【摘要】：目的探討MRI在診斷臂叢節(jié)后神經(jīng)損傷中的影像表現(xiàn)及其臨床應(yīng)用價(jià)值 材料和方法搜集16例臨床懷疑為臂叢神經(jīng)節(jié)后損傷的患者,均存在不同程度的感覺、運(yùn)動(dòng)功能障礙或/和肌肉萎縮等表現(xiàn),術(shù)前采用飛利浦Achieva3. OT TX超導(dǎo)型MR掃描儀行臂叢神經(jīng)掃描檢查、神經(jīng)電生理學(xué)檢查,同時(shí)行手術(shù)探查,通過(guò)兩種檢查方法與手術(shù)探查、術(shù)中電生理所見或臨床證實(shí)進(jìn)行比較,分別計(jì)算兩種檢查方法診斷臂叢神經(jīng)節(jié)后損傷的準(zhǔn)確率,利用統(tǒng)計(jì)學(xué)方法,比較兩種方法對(duì)于節(jié)后損傷的準(zhǔn)確率有無(wú)差異,同時(shí)分別計(jì)算每個(gè)節(jié)后神經(jīng)根在MRI檢查中的診斷準(zhǔn)確率有無(wú)差異。 結(jié)果MRI檢查對(duì)臂叢神經(jīng)節(jié)后損傷靈敏度、特異度、準(zhǔn)確度分別為94%、72%、83%。節(jié)后損傷在MRI中的征象：神經(jīng)表現(xiàn)正常,神經(jīng)走形、信號(hào)未見明顯異常,與健側(cè)一致；神經(jīng)連續(xù)、變性增粗,伴或不伴周圍高信影或受壓改變；神經(jīng)瘢痕組織形成,走行僵直、結(jié)構(gòu)紊亂,伴或不伴周圍高信號(hào)影；神經(jīng)走行區(qū)可見結(jié)節(jié),外傷性神經(jīng)瘤的形成；神經(jīng)斷裂、斷端分離消失。臂叢節(jié)后各神經(jīng)根損傷在MRI中的診斷準(zhǔn)確率頸5-胸1分別為78%、85%、64%、93%、93%。肌電圖診斷節(jié)后損傷準(zhǔn)確率為80%,MRI和肌電圖兩種檢查方法診斷準(zhǔn)確率差異無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論MRI可以清楚的同時(shí)顯示臂叢神經(jīng)節(jié)前、后損傷的影像診斷,且無(wú)創(chuàng)無(wú)輻射,對(duì)臂叢神經(jīng)節(jié)后損傷可以提供準(zhǔn)確而清晰的定位定性診斷,具有較高的準(zhǔn)確率,同時(shí)在診斷臂叢神經(jīng)干的診斷效能上是不同的,MRI診斷臂叢節(jié)后損傷與肌電圖檢查結(jié)果的準(zhǔn)確率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),故MRI可作為嚴(yán)重?fù)p傷或疾病急性期的首選檢查方法,臨床上術(shù)前提供手術(shù)區(qū)組織損傷的情況,早期制定手術(shù)方案,有助于預(yù)后。
[Abstract]:Objective to investigate the imaging features and clinical value of MRI in the diagnosis of postganglionic nerve injury of brachial plexus. Patients with motor dysfunction or / and muscular atrophy were treated with Philips Achieva3 before operation. OT-TX superconducting Mr scanner was used to examine brachial plexus, nerve electrophysiology and surgical exploration. The two methods were compared with operative exploration, intraoperative electrophysiological findings or clinical evidence. The accuracy of the two methods in the diagnosis of postganglionic injury of brachial plexus was calculated, and the statistical method was used to compare the accuracy of the two methods for postganglionic injury. At the same time, the diagnostic accuracy of each postganglionic nerve root in MRI was calculated. Results the sensitivity, specificity and accuracy of MRI for postganglionic injury of brachial plexus were 9472 and 83, respectively. The signs of postganglionic injury in MRI were as follows: the nerve showed normal appearance, the shape of the nerve was normal, the signal was not abnormal, and the signal was consistent with the healthy side; the nerve was continuous, denatured and thickened, accompanied with or without the surrounding hyperbolic or compressed changes; the nerve scar tissue was formed and walked stiffly. Structure disorder, with or without peripheral hyperintense shadow; nodule was seen in the nerve walk area, traumatic neuroma was formed; nerve was broken, and the broken end was separated and disappeared. Diagnostic accuracy of nerve root injury after brachial plexus in MRI: the accuracy of cervical 5-thorax 1 was 78.85, and 93s were 93s. The accuracy of electromyography in the diagnosis of postganglionic injury was not significantly different from that of MRI and electromyography. Conclusion MRI can clearly display the imaging diagnosis of pre- and post-ganglionic injury of brachial plexus at the same time, and it can provide accurate and clear diagnosis of postganglionic injury of brachial plexus with high accuracy. At the same time, in the diagnosis of brachial plexus trunk, there was no significant difference in the accuracy of MRI in the diagnosis of postganglionic injury of brachial plexus and electromyography (P0.05). Therefore, MRI can be used as the first choice in the diagnosis of severe injury or acute stage of disease. It is helpful for prognosis to provide the condition of tissue injury in the operation area before operation and to make the operation plan in the early stage.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R651.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 何平;許孟君;郟潛新;歐陽(yáng)林;;MRI神經(jīng)根成像在臂叢節(jié)后神經(jīng)損傷中的應(yīng)用[J];中國(guó)骨與關(guān)節(jié)損傷雜志;2010年09期

2 韓月東,孫立軍,趙海濤,龔雪鵬,張勁松,劉凱,葛亞麗;臂叢神經(jīng)腫瘤性病變MRI診斷[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2002年06期

3 李新春,陳健宇,王欣璐,沈君,劉慶余,梁碧玲;兔坐骨神經(jīng)急性擠壓傷的MRI與病理學(xué)對(duì)比初步研究[J];中華放射學(xué)雜志;2004年02期

4 陳建宇;劉慶余;沈君;梁碧玲;高明勇;葉瑞心;鐘鏡聯(lián);;臂叢神經(jīng)損傷的 MRI 診斷[J];中華放射學(xué)雜志;2007年06期

5 沈尊理,陳德松,顧玉東,200040,楊國(guó)敬;臂叢神經(jīng)椎間孔處的顯微解剖及其臨床意義[J];中華手外科雜志;1996年01期

6 李新春,陳健宇,劉慶余,沈君,梁碧玲;正常臂叢節(jié)后神經(jīng)MR神經(jīng)成像術(shù)[J];中國(guó)醫(yī)學(xué)影像技術(shù);2004年01期

7 高明勇,梁碧玲,許揚(yáng)濱,黃穗喬,陳健宇,鐘鏡聯(lián),葉瑞心;臂叢節(jié)后神經(jīng)損傷的MRI診斷探討[J];中國(guó)醫(yī)學(xué)影像技術(shù);1998年07期

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