High-frequency Ultrasonographic Evaluation Of Morphological Changes Of Peripheral Nerve In Hemiplegic Patients After Stroke

Objective:To assess the abnormal changes in different sites of the median nerve(MN) and the ulnar nerve(UN) of the stroke patients with hemiplegia by using the high frequency ultrasonography(HFUS). And analyze the correlation between the median nerve, ulnar nerve cross-sectional area(CSA) of sotrke patients and age, height, weight, body mass index, course of disease.Method:51 stroke patients with hemiplegia treated in our hospital from June 2015 to November 2015 were randomly selected and divided into group B(affected side group,51 patients) and group C(unaffected side group, 51 patients) according to their hemiplegic limb sides; other 42 healthy volunteers were selected as the control group A.The width(W), thickness(T) and cross-sectional area(CSA) of six sites of MN and eight sites of UN in both sides were measured. Six MN sites included: at the wrist transverse crease(referred to as MN1), at the level of pisiform bone(MN2), at the level of hamate bone(MN3), 6 cm above the wrist transverse crease(MN4), 4 cm above the medial epicondyle(MN5), at the midpoint of the humerus(MN6); and eight UN sites included:at the cubital tunnel(UN1), at the cubital tunnel outlet(UN2), at the cubital tunnel inlet( UN3), 6 cm above the medial epicondyle(UN4), at the midpoint of the humerus(UN5), 8 cm below the medial epicondyle(UN6), 6 cm above the wrist transverse crease(UN7) and at Guyon’s canal(UN8). In addition, the correlation analysis was made withthe ultrasound results related to age, height, weight, body mass index and course of disease.Result:1. Comparison of MN:(1) Comparison of W: comparing the three groups, the widths of six MN sites in group B were all smaller than the control group(P<0.05); for group C, except at the level of pisiform bone, the widths of other sites were smaller than the control group(P<0.05); meanwhile, group B and group C were compared(P> 0.05)and showed no statistically significant difference.(2) Comparison of T: comparing the three groups, the thickness comparison of MN in these groups all showed P>0.05 and had no statistically significant difference. The comparison between group B and group C also showed P>0.05, with no statistically significant difference.(3) Comparison of CSA:comparing the three groups, group B and C were just smaller than group A in three sites,including 6 cm above the wrist transverse crease, 4 cm above the medial epicondyle and at the midpoint of the humerus(P<0.05); the comparison between group B and group C showed P>0.05 and had no statistically significant difference.2. Comparison of UN:(1) Comparison of W: comparing the three groups, except the sites at the cubital tunnel outlet, 6 cm above the wrist transverse crease and at Guyon’s canal, the widths of the remaining five sites in group B and C were both smaller than that of group A(P <0.05); while the comparison of group B and group C showed P>0.05,with no statistically significant difference.(2) Comparison of T: comparing the three groups, group B was only smaller than group A in two sites, including at the cubital tunnel, 8 cm below the medial epicondyle(P<0.05) and group C was just smaller than A group at the cubital tunnel(P<0.05); while in comparing group B and group C, the result was P>0.05, with no statistically significant difference.(3) Comparison of CSA:comparing the three groups, group B was only smaller than A group in the sites at the cubital tunnel, at the cubital tunnel inlet and at the midpoint of the humerus(P<0.05),and group C was only smaller than A group at the cubital tunnel, at the cubital tunnelinlet and at the midpoint of the humerus(P<0.05); while in comparing group B and group C, the result was P>0.05, without significant difference.3. The CSAs of median nerve and ulnar nerve were positively correlated with the age, weight, body mass index, but showed no significant correlation with height and course of disease.Conclusion:1. HFUS can accurately assess the width, thickness and cross-sectional area of the peripheral median nerve and ulnar nerve, providing a theoretical basis for the morphological changes of peripheral nerves.2.The peripheral nerves in both the affected and unaffected sides of the stroke patients with hemiplegia were morphological changed. According to the measurement results of HFUS, the difference between the patients’ affected and unaffected sides was not significant, but compared to the control group, the width, thickness and CSA all decreased at different degrees.3. The cross-sectional area of median nerve and ulnar nerve in the affected sides of the stroke patients with hemiplegia showed a positive correlation with age, weight and body mass index, but had no significant correlation with height and course of disease.