【摘要】：目的：明確正常成人項(xiàng)部肌肉骨骼系統(tǒng)的聲像圖特征，闡明正常成人項(xiàng)部肌肉骨骼系統(tǒng)的高頻超聲掃查方法。 方法：利用高頻超聲IE33檢查30例（男15例，女15例，左右共60側(cè)）正常成人項(xiàng)部，描述并記錄正常成人項(xiàng)部的骨骼、肌肉、血管、神經(jīng)、韌帶的毗鄰關(guān)系及聲像圖特征；測(cè)量枕大神經(jīng)入頭半棘肌點(diǎn)處橫截面積，按照左右側(cè)分組，采取配對(duì)樣本t檢驗(yàn)進(jìn)行分析，左、右側(cè)對(duì)比判斷枕大神經(jīng)入肌點(diǎn)處橫截面積差異有無統(tǒng)計(jì)學(xué)意義；按照男女性別分組，采取獨(dú)立樣本的t檢驗(yàn)進(jìn)行分析，男、女組對(duì)比判斷枕大神經(jīng)入肌點(diǎn)處橫截面積差異有無統(tǒng)計(jì)學(xué)意義；測(cè)量頸深動(dòng)脈內(nèi)徑及峰值流速，使用計(jì)算機(jī)統(tǒng)計(jì)學(xué)軟件得出均數(shù)（x）及標(biāo)準(zhǔn)差（s），從而求出頸深動(dòng)脈內(nèi)徑及峰值流速的95%可信區(qū)間（95%CI）；探查枕動(dòng)脈于項(xiàng)部走行情況，計(jì)算出兩種類型累計(jì)例數(shù)所占總樣本的百分比。 結(jié)果：本研究以項(xiàng)部肌肉、骨骼、神經(jīng)、血管、韌帶為解剖標(biāo)志，得出正常成人項(xiàng)部的多個(gè)切面聲像圖；描述了項(xiàng)部第1頸椎至第2頸椎水平椎枕肌構(gòu)成枕下三角的聲像圖特點(diǎn)及枕下三角內(nèi)枕下神經(jīng)與椎動(dòng)脈解剖關(guān)系；闡明了項(xiàng)部第3頸椎至第5頸椎水平橫突棘肌層次關(guān)系；概括了項(xiàng)部第6頸椎至第7頸椎水平夾板肌毗鄰關(guān)系；具體說明了項(xiàng)部枕大神經(jīng)走行特點(diǎn)，測(cè)量了枕大神經(jīng)入頭半棘肌點(diǎn)處橫截面積；明晰了肩胛背神經(jīng)自中斜角穿出后與肩胛背動(dòng)脈在背部伴行的聲像特征及項(xiàng)部副神經(jīng)自胸鎖乳突肌后緣穿出后走行于肩胛提肌與斜方肌之間的聲像特點(diǎn)；明確了項(xiàng)部頸深動(dòng)脈及枕動(dòng)脈的走行特點(diǎn)，測(cè)得了項(xiàng)部頸深動(dòng)脈內(nèi)徑及峰值流速，詳細(xì)地記錄了項(xiàng)部枕動(dòng)脈兩種不同走行情況的累計(jì)例數(shù)；明確了項(xiàng)韌帶各部分肌纖維來源的聲像特點(diǎn)。統(tǒng)計(jì)學(xué)結(jié)果顯示：男、女組對(duì)比，枕大神經(jīng)入肌點(diǎn)處橫截面積差異有統(tǒng)計(jì)學(xué)意義（P0.05）；左右側(cè)對(duì)比，，枕大神經(jīng)入肌點(diǎn)處橫截面積差異無顯著性（P0.05）；頸深動(dòng)脈內(nèi)徑的均數(shù)±標(biāo)準(zhǔn)差（x±s）為1.51±0.15mm，峰值流速的均數(shù)±標(biāo)準(zhǔn)差（x±s）為2.84±0.48m/s；枕動(dòng)脈走行于頭夾肌與頭最長(zhǎng)肌肌間（46支）占77%，枕動(dòng)脈走行于頭最長(zhǎng)肌與頭上斜肌肌間（14支）占23%。 結(jié)論：高頻超聲可作為正常成人項(xiàng)部的肌肉骨骼系統(tǒng)的首選的無創(chuàng)性檢查，值得在臨床推廣。
[Abstract]:Objective: to identify the sonographic features of the musculoskeletal system in normal adults and to elucidate the method of high frequency ultrasound scanning for the musculoskeletal system in normal adults. Methods: 30 normal adults (15 males, 15 females, 60 sides) were examined by high frequency ultrasound (IE33). The adjacent relationship of bone, muscle, blood vessels, nerves and ligaments were described and recorded. The cross sectional area of the occipital great nerve into the point of the semis spinalis of the occipital nerve was measured and divided into groups according to the left and right sides. The paired t-test was used to analyze the cross-sectional area of the occipital great nerve entering the muscle point. According to the sex group of men and women, the T-test of independent samples was used to analyze the difference of cross-sectional area between male and female groups in the point of occipital great nerve entering the muscle. The internal diameter and peak velocity of the deep carotid artery were measured and the 95% confidence interval (95%CI) of the internal diameter and peak velocity of the deep carotid artery was obtained by using the computer statistical software to obtain the mean (x) and standard deviation (s),. The occipital artery was searched and the percentage of the total samples of the two types of accumulative cases was calculated. Results: in this study, the anatomical signs of nape muscles, bones, nerves, blood vessels and ligaments were used as anatomic markers. This paper describes the sonographic characteristics of the inferior occipital triangle formed by the horizontal occipital muscles of the first to second cervical vertebrae and the anatomical relationship between the suboccipital nerve and the vertebral artery in the suboccipital triangle, and clarifies the relationship between the horizontal transverse spinous muscle of the third cervical vertebra and the fifth cervical vertebrae. The contiguous relationship between the sixth cervical vertebra and the seventh cervical vertebrae was summarized, the characteristics of the great occipital nerve and the cross sectional area of the greater occipital nerve into the point of the semis spinalis were measured. The sonographic characteristics of the dorsal scapular nerve and the dorsal scapular artery accompanying with the dorsal scapular artery in the back were clarified, and the characteristics of the accessory nerve of the nape running from the posterior edge of the sternocleidomastoid muscle through the posterior edge of the sternocleidomastoid muscle between the levator scapularis muscle and the trapezius muscle were clarified. The internal diameter and peak flow velocity of deep carotid artery and occipital artery were measured, and the cumulative cases of two different patterns of occipital artery were recorded in detail. The sonographic characteristics of the source of muscle fibers in various parts of the nape ligament were defined. The results showed that there were significant differences in cross sectional area between male and female groups (P0.05), while there was no significant difference between left and right side (P0.05). The mean 鹵standard deviation (x 鹵s) of the internal diameter of the deep carotid artery was 1.51 鹵0.15 mm, and the mean 鹵standard deviation of the peak velocity (x 鹵s) was 2.84 鹵0.48 m / s; The occipital artery was located between the head clamp muscle and the longest head muscle (46 branches) and the occipital artery between the longest head muscle and the superior oblique head muscle (14 branches), and the occipital artery was located between the longest head muscle and the superior oblique head muscle (14 branches). Conclusion: high frequency ultrasound can be used as the first choice of noninvasive examination of musculoskeletal system in normal adults, and it is worth popularizing in clinic.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R681

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