本文選題：超聲 + 腕管綜合征�。� 參考：《大連醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:利用高頻超聲測量腕管綜合征(carpal tunnel syndrome,CTS)患者豌豆骨水平的正中神經(jīng)的橫截面積及前臂遠端旋前方肌水平的正中神經(jīng)橫截面積,并以此兩個橫截面積為基礎(chǔ)計算出兩個相關(guān)參數(shù),即面積增量和面積比。研究能否根據(jù)超聲豌豆骨水平正中神經(jīng)的橫截面積、面積增量、面積比三個參數(shù)進行CTS的診斷和CTS嚴重程度的分級,以及其分級結(jié)果是否可靠。方法:87例病人,共98個手腕[女73例,有9例是雙側(cè),男14例,有兩例是雙側(cè),年齡31-73歲,平均(55.10±9.41)歲作為CTS組,均經(jīng)臨床及神經(jīng)電生理檢查(nerve conduction studies,NSC)證實為CTS患者,并選取志愿者42名作為對照組,均無上肢麻木、疼痛等癥狀,均進行檢查排除CTS。超聲測量豌豆骨水平正中神經(jīng)的橫截面積和前臂遠端旋前方肌水平正中神經(jīng)的橫截面積(在旋前方肌水平全段正中神經(jīng)的橫截面積變化較小,我們測量選擇在旋前方肌的遠側(cè)緣),并以兩個橫截面積測量參數(shù)為基礎(chǔ)進行面積增量、面積比兩個相關(guān)參數(shù)的計算:面積增量是正中神經(jīng)豌豆骨水平橫截面積與前臂遠端旋前方肌水平橫截面積之差,面積比是正中神經(jīng)豌豆骨水平橫截面積與前臂遠端旋前方肌水平橫截面積之比。以NCS分級結(jié)果為基礎(chǔ),將超聲檢測豌豆骨水平正中神經(jīng)橫截面積、面積增量、面積比進行分級。對各組數(shù)據(jù)進行ANOVE方差分析和獨立樣本t檢驗。對相鄰兩組做ROC曲線分析,求出各級之間的最佳閾值,及其敏感性及特異性。最后將超聲豌豆骨水平正中神經(jīng)橫截面積、面積增量、面積比分別與作為金標準的NCS結(jié)果進行Kappa一致性分析。結(jié)果:根據(jù)NCS的分級結(jié)果,將CTS病人分為正常、輕度、中度、重度組,超聲豌豆骨水平正中神經(jīng)橫截面積,面積增量和面積比,在各組間均有顯著差異(P0.05)。豌豆骨水平正中神經(jīng)的橫截面積的(?)±S,正常組、輕度組,中度組,重度組的分別是0.07±0.01cm~2、0.10±0.02 cm~2、0.13±0.01 cm~2、0.18±0.03 cm~2。面積增量的(?)±S,正常組、輕度組、中度組、重度組的分別是0.03±0.01 cm~2、0.06±0.01 cm~2、0.08±0.01 cm~2、0.12±0.03 c m~2。面積比的(?)±S,正常組、輕度組、中度組、重度組的分別是1.78±0.27、2.34±0.26、2.71±0.31、3.13±0.50。通過制作各相鄰組之間的ROC,豌豆骨水平橫截面積在區(qū)分正常、輕、中、重組時的最佳閾值是0.09 cm~2、0.12 cm~2、0.15 cm~2;面積增量在區(qū)分正常、輕、中、重組時的最佳閾值是0.05 cm~2、0.08 cm~2、0.10 cm~2;面積比在區(qū)分正常、輕、中、重組時的最佳閾值是2.1、2.5、2.9。豌豆骨水平正中神經(jīng)的橫截面積的分級結(jié)果與NCS分級結(jié)果的Kappa值是0.702,面積增量的分級結(jié)果與NCS的分級結(jié)果的Kappa值是0.823,面積比的分級結(jié)果與NCS的分級結(jié)果的Kappa值是結(jié)論0.580。結(jié)論:超聲測量的豌豆骨正中神經(jīng)水平橫截面積、面積增量、面積比有助于CTS的嚴重程度預(yù)測。面積增量對于CTS的診斷及CTS嚴重程度的分級的鑒別能力最強。面積增量的分級結(jié)果與NCS分級結(jié)果有較高的一致性,豌豆骨水平正中神經(jīng)的橫截面積及面積比的分級結(jié)果與NCS的一致性一般。超聲對于CTS的診斷是一種有效的輔助檢查方法。
[Abstract]:Objective: to measure the cross sectional area of the median nerve of the carpal tunnel syndrome (CTS) patients with the level of the pea bone and the lateral area of the median nerve of the distal forearm level of the forearm by high frequency ultrasound, and calculate the area increment and area ratio based on the two cross sectional areas. The cross sectional area of the median nerve of the pea bone, area increment, area ratio of three parameters to the diagnosis of CTS and the classification of CTS severity, and the reliability of its classification results. Methods: 87 patients were 98 wrist [female 73 cases, 9 cases with bilateral, 14 men, two were bilateral, age 31-73, and average (55.10 + 9.41) years old as group CTS, " All nerve conduction studies (NSC) were all confirmed as CTS patients, and 42 volunteers were selected as the control group without upper limb numbness and pain. The cross-sectional area of the median nerve of pea bone level and the transverse area of median nerve at the distal forearm level of forearm were all checked out by CTS. ultrasound. The transversal area of the median nerve in the whole segment of the lateral circumflex muscle was smaller. We measured the distal margin of the lateral circumflex muscle. The area increment was based on the two cross sectional area measurements. The area was compared to two related parameters: the area increment was the horizontal cross section of the median nerve pea bone and the water of the forearm forward muscle. The ratio of the area to the horizontal cross section is the ratio of the horizontal cross section of the median nerve pea bone to the horizontal cross section of the forearm. Based on the results of NCS classification, the transversal area, area increment and area ratio of the median nerve of pea bone were measured by ultrasound, and the data of each group were analyzed by ANOVE variance and independent sample t Test the ROC curve of two adjacent groups, and find the best threshold, its sensitivity and specificity between all levels. Finally, the transverse area, area increment, area ratio of the ultrasonic pea bone level, area ratio and the NCS results as the gold standard are analyzed Kappa consistency. Results: according to the NCS classification results, the CTS patients are divided into normal. In the mild, moderate, severe group, the transversal area of the median nerve of the pea bone, the area increment and area ratio, there were significant differences between each group (P0.05). The cross section of the median nerve of the pea bone (?) + S, the normal group, the mild group, the moderate group and the severe group were 0.07 + 0.01cm~2,0.10 + 0.02 cm~2,0.13 + 0.01 cm~2,0.18 + 0.03 cm~2 respectively. The area increment (?) + S, the normal group, the mild group, the moderate group and the severe group were 0.03 + 0.01 cm~2,0.06 + 0.01 cm~2,0.08 + 0.01 cm~2,0.12 + 0.03 C m~2. area ratio (?) + S, the normal group, the mild group, the moderate group, and the severe group were 1.78 + 0.27,2.34 + 0.26,2.71 + 0.31,3.13 + 0.50. through the production of the ROC, pea bone between the adjacent groups The optimal threshold of horizontal cross section area is 0.09 cm~2,0.12 cm~2,0.15 cm~2 when the reorganization is normal, light and medium, and the optimum threshold of area increment is 0.05 cm~2,0.08 cm~2,0.10 cm~2 when it is normal, light and medium. The optimum threshold of area ratio is normal, light and medium, and the optimum threshold is the transverse of the median nerve of the 2.1,2.5,2.9. pea bone level. The Kappa value of the sectional area and the NCS classification result is 0.702, the area increment classification result and the NCS classification result Kappa value is 0.823, the area ratio classification result and the NCS grading result Kappa value is the conclusion 0.580. conclusion: the ultrasonic measuring the pea bone median nerve water flat cross section area, area increment, area ratio help CTS The area increment is the strongest for the diagnosis of CTS and the classification of CTS severity. The results of the area increment are in good agreement with the NCS classification results. The results of the cross section area and area ratio of the median nerve of the pea bone are consistent with the NCS. The diagnosis of CTS is a kind of method. An effective auxiliary examination method.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.1;R688

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