本文選題：磁共振　切入點(diǎn)：膝關(guān)節(jié)　出處：《河北北方學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：隨著磁共振(Magnetic resonance,MR)技術(shù)的不斷發(fā)展與進(jìn)步,其在膝關(guān)節(jié)疾病的診斷上已經(jīng)成為醫(yī)生的首選。而在軍事訓(xùn)練中膝關(guān)節(jié)損傷發(fā)生率較高,常導(dǎo)致骨、半月板、韌帶、髕下脂肪墊等的損傷,因此通過(guò)MR來(lái)對(duì)膝關(guān)節(jié)軍事訓(xùn)練傷進(jìn)行研究較為合理。另一方面,MR功能成像技術(shù)的發(fā)展更為我們對(duì)膝關(guān)節(jié)神經(jīng)損傷的診斷帶來(lái)了新思路。3.0T磁共振新技術(shù)——擴(kuò)散張量成像(diffusion tensor imaging,DTI)技術(shù)及擴(kuò)散張量纖維示蹤技術(shù)(diffusion tensor tractography,DTT)在中樞神經(jīng)系統(tǒng)疾病的診斷上已廣泛應(yīng)用,而在周?chē)窠?jīng)損傷的應(yīng)用上尚待進(jìn)一步研究,在膝關(guān)節(jié)脛神經(jīng)的損傷研究上,國(guó)內(nèi)更是尚無(wú)相關(guān)探索。本研究通過(guò)收集2014年6月-2015年12月來(lái)我院就診的所有軍人膝關(guān)節(jié)MR檢查結(jié)果,首先計(jì)算膝關(guān)節(jié)軍事訓(xùn)練傷陽(yáng)性率,隨后進(jìn)一步分析陽(yáng)性患者各種損傷的分布情況,將總體情況按照骨挫傷、半月板損傷、髕下脂肪墊損傷及韌帶損傷進(jìn)行匯總、整理、統(tǒng)計(jì)分析。另外對(duì)軍人髕下脂肪墊損傷進(jìn)行了分型及相關(guān)分析,以便于進(jìn)一步加強(qiáng)對(duì)該疾病的診斷及及時(shí)診治。而對(duì)于臨床診斷為脛神經(jīng)損傷的患者,行常規(guī)掃描序列及DTI序列成像,并選取相匹配的健康志愿者作為對(duì)照組,行相同檢查,測(cè)量脛神經(jīng)各向異性值(fractional anisotropy,FA)及表觀彌散系數(shù)值(apparent diffusion coefficient,ADC)。采用獨(dú)立樣本t檢驗(yàn)對(duì)兩組病例FA值、ADC值進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05為差異具有統(tǒng)計(jì)學(xué)意義,并進(jìn)一步繪制FA值及ADC值的ROC曲線,分析其特異性及敏感性,最后應(yīng)用DTT顯示正常及不同損傷程度的脛神經(jīng)纖維束。結(jié)果顯示:2014年6月-2015年12月共768例軍人來(lái)我院行膝關(guān)節(jié)MR檢查,共823個(gè)膝關(guān)節(jié),左:340,右:373,雙:55;男745例,女23例,年齡18-45歲,平均年齡26.7歲,損傷膝關(guān)節(jié)共756個(gè),陽(yáng)性率達(dá)91.9%,其中骨挫傷:247例,半月板損傷398例,韌帶損傷297例,肌腱及軟組織損傷107例,髕下脂肪墊損傷111例,關(guān)節(jié)腔積液790例,關(guān)節(jié)囊及滑膜病變29例,神經(jīng)損傷15例,軟骨損傷91例。對(duì)20例臨床懷疑脛神經(jīng)損傷患者行DTI檢查,結(jié)果15例患者有脛神經(jīng)損傷,測(cè)量其ADC值及FA值,損傷組ADC值為1.43±0.07x10-3mm2/s,對(duì)照組ADC值為1.35±0.10x10-3mm2/s,損傷組FA值為0.51±0.05,對(duì)照組FA值為0.58±0.05,兩個(gè)值在兩組中差別均具有統(tǒng)計(jì)學(xué)意義;并且FA值的ROC曲線下面積為0.884,ADC值的ROC曲線下面積為0.724,兩者均介于0.7~0.9之間,可見(jiàn)其對(duì)脛神經(jīng)損傷的診斷具有一定的價(jià)值。通過(guò)ROC曲線比較其診斷效能發(fā)現(xiàn),FA值診斷臨界點(diǎn)為0.57,約登指數(shù)為1.667,敏感性、特異性分別為:0.733、0.934,ADC值診斷臨界點(diǎn)為1.35,約登指數(shù)為1.467,敏感性、特異性分別為:0.867、0.600�？傊�,軍事訓(xùn)練致膝關(guān)節(jié)損傷發(fā)生率較高,通過(guò)MR可以較為準(zhǔn)確的對(duì)軍事訓(xùn)練中骨挫傷、半月板損傷、髕下脂肪墊損傷及韌帶損傷進(jìn)行診斷,并且初步研究表明DTI聯(lián)合DTT技術(shù)在診斷外傷性脛神經(jīng)損傷上,FA值及ADC值可幫助量化分析脛神經(jīng)損傷,進(jìn)而進(jìn)一步分析其損傷程度,且FA值診斷效能較ADC值高。
[Abstract]:With magnetic resonance (Magnetic resonance MR) development and progress of technology, in the diagnosis of knee joint disease has become the first choice for doctors. While in the military training of knee joint injury in high incidence, often leads to bone, meniscus, ligament, the infrapatellar fat pad injury, therefore MR to the knee joint military training injury research more reasonable. On the other hand, brings a new way of.3.0T magnetic resonance diffusion tensor imaging: a new technique to develop MR functional imaging techniques for our diagnosis of knee joint nerve injury (diffusion tensor, imaging, DTI) and diffusion tensor fiber tractography (diffusion tensor tractography, DTT) has widely used in the diagnosis of diseases of the central nervous system, and in the application of peripheral nerve injury on further research, in the study of knee injuries of the tibial nerve, the country is no exploration. This study collected in June 2014 -2015 December in our hospital, all the soldiers of knee joint MR examination results, first calculate the positive rate of knee joint injury in military training, followed by further analysis of the distribution of positive patients with various injuries, will be in accordance with the overall situation of bone contusion, meniscus injury, analysis of infrapatellar fat pad injury and ligament injury were summarized. Sorting, statistics. In addition to the military injury of infrapatellar fat pad were classified and the correlation analysis, in order to further strengthen the timely diagnosis and diagnosis of the disease. The clinical diagnosis of tibial nerve injury patients underwent conventional scanning sequence and DTI sequence, and selected matched healthy volunteers as the control group. For the same examination, measurement of tibial nerve anisotropy (fractional anisotropy, FA) and apparent diffusion coefficient (apparent diffusion, coefficient, ADC). Recovery test with independent samples t In the two groups, FA value, ADC value were statistically analyzed, P0.05 difference has statistical significance, and further draw the ROC curve of FA value and ADC value, analyze its specificity and sensitivity, finally the application of DTT in normal and tibial nerve fibers with different damage degree of beam. The results showed: June 2014 -2015 year in December a total of 768 cases the soldiers came to our hospital for knee joint MR examination, a total of 823 knees, left: 340, right: 373, double: 55; male 745 cases, female 23 cases, age 18-45 years old, the average age of 26.7 years, a total of 756 knee injuries, the positive rate was 91.9%, of which 247 cases of bone contusion. 398 cases of meniscus injury, ligament injury in 297 cases, 107 cases of tendon and soft tissue injury, the infrapatellar fat pad injury in 111 cases, 790 cases of joint effusion, joint capsule and synovial lesions in 29 cases, 15 cases of nerve injury, 91 cases of cartilage injury. 20 cases of clinically suspected patients with tibial nerve injury DTI examination results 15 patients with tibial nerve damage Injury, measuring its ADC value and FA value, the value is 1.43 + 0.07x10-3mm2/s injury group ADC, group ADC = 1.35 + 0.10x10-3mm2/s = 0.51 + 0.05 group, injury group FA, group FA was 0.58 + 0.05 control, two values in the two groups there were statistically significant difference; ROC curve and FA the value is 0.884, the area of ROC curve of ADC value was 0.724, between the two are between 0.7~0.9, the diagnosis of tibial nerve injury has a certain value. The ROC curves to compare the diagnostic efficacy of FA diagnostic value found at the critical point of 0.57, Youden index was 1.667, the sensitivity and specificity were: the 0.733,0.934 and ADC values in diagnosis of critical point was 1.35, Youden index was 1.467, the sensitivity and specificity of 0.867,0.600. were: in short, caused by military training injuries of knee joint was higher by MR can be more accurately on the military training of bone contusion, meniscus injury, injury of infrapatellar fat pad And ligament injury diagnosis, and preliminary research shows that DTI and DTT technology in diagnosis of traumatic tibial nerve injury, FA value and ADC value can help quantitative analysis of tibial nerve injury, and further analyze the degree of injury, and FA value is higher than that of ADC.

【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.2;R82

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