本文關(guān)鍵詞： 磁共振 彌散張量 纖維束示蹤 腰椎間盤突出癥 腰骶部脊神經(jīng)　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:使用DTI成像技術(shù)探討健康志愿者正常神經(jīng)根和腰椎間盤突出受壓神經(jīng)根各向異性分數(shù)(FA)值與表觀擴散系數(shù)(ADC)值之間的差異;受壓神經(jīng)根微觀結(jié)構(gòu)變化與臨床癥狀(ODI指數(shù))及癥狀持續(xù)時間之間的相關(guān)性;聯(lián)合纖維束示蹤成像技術(shù)(FT)判斷神經(jīng)根的形態(tài)及內(nèi)部微觀結(jié)構(gòu)的變化情況,為臨床系統(tǒng)全面評價椎間盤突出、及時采取有效治療提供可靠依據(jù)。方法:收集健康志愿者和腰椎間盤突出癥患者各32例,應用Philips3.0T MRI設(shè)備行L4至S1神經(jīng)根常規(guī)MRI及DTI檢查,選擇椎間孔內(nèi)側(cè)脊神經(jīng)根區(qū)域為感興趣區(qū),定量測量健康對照組和腰椎間盤突出受壓神經(jīng)根組及對側(cè)未受壓神經(jīng)根組的FA值及ADC值,分析組間是否存在統(tǒng)計學差異;分析健康志愿者L4-S1神經(jīng)根不同節(jié)段及不同年齡段是否存在統(tǒng)計學差異;分析受壓神經(jīng)根組FA值和ADC值與臨床癥狀、癥狀持續(xù)時間之間的相關(guān)性。同時行L4、L5、S1神經(jīng)根FT。結(jié)果:1健康志愿者L4-S1各節(jié)段神經(jīng)根的平均FA值和ADC值均無統(tǒng)計學差別(P㧐0.05)。健康志愿者年齡㧐35歲組和年齡㩳35歲組平均FA值和ADC值無統(tǒng)計學差別(P㧐0.05);2腰椎間盤突出患者受壓神經(jīng)根組FA值明顯低于健康對照組FA值及對側(cè)未受壓神經(jīng)根組FA值(P㩳0.05),差異有統(tǒng)計學意義;受壓神經(jīng)根組ADC值明顯低于健康對照組ADC值及對側(cè)未受壓神經(jīng)根組ADC值(P㩳0.05),差異有統(tǒng)計學意義;對側(cè)未受壓神經(jīng)根組FA值及ADC值與健康對照組FA值及ADC值均無統(tǒng)計學差異(P㧐0.05);3受壓神經(jīng)根組FA值與ODI指數(shù)(r=-0.984)、癥狀持續(xù)時間(r=-0.940)呈明顯的負相關(guān)關(guān)系(P㩳0.05)。受壓神經(jīng)根組ADC值與ODI指數(shù)(r=-0.097)、癥狀持續(xù)時間(r=-0.009)無明顯相關(guān)性(P㧐0.05);4纖維束示蹤成像技術(shù)(FT)可清晰顯示L4-S1神經(jīng)根走形特點。正常神經(jīng)根走行對稱、自然,受壓神經(jīng)根稀疏、移位、變細。結(jié)論:1 腰骶神經(jīng)根DTI成像能對腰椎間盤突出癥的神經(jīng)根變化提供量化數(shù)值,定量反映神經(jīng)損傷程度和范圍。DTI能早期發(fā)現(xiàn)腰骶神經(jīng)根損傷,為早診早治提供新的檢查手段。2 獲得了健康志愿者的FA值,同時發(fā)現(xiàn)腰椎間盤突出患者對側(cè)未受壓神經(jīng)根FA值與健康對照組FA值與無統(tǒng)計學差異,可以作為正常對照。3 FA值是神經(jīng)根損傷的定量參考指標,FA值與臨床癥狀(ODI指數(shù))及持續(xù)時間之間呈負向關(guān)系,即臨床癥狀越重或病史越長FA值越小,通過FA值能進一步評價椎間盤突出患者神經(jīng)根的損傷程度和損傷時間,為及早干預和判斷預后提供參考依據(jù)。4 ADC值的變化目前尚存爭議,其是否能夠作為評價腰椎間盤突出癥神經(jīng)根損傷的參考指標,仍需進一步探究。5 FT能直觀地顯示神經(jīng)根受壓形態(tài)的改變、確定受壓的位置,值得推廣應用。
[Abstract]:Objective: to investigate the difference between normal nerve root and lumbar disc herniated nerve root anisotropy fraction (FAA) and apparent diffusion coefficient (DTI) by DTI imaging. The correlation between the microstructural changes of compressed nerve roots and the ODI index of clinical symptoms and the duration of symptoms; Combined with fiber tracer imaging (FTT), the changes of the morphology and internal microstructure of nerve root were judged, and the disc herniation was evaluated comprehensively for clinical system. Methods: 32 healthy volunteers and 32 patients with lumbar disc herniation were collected. The L4 to S1 nerve roots were examined by routine MRI and DTI with Philips3.0T MRI equipment. The medial spinal roots of intervertebral foramen were selected as the region of interest. FA and ADC were measured quantitatively in healthy control group, lumbar disc herniated nerve root group and contralateral uncompressed nerve root group. To analyze whether there were statistical differences in different segments and ages of L4-S1 nerve root in healthy volunteers. To analyze the correlation between FA value, ADC value and clinical symptom and symptom duration in compressed nerve root group. Results there was no significant difference in the mean FA value and ADC value of each segment of L4-S1 nerve root in 1: 1 healthy volunteers. Age of healthy volunteers? Age group and age? There was no significant difference in average FA value and ADC value between 35 years old group. The FA value of the compressed nerve root group in patients with lumbar disc herniation was significantly lower than that in the healthy control group and the contralateral uncompressed nerve root group. The ADC value of the compressed nerve root group was significantly lower than that of the healthy control group and the contralateral uncompressed nerve root group, and the ADC value of the contralateral uncompressed nerve root group was significantly lower than that of the control group. There was no significant difference in FA and ADC between the contralateral uncompressed nerve root group and the healthy control group. There was a significant negative correlation between FA value and ODI index (r = 0.984) and duration of symptoms (r = 0.940) in the group of compressed nerve root (P < 0. 05), but there was a negative correlation between FA value and ODI index (r = 0. 984, P < 0. 940). There was no significant correlation between ADC value and ODI index (r = 0.097) and duration of symptoms (r = 0. 009) in compressed nerve root group (P < 0. 05). 0.05; (4) the fiber tracer imaging technique (FTFT) can clearly show the shape of L4-S1 nerve root. The normal nerve root is symmetrical, natural, compressed and sparse and transposition. Conclusion DTI imaging of lumbosacral nerve root can provide quantitative value for the changes of nerve root in lumbar intervertebral disc herniation, and quantitatively reflect the extent and extent of nerve injury. The FA value of healthy volunteers was obtained for early diagnosis and early treatment. At the same time, the FA value of contralateral uncompressed nerve root in patients with lumbar disc herniation was not significantly different from that of healthy control group. As a normal control, the FA value is a quantitative reference index for nerve root injury. There is a negative relationship between FA value and the clinical symptom / ODI index and duration. That is, the more serious the clinical symptoms or the longer the history of the FA value is smaller, the FA value can further evaluate the degree and duration of nerve root injury in patients with disc herniation. In order to provide reference basis for early intervention and prognosis, the change of ADC value is still in dispute. Whether it can be used as a reference index for evaluating nerve root injury of lumbar disc herniation. It is necessary to further explore that the shape change of nerve root compression can be visualized and the position of compression can be determined by 5.5FT, which is worth popularizing and applying.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R681.53

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