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中华医学超声杂志(电子版) ›› 2026, Vol. 23 ›› Issue (06) : 497 -505. doi: 10.3877/cma.j.issn.1672-6448.2026.06.009

肌肉骨骼超声影像学

超声引导下水分离联合经皮松解术治疗腓总神经卡压综合征的临床应用
周婉1, 陈自力1, 梁浩1, 许善补2, 杨莉1, 向慧娟1, 杜锐1,†()   
  1. 1 430070 武汉,中部战区总医院超声诊断科
    2 430070 武汉,中部战区总医院康复医学科
  • 收稿日期:2025-11-08 出版日期:2026-06-01
  • 通信作者: 杜锐

Clinical value of ultrasound-guided hydrodissection combined with percutaneous neurolysis in common peroneal nerve entrapment syndrome

Wan Zhou1, Zili Chen1, Hao Liang1, Shanbu Xu2, Li Yang1, Huijuan Xiang1, Rui Du1,†()   

  1. 1 Department of Ultrasound, General Hospital of Central Theater Command, Wuhan 430070, China
    2 Department of Rehabilitation Medicine, General Hospital of Central Theater Command, Wuhan 430070, China
  • Received:2025-11-08 Published:2026-06-01
  • Corresponding author: Rui Du
引用本文:

周婉, 陈自力, 梁浩, 许善补, 杨莉, 向慧娟, 杜锐. 超声引导下水分离联合经皮松解术治疗腓总神经卡压综合征的临床应用[J/OL]. 中华医学超声杂志(电子版), 2026, 23(06): 497-505.

Wan Zhou, Zili Chen, Hao Liang, Shanbu Xu, Li Yang, Huijuan Xiang, Rui Du. Clinical value of ultrasound-guided hydrodissection combined with percutaneous neurolysis in common peroneal nerve entrapment syndrome[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2026, 23(06): 497-505.

目的

探讨超声引导下水分离联合经皮松解术治疗腓总神经卡压综合征(CPNES)的临床应用价值,并评价腓总神经超声指标的变化。

方法

回顾性分析2023年6月至2025年3月于本院诊治并确诊为CPNES患者66例,根据治疗方式分为联合治疗组(超声引导下水分离联合经皮松解术,36例)和单纯水分离组(30例)。符合正态分布的计量资料以

±s表示,不符合正态分布者以M(Q1,Q3)表示;计数资料以[例数(%)]表示。2组治疗前及治疗后1周、1个月、3个月、6个月的疼痛视觉模拟评分(VAS)、Kofoed踝关节评分、麻木改善情况及超声指标根据情况比较均采用独立样本秩和检验,并记录治疗相关并发症。组内同一组患者不同时间点的VAS评分、Kofoed评分、麻木改善等级及超声指标根据情况比较均采用Friedman检验。以P<0.05为差异具有统计学意义。

结果

2组治疗后VAS评分、Kofoed评分、麻木症状以及腓总神经受压处内径均较治疗前显著改善(P均<0.05),2组治疗前后血流信号分级无明显变化。联合治疗组在各随访时间点VAS评分均显著低于单纯水分离组(P均<0.05),且Kofoed评分亦显著高于单纯水分离组(P均<0.05),联合治疗组麻木改善情况优于单纯水分离组(P均<0.05)。2组治疗后1个月、3个月及6个月腓总神经内径均较治疗前增大,差异均有统计学意义(P均<0.05),治疗后1周内径比较差异无统计学意义(P>0.05)。随访期间2组均未见严重并发症,联合治疗组复发2例,单纯水分离组复发5例。

结论

超声引导下水分离联合经皮松解术治疗CPNES安全有效,治疗后腓总神经受压处内径显著增大,显著缓解疼痛、改善感觉功能并促进踝关节功能恢复,疗效优于单纯水分离术,具有良好的临床推广价值。

Objective

To evaluate the clinical efficacy and safety of ultrasound-guided hydrodissection combined with percutaneous neurolysis in the treatment of common peroneal nerve entrapment syndrome (CPNES), and to assess changes in ultrasound parameters of the common peroneal nerve.

Methods

A retrospective analysis was conducted on 66 patients diagnosed with CPNES and treated at our hospital between June 2023 and March 2025. Patients were allocated into two groups according to treatment modality: the combined treatment group (ultrasound-guided hydrodissection plus percutaneous neurolysis, 36 cases) and the hydrodissection-only group (30 cases). After normality testing, continuous data conforming to a normal distribution are expressed as the mean ± standard deviation, while non-normally distributed data are presented as median (Q1, Q3); categorical data are expressed as numbers (percentages). Visual analogue scale (VAS) scores, Kofoed ankle scores, numbness improvement grades, and ultrasound parameters were recorded before treatment and at 1 week, 1 month, 3 months, and 6 months after treatment. Treatment-related complications were also documented. Between-group comparisons of the above parameters at each time point were performed using the independent-samples rank sum test (Mann-Whitney U test) as appropriate, and within-group comparisons across different time points were performed using the Friedman test. A P-value<0.05 was considered statistically significant.

Results

In both groups, VAS scores, Kofoed scores, numbness symptoms, and the inner diameter at the compressed segment of the common peroneal nerve improved significantly after treatment compared with baseline (all P<0.05), whereas blood flow signal grading showed no obvious change before or after treatment in either group. At all follow-up time points, the combined treatment group showed significantly lower VAS scores and significantly higher Kofoed scores than the hydrodissection-only group (all P<0.05). The combined treatment group also exhibited superior numbness improvement compared with the hydrodissection-only group (all P<0.05). In both groups, the inner diameter at the most compressed segment of the common peroneal nerve increased significantly at 1, 3, and 6 months after treatment compared with baseline (all P<0.05), whereas no significant change was observed at 1 week (P>0.05). No serious complications occurred during follow-up. Recurrence was observed in 2 cases in the combined treatment group and 5 cases in the hydrodissection-only group.

Conclusion

Ultrasound-guided hydrodissection combined with percutaneous neurolysis is a safe and effective treatment for CPNES. It significantly increases the inner diameter at the compressed segment of the common peroneal nerve, relieves pain, improves sensory function, and enhances ankle function, offering superior outcomes compared with hydrodissection alone, and demonstrates good clinical value for widespread application.

图1 联合治疗组患者超声声像图。图a为治疗前腓总神经长轴声像图(黄色箭头示神经卡压位置);图b为超声引导下腓总神经短轴声像图(黄色箭头示神经卡压位置,红色箭头示穿刺针);图c为治疗后1周腓总神经长轴声像图;图d为治疗后1个月腓总神经长轴声像图;图e为治疗后3个月腓总神经长轴声像图;图f为治疗后6个月腓总神经长轴声像图
图2 单纯水分离组患者超声声像图。图a为治疗前腓总神经长轴声像图(黄色箭头示神经卡压位置);图b为超声引导下腓总神经短轴声像图(黄色箭头示神经卡压位置,红色箭头示穿刺针);图c为治疗后1周腓总神经长轴声像图;图d为治疗后1个月腓总神经长轴声像图;图e为治疗后3个月腓总神经长轴声像图;图f为治疗后6个月腓总神经长轴声像图
表1 治疗前联合治疗组和单纯水分离组腓总神经卡压综合征患者基线特征比较
表2 联合治疗组和单纯水分离组腓总神经卡压综合征患者VAS评分比较[M(Q1,Q3)]
图3 2组患者治疗前后各随访时间点VAS评分及Kofoed评分分布情况。图a为联合治疗组及单纯水分离组VAS评分情况;图b为联合治疗组及水分离组Kofoed评分情况
表3 联合治疗组和单纯水分离组腓总神经卡压综合征患者Kofoed评分比较[M(Q1,Q3)]
表4 联合治疗组和单纯水分离组腓总神经卡压综合征患者麻木改善情况比较(66例)
表5 联合治疗组和单纯水分离组腓总神经卡压综合征患者腓总神经受压处内径变化情况比较[mm,M(Q1,Q3)]
表6 联合治疗组和单纯水分离组腓总神经卡压综合征患者腓总神经超声血流信号分级变化比较(例)
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