本文選題：平山病　切入點(diǎn)：影像學(xué)表現(xiàn)　出處：《復(fù)旦大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：第一部分平山病患者不同體位脊髓形態(tài)的影像學(xué)測(cè)量與對(duì)比研究背景：“平山病”即青少年上肢遠(yuǎn)端良性肌萎縮癥,最早于1959年由日本學(xué)者平山惠造報(bào)道,是一類具有自限性的良性下運(yùn)動(dòng)神經(jīng)元疾病,盡管其發(fā)病機(jī)制一直沒(méi)有定論,但隨著對(duì)該疾病認(rèn)識(shí)的發(fā)展,目前MRI已經(jīng)被認(rèn)為是平山病診斷的重要影像學(xué)檢查,而中立位MRI上脊髓非對(duì)稱性前角萎縮和LOA及屈頸狀態(tài)下MRI硬膜外靜脈叢擴(kuò)張和脊髓的硬脊膜后壁前移導(dǎo)致脊髓變扁平的現(xiàn)象被認(rèn)為是較可靠的影像學(xué)特征。目的：本研究將通過(guò)影像學(xué)測(cè)量平山病患者術(shù)前術(shù)后不同體位下脊髓前移程度、變扁平程度的情況,進(jìn)一步證實(shí)平山病的影像學(xué)表現(xiàn),并總結(jié)其影像學(xué)改變特征,評(píng)估其在診斷及選擇治療決策上的價(jià)值。方法：本研究共納入2011年1月-2014年1月于華山醫(yī)院骨科行手術(shù)治療的平山病患者92名(男性91名,女性1名；年齡19.46±2.73歲；身高：172.53±4.80cm)進(jìn)行回顧性研究,病程平均1.743±1.435年。所有患者在華山醫(yī)院骨科接受2個(gè)節(jié)段的頸前路自體髂骨植骨融合內(nèi)固定術(shù)治療(40例融合C4-6,42例融合C5-7,10例融合C6-T1),測(cè)量頸椎過(guò)伸過(guò)屈位上的頸椎曲度變化及標(biāo)準(zhǔn)中立位MRI和屈曲位MRI上的脊髓前移及變扁平現(xiàn)象,采用影像學(xué)的Pfirrman分級(jí)方法評(píng)估并觀察椎間盤是否存在退變。并對(duì)其中17例患者完成了影像學(xué)隨訪(術(shù)后1年至2年)。使用SPSS 19.0對(duì)結(jié)果進(jìn)行分析。結(jié)果：①在C3-T1各節(jié)段的MRI上,屈頸位與中立位相比,脊髓前移明顯增大(P0.05),而脊髓前移距離與椎管的比值同樣也明顯增大(P0.05),以C4-5、C5-6、C6-7這三個(gè)節(jié)段表現(xiàn)更為明顯,均前移了50%以上,其中C6-7節(jié)段較中立位前移了82.4%。②在C4-7各節(jié)段的MRI上,屈頸位與中立位相比,前后徑明顯減小(P0.05),前后徑橫徑比值在C3-7的各節(jié)段上均無(wú)顯著性差異(P0.05),橫徑在這3個(gè)節(jié)段上脊髓屈頸時(shí)橫向減小5%-8%(P0.05)③主訴4年組的前移程度和脊髓前移距離椎管前后徑比值,與其他主訴時(shí)間組相比,無(wú)顯著性差異,不隨主訴之間發(fā)生改變。④與術(shù)前相比,C4-T1各節(jié)段上橫斷面的前后徑術(shù)后明顯減小(P0.05),C4-6各節(jié)段的脊髓前移距離與椎管的比值在術(shù)后也明顯減小(P0.05)結(jié)論：屈曲位上,平山病患者的脊髓前移現(xiàn)象確實(shí)存在,而這一脊髓前移的現(xiàn)象并不會(huì)隨病程增長(zhǎng)而緩解,平山病的致病因素并不能隨病情進(jìn)展自行解除而緩解。因此,目前采取對(duì)患者進(jìn)行頸前路手術(shù)后脊髓前移減少,是對(duì)解除平山病可能致病因素的一個(gè)有效的干預(yù)措施。第二部分動(dòng)力位F波在平山病療效評(píng)估及預(yù)測(cè)中的應(yīng)用背景：“平山病”即青少年上肢遠(yuǎn)端良性肌萎縮癥,是一類具有自限性的良性下運(yùn)動(dòng)神經(jīng)元疾病,常于發(fā)病2-5年后自然靜止。目前由于缺乏有效的即刻療效評(píng)估及預(yù)測(cè)的方法,故術(shù)后患者癥狀恢復(fù)究竟是歸因于手術(shù)還是自然轉(zhuǎn)歸無(wú)法予以鑒別,所以國(guó)際上對(duì)于平山病是否應(yīng)予以手術(shù)治療、何時(shí)應(yīng)予以手術(shù)治療等尚存爭(zhēng)議。目的：本研究探討動(dòng)力位F波對(duì)平山病療效評(píng)估,進(jìn)一步分析動(dòng)力位F波在預(yù)測(cè)平山病治療效果的有效性及可靠性。方法：本研究共納入正常志愿者15例；平山病患者36例手術(shù)治療。所有研究對(duì)象分別于術(shù)前及術(shù)后(5日及6月)進(jìn)行動(dòng)力位F波檢測(cè),于頸部中立位及屈頸30分鐘后等狀態(tài)下,通過(guò)在腕部刺激正中神經(jīng)及尺神經(jīng)進(jìn)而從拇短展肌及小指展肌上連續(xù)記錄10次F波,并測(cè)量平均潛伏期,平均波幅,響應(yīng)頻率等相關(guān)參數(shù)。使用SPSS 19.0對(duì)結(jié)果進(jìn)行分析。結(jié)果：在正常研究對(duì)象中,所有F波參數(shù)在屈頸30min后較中立位時(shí)無(wú)明顯差異(P0.05)。頸椎中立位時(shí),平山病患者的F波平均波幅及響應(yīng)頻率明顯低于正常研究對(duì)象(P0.05)；而屈頸30min后,尺神經(jīng)F波響應(yīng)頻率及波幅的增加分別表現(xiàn)在20例及23例平山病患者中,而正中神經(jīng)F波響應(yīng)頻率及波幅的增加則分別表現(xiàn)在7例及19例平山病患者中。經(jīng)手術(shù)治療后5日,36例病人中有動(dòng)力位F波明顯變化的17例患者上述F波表現(xiàn)完全消失,且至術(shù)后6月隨訪時(shí),該現(xiàn)象仍然未再次出現(xiàn)。握力測(cè)試顯示,術(shù)前存在動(dòng)力位F波變化較大的17例患者中有11例握力出現(xiàn)恢復(fù),余6例握力未見(jiàn)明顯減退,明顯優(yōu)于術(shù)前動(dòng)力位F波無(wú)變化者(10例中4例握力減退,6例握力無(wú)明顯改變)。結(jié)論：動(dòng)力位F波對(duì)平山病手術(shù)療效進(jìn)行評(píng)估與預(yù)測(cè)具有良好的臨床可行性,且F波的波幅及尺神經(jīng)F波響應(yīng)頻率可能是較為敏感且可靠的一類評(píng)估參數(shù)。
[Abstract]:Measurement and comparative study of the first part of the image of different background of Hirayama disease: the morphology of spinal cord position "Hirayama disease" that adolescents benign distal upper extremity muscular atrophy, the earliest in 1959 by a Japanese scholar Hirayama E reported, which is a kind of benign disease from motor nerve element limiting, although its pathogenesis has not been conclusive, but with the development of the understanding of the disease, at present, MRI has been considered an important examination of imaging diagnosis of Hirayama disease, and neutral MRI on spinal cord anterior horn asymmetry atrophy and LOA and dural flexor MRI dilatation of the epidural venous plexus and spinal cord neck under the condition of the posterior wall of spinal cord forward phenomenon has been flattened that is characteristic of more reliable imaging. Objective: To study the measurement of Hirayama disease patients before and after operation in different positions by imaging the extent of anterior spinal cord, flattened degree, further confirmed The imaging performance of Hirayama disease, and summarize the imaging characteristics, evaluate the diagnosis and treatment decision making value. Methods: This study included the January 2011 -2014 year in January in Huashan Hospital Department of orthopedics of the surgical treatment of 92 patients with Hirayama disease (91 male, 1 female; age 19.46 + 2.73 years old; height: 172.53 + 4.80cm) were analyzed retrospectively. The average duration was 1.743 + 1.435 years. All the patients underwent 2 segmental anterior cervical fusion with autologous iliac bone graft fixation in the Department of orthopedics of Huashan hospital (40 cases C4-6,42 cases C5-7,10 cases of fusion fusion fusion C6-T1), measuring cervical hyperextension and flexion. Cervical curvature change and neutral position of MRI and MRI on spinal flexion and forward flattening phenomenon, classification method using Pfirrman imaging evaluation and observation of intervertebral disc degeneration. The existence of which 17 patients completed the imaging with 璁，

本文編號(hào)：1625991