model. The facial ...

Use of In Vivo Single-fiber Recording and Intact Dorsal Root Ganglion with Attached Sciatic Nerve to Examine the Mechanism of Conduction Failure

使用 Vivo 单纤维记录和带附骨神经的固定背道根结条，以检查传导失败机制

Single-fiber recording has been a classical and effective electrophysiological technique over the last few decades because of its specific application for ...