Study On Value Of Shear-wave Elastic Imaging In The Diagnosis Of Ulnar Nerve Diseases And Post-operative Of Tendon Repture

Part One Application of shear wave elastic imaging in the diagnosis of cubital tunnel syndromeObjective: To investigate the diagnostic value of shear wave elastic imaging(SWE)in the diagnosis of cubitus syndrome.Methods: From April 2016 to April 2017,80 patients with ulnar neuropathy who would be treated by hand surgery in our hospital from April2016 to April 2017 were collected.According to the results of electrophysiological examination and clinical symptoms,the patients were divided into two groups: group a(with clinical symptoms,normal electrophysiological examination)and group b(with clinical symptoms and abnormal electrophysiological examination).40 age-matched healthy adults were used as control group,excluding patients with upper limb trauma,hypertension,diabetes and other possible peripheral nerve diseases.Ultrasound examination was performed on patients and control group before surgery.Aixplorer Shear Wave TM real-time shear wave elastography ultrasonic diagnostic instrument with probe frequency of 4-15 MHz was used to identify the ulnar nerve from the upper elbow 10 cm to the lower 10 cm,and to measure the diameter and cross-sectional area of ulnar nerve between the olecranon and the medial epicondyle of humerus.Then the probe was rotated90°longitudinally,and the SWE mode was started at the following three measuring points.The Young's modulus of the ulnar nerve was measured in the region of interest,and the data was recorded as follows: 1.the mean value of elastic modulus of ulnar nerve at the entrance of cubital tunnel,2.the mean value of elastic modulus of ulnar nerve at the cubital tunnel,3.the mean value of elastic modulus of ulnar nerve at the exit of cubital tunnel.The measurements were compared among the three groups.Results:1.The images of all the tested nerves in Q-BOX were clear.In the control group,the neuroelastic images were mainly blue or blue mixed green,while in the case group,they were mostly blue yellow or even red.2.The Young's modulus of ulnar nerve was measured successfully by SWE technique in the case group and the control group.The Young's modulus values at the three sites in the control group were 53.33 ±8.99 kPa?48.04±6.67 kPa?43.83 ±7.06 kPa respectively,and the Young's modulus values at the three sites in the case a group were 52.46 ±10.35kPa?46.62 ±8.94kPa?43.82 ±8.97 kPa respectively,and in case b group,the Young's modulus of the locus was 66.98 ±13.84 kPa?57.25 ±11.59kPa?51.97 ±11.65 k Pa respectively.3.Young's modulus measured by SWE was slightly lower than that of normal control group at three sites of ulnar nerve in group a,but the difference was not statistically significant.The value of Young's modulus at three sites of ulnar nerve in group b was higher than that in control group and case a group(P < 0.05).Conclusions:1.The shear wave elastic imaging technique and the measured Young's modulus can be used to quantitatively evaluate the ulnar nerve hardness.2.The hardness of ulnar nerve did not change obviously in the early stage of cubital tunnel syndrome,and the hardness of ulnar nerve increased significantly after the extension of disease time.The quantitative measurement of ulnar nerve elasticity by shear wave elastic imaging can provide the imaging reference for diagnosis of disease.Part II The application of shear wave elastic imaging in the follow-up of digital flexor tendon repairObjective: Shear wave elastography(SWE)technique was used to evaluate the elastic changes during tendon healing after digital flexor tendon rupture repair.Methods: From June 2016 to April 2017 20 patients with digital flexor tendon rupture and surgery treatment were recruited.A total of 28 digital flexor tendons were analyzed.Ultrasound examination and shear wave elastography was performed in the patients at 3 month,6 month and 9 month after surgery respectively.The young's modulus values of the tendon were measured in different healing process,and the changes of the elasticity were analyzed.Results:1.The average elastic value of the normal digital flexor tendon was282.4±30.913.2kPa(range 269.5-305.9 kPa).2.The average elastic value of the affected tendon was 157.5 ±13.2kPa(range 140.3-183.4kPa)at 3 months after tendon repair,173.9 ±20.3kPa(range 150.8-231.7 kPa)at 6 months after tendon repair,and 202.4 ±27.9kPa(range 169.56-255.92kPa)at 9 months after tendon repair.3.The differences were statistically significant between 3 months and 6months,6 months and 9 months after operation.Conclusion:1.Shear wave elastography can be used for quantitative evaluation of tendon elasticity after tendon rupture repair.2.The hardness of the repaired digital flexor tendon was less than the normal tendon.With the extension of tendon healing time,the hardness of tendon increases significantly,providing imaging evidence for clinicians to guide rehabilitation of patients.