發(fā)布時間：2018-03-05 05:20

  本文選題：高血壓腦出血　切入點：基底節(jié)　出處：《揚州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 本研究通過DTT (Diffusion Tensor Tractography,彌散張量纖維束成像)重建雙側(cè)CST(Cortico Spinal Tract,皮質(zhì)脊髓束)3D圖像,顯示高血壓基底節(jié)區(qū)腦出血后神經(jīng)纖維束的損傷情況,通過分析不同程度損傷和肢體遠(yuǎn)期肌力恢復(fù)之間的關(guān)系,探討DTT技術(shù)在高血壓基底節(jié)區(qū)腦出血預(yù)后評估中的價值。 方法 對25例采用保守治療的單側(cè)高血壓基底節(jié)區(qū)腦出血病例,在入院時、出院時以及出院3個月三個不同時間段進(jìn)行量表評估。根據(jù)CST損傷分級將其分為四組：CST1級；CST2級；CST3級；CST4級。評估指標(biāo)為：肌力、改良Rankin評分及FMA (Fugl-Meyer Assessment,Fugl-Meyer運動)評分。結(jié)果采用SPSS19.0軟件進(jìn)行多樣本均數(shù)間兩兩比較的q檢驗,以P0.05作為顯著性差異指標(biāo)。 結(jié)果 1、肌力 根據(jù)CST損傷分級的結(jié)果,對25例患者出血對側(cè)肢體的肌力進(jìn)行統(tǒng)計學(xué)分析,具有顯著差異。同一分級的患者3次肌力評估時,其結(jié)果較前一次均有不同程度提升,下肢肌力恢復(fù)較上肢好。結(jié)果發(fā)現(xiàn)CST損傷分級與肢體功能障礙成正相關(guān),CST損傷分級越低的患者,其肌力遠(yuǎn)期恢復(fù)結(jié)果較為理想,即CST1CST2CST3CST4.且CST1級和CST2級的患者其出院3個月后肌力基本恢復(fù)正常,而CST4級的患者,預(yù)后較差。 2、Rankin評分 同一分級的患者在三個不同時間段內(nèi)行Rankin評分時發(fā)現(xiàn),其每一次評分較前都有不同,即入院時評分最高,而出院3個月時評分最低。對分級的四組數(shù)據(jù)在出院3個月進(jìn)行檢驗時發(fā)現(xiàn)：CST1與CST2其兩組間在統(tǒng)計學(xué)方面無明顯差異(P0.05),而其他各組間相互比較其P值均0.05,具有統(tǒng)計學(xué)意義。因此CST3級和CST4級的患者,由于其遠(yuǎn)期評分高于CST1級和CST2級的患者,結(jié)果肢體功能恢復(fù)情況差于CST1級與CST2級的患者。 3、FMA評分 對出血對側(cè)肢體的運動功能進(jìn)行FMA評分,其總分為100分,與健側(cè)相比。結(jié)果發(fā)現(xiàn)每一組患者不同三個時間段內(nèi)的FMA評分逐步提高。出院三個月CST1-2級的患者FMA評分均基本滿分,而CST4級的患者,評分與其它三組相比,其評分最低,且各組間相互比較,其p值均0.05,具有明顯差異,遠(yuǎn)期運動功能評分CST1、CST2、CST3、CST4。 結(jié)論 早期DTT可了解血腫對CST的破壞程度,并可預(yù)測患者遠(yuǎn)期肢體功能恢復(fù)。不同分級CST患者遠(yuǎn)期肢體功能的恢復(fù)情況與CST分級的結(jié)果高度相符。對患者的預(yù)后評估提供了較為可靠的影像依據(jù),且此項檢查無創(chuàng)、價廉,具有良好的社會和經(jīng)濟(jì)效益。
[Abstract]:objective
The study by DTT (Diffusion Tensor Tractography, diffusion tensor imaging (CST) reconstruction of bilateral Cortico Spinal Tract, 3D image display, corticospinal tract) injury of nerve fiber bundles in hypertensive cerebral hemorrhage in basal ganglia, by analyzing the relationship between the different degree of injury and limb muscle strength recovery forward, discusses the DTT technology in prognosis the assessment value of hypertensive cerebral hemorrhage in basal ganglia.
Method
Of 25 cases with conservative treatment of unilateral intracerebral hemorrhage on admission, discharge and 3 months after discharge in three different time scale assessment. According to the CST classification of injury will be divided into four groups: CST1; CST2; CST3; assessment indicators: CST4 level. Muscle strength, the modified Rankin score and FMA (Fugl-Meyer Assessment, Fugl-Meyer motion) score. Results by using SPSS19.0 software Q test for multi sample mean comparison between the 22, with P0.05 as the significant difference between the indicators.
Result
1, muscle strength
According to the classification results of CST damage, 25 cases of hemorrhage in patients with contralateral limb muscle strength were analyzed, with significant difference. The same grade of patients 3 times strength assessment, the results of previous times have varying degrees of improvement, lower limb muscle strength recovery is good. The upper limb CST injury grading and limb dysfunction is related to CST classification patients with lower strength, long-term recovery of the ideal result, namely CST1CST2CST3CST4. and CST1 level and CST2 level in patients with muscle discharge returned to normal after 3 months, while the CST4 level in patients with poor prognosis.
2, Rankin score
The same grade were found in three different time periods within the Rankin score, the score before each time are different, which was the highest score, and 3 months after discharge. The lowest score of the four sets of data for classification in 3 months after inspection found: CST1 and CST2 two between the groups there is no significant difference in Statistics (P0.05), and other groups were compared between the P value was 0.05, with statistical significance. The CST3 level and CST4 level of patients, because of its long-term score is higher than that of CST1 and CST2 patients, the recovery of limb function difference in CST1 level and CST2 level of patients.
3, FMA score
The bleeding on motor function of limbs were FMA score, the total score of 100 points, compared with the contralateral side. Results showed that each group of three patients with different time period FMA score gradually increased. Three months CST1-2 patients FMA scores were the basic score, and CST4 patients compared with the score the other three groups, the lowest score, and between groups were compared with each other, the p value was 0.05, with obvious difference, forward movement function score of CST1, CST2, CST3, CST4.
conclusion
Early DTT can understand the damage degree of hematoma on CST, and it can predict the long-term recovery of limb function in patients with different grade. Function of limbs long-term rehabilitation of CST patients with CST. The results of the classification of highly consistent provides reliable imaging basis for prognosis evaluation of the patients, and the examination is non-invasive, cheap, good the social and economic benefits.

【學(xué)位授予單位】：揚州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.34

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李靜;李澄;王葦;;纖維束示蹤成像定量評價皮質(zhì)脊髓束損傷與腦出血后6個月運動功能結(jié)果的相關(guān)性[J];磁共振成像;2010年01期

2 方靖琴;張偉國;陳金華;張樂天;汪黎黎;;應(yīng)用磁共振波譜分析和彌散張量成像鑒別顱內(nèi)良、惡性腫瘤[J];第三軍醫(yī)大學(xué)學(xué)報;2009年21期

3 張龍江 ,祁吉;白質(zhì)纖維束示蹤成像的原理及應(yīng)用[J];國外醫(yī)學(xué)(臨床放射學(xué)分冊);2005年05期

4 李翠寧;劉懷軍;賈林毅;耿左軍;池琛;崔彩霞;黃勃原;;右利手正常年輕人腦投射纖維DTI參數(shù)圖研究[J];磁共振成像;2010年02期

5 吳勁松;洪汛寧;周良輔;毛穎;杜固宏;;白質(zhì)纖維束的彌散張量成像在腦膠質(zhì)瘤外科的應(yīng)用[J];中國臨床神經(jīng)科學(xué);2007年03期

6 李翠寧;劉懷軍;賈林毅;耿左軍;池琛;崔彩霞;黃勃源;劉瑞春;;健康右利手年輕人腦白質(zhì)投射纖維各向異性研究[J];中國全科醫(yī)學(xué);2010年14期

7 王加充;趙建農(nóng);王鵬程;彭其斌;王義彪;;磁共振彌散張量成像對腦皮質(zhì)運動區(qū)腫瘤患者偏癱肢體術(shù)后運動功能的評估價值[J];中國全科醫(yī)學(xué);2013年36期

8 汪啟東;徐曉俊;張敏鳴;;兩側(cè)內(nèi)囊非對稱性的磁共振彌散張量成像研究[J];浙江大學(xué)學(xué)報(醫(yī)學(xué)版);2008年05期

9 曾勁松;;高血壓基底節(jié)區(qū)腦出血錐體束損傷的彌散張量纖維束成像評價[J];中華臨床醫(yī)師雜志(電子版);2009年08期

10 劉學(xué)鈞 ,李建利,陳漢其;大腦左右半球不對稱的解剖學(xué)觀察及臨床意義[J];中國煤炭工業(yè)醫(yī)學(xué)雜志;2003年07期

，

本文編號：1568910