本文選題：腕管 + 正中神經(jīng)�。� 參考：《南方醫(yī)科大學(xué)》2015年碩士論文

【摘要】：背景：腕管的核磁共振(MR)研究始于上個世紀(jì),MR的腕管橫斷面影像所提供的信息最全面,能區(qū)分腕部的所有肌腱、神經(jīng)、韌帶、血管,而且能顯示腕管各壁輪廓,而腕管冠狀面影像則有助于將腕骨區(qū)分開來。研究報道顯示,腕管平面范圍內(nèi)的正中神經(jīng)在MR成像上的影像結(jié)構(gòu)與大體及斷層解剖基本一致。MR成像也被認(rèn)為是現(xiàn)階段診斷腕管綜合征最有價值的影像學(xué)方法。臨床上腕管綜合征的傳統(tǒng)核磁共振表現(xiàn)多集中在正中神經(jīng)的研究,且多數(shù)停留在大體形態(tài)變化這一水平。腕管綜合征的MR表現(xiàn)包括正中神經(jīng)的增粗、變扁及T2WI像上正中神經(jīng)信號的增高。以往的尸體標(biāo)本腕管結(jié)構(gòu)的大體解剖和斷層解剖基礎(chǔ)研究并不能完全代表活體MRI影像解剖,而絕大部分的腕管正中神經(jīng)解剖學(xué)定量研究數(shù)據(jù)均來源于國外人群,并不能作為我國人群診斷腕管綜合征(CTS, carpal tunnel syndrome)的斷層影像參考標(biāo)準(zhǔn)。而在國內(nèi),針對臨床上已明確診斷為CTS患者腕管正中神經(jīng)的MRI斷層定量解剖學(xué)研究已有報道,但作為重要參考依據(jù)的正常人群形態(tài)學(xué)定量解剖學(xué)研究卻鮮有報道。因此,本課題通過采集我國正常青年人群腕部斷層MRI影像數(shù)據(jù),定量研究正中神經(jīng)在腕管內(nèi)的解剖學(xué)形態(tài)特點(diǎn),獲取正常人群正中神經(jīng)的膨脹率、扁平率以及彎曲率等數(shù)據(jù),為鑒別診斷腕管綜合征提供有價值影像解剖依據(jù)。目的：臨床上CTS患者腕管正中神經(jīng)的MRI斷層定量解剖學(xué)研究已有報道,但絕大部分的腕管正中神經(jīng)解剖學(xué)定量研究數(shù)據(jù)均來源于國外人群,并不能作為我國人群診斷CTS的斷層影像參考標(biāo)準(zhǔn)。通過對我國正常青年人群腕管正中神經(jīng)斷層解剖參數(shù)的測量,定量研究正中神經(jīng)在腕管內(nèi)的解剖學(xué)形態(tài)特點(diǎn),為國人腕管正中神經(jīng)形態(tài)學(xué)研究以及臨床上腕管綜合征(CTS)的診治提供參考依據(jù)。方法：本研究共采集32例志愿者,其中4例志愿者僅采集單側(cè)腕部數(shù)據(jù)。剔除4例不完整雙側(cè)腕部數(shù)據(jù),剔除單側(cè)腕部數(shù)據(jù)后統(tǒng)計結(jié)果無差異,故最終納入雙側(cè)腕部完整數(shù)據(jù)28例,共56側(cè)腕部MRI影像數(shù)據(jù),其中男性13例,女性15例,年齡21-33歲,平均23.6歲。全部志愿者均無腕部外傷史及相關(guān)病史,雙側(cè)腕關(guān)節(jié)活動、感覺功能經(jīng)骨科�？撇轶w均為正常。采用SIEMENS Avanto1.5T核磁共振掃描儀對志愿者進(jìn)行掃描,采用膝關(guān)節(jié)線圈,志愿者取仰臥位,單側(cè)手伸直舉過頭頂,對側(cè)手放于身體一側(cè),采用偏中心掃描野。掃描方位：以軸位為主,輔以冠狀位和矢狀位。通過直接測量尺橈骨遠(yuǎn)端平面正中神經(jīng)的長徑、短徑；正中神經(jīng)豌豆骨近端平面的長徑、短徑；鉤骨平面正中神經(jīng)的長、短徑,進(jìn)而計算出這三個腕管層面內(nèi)正中神經(jīng)的橫截面積、扁平率和膨脹率,其中每個平面的正中神經(jīng)的橫截面積(CSA)為該橫截面的正中神經(jīng)長徑×短徑,正中神經(jīng)的扁平率(MNFR)為該平面的正中神經(jīng)的長徑/短徑,正中神經(jīng)的膨脹率(MNSR)為豌豆骨層面的橫截面積/橈骨遠(yuǎn)端層面的橫截面積。對于獲得的這些影像解剖學(xué)測量數(shù)據(jù),采用SPSS20.0統(tǒng)計學(xué)軟件對其進(jìn)行統(tǒng)計學(xué)分析,計量資料用均數(shù)±標(biāo)準(zhǔn)差(±SD)表示,兩配對樣本資料采用兩配對樣本t檢驗,兩獨(dú)立樣本資料采用兩獨(dú)立樣本t檢驗。探究數(shù)據(jù)的相關(guān)性采用相關(guān)性分析,正態(tài)分布采用Person方法,非正態(tài)資料采用Spearman相關(guān)分析方法,顯著性水平設(shè)置為0.05。將測量指標(biāo)進(jìn)行不同性別、不同側(cè)肢體之間比較,并進(jìn)一步把正中神經(jīng)的橫截面積(CSA)分別與年齡、身高、體重進(jìn)行相關(guān)統(tǒng)計學(xué)分析,把正中神經(jīng)扁平率(MNFR)分別與年齡、身高、體重進(jìn)行相關(guān)統(tǒng)計學(xué)分析,把正中神經(jīng)膨脹率(MNSR)分別與年齡、身高、體重進(jìn)行相關(guān)統(tǒng)計學(xué)分析。結(jié)果：青年人群中左手和右手的CSA無統(tǒng)計學(xué)差異,固定男女性別因素情況下,左右手之間的CSA同樣無統(tǒng)計學(xué)差異。由此,在合并和均值化雙側(cè)腕管的CSA數(shù)據(jù)基礎(chǔ)上比較不同性別的CSA,同樣無統(tǒng)計學(xué)差異；而在固定左右手因素后,比較男性和女性CSA,均無統(tǒng)計學(xué)差異。全部志愿者M(jìn)NFR左側(cè)1.04-3.75,平均1.82,MNFR右側(cè)1.08-2.26,平均1.77。男性MNFR左側(cè)1.04-2.21,平均1.63,右側(cè)1.04-2.24,平均1.65。女性MNFR左側(cè)1.42-3.75,平均1.98；右側(cè)1.44-2.26；平均1.86。左手和右手的MNFR無統(tǒng)計學(xué)差異,固定男女性別因素情況下,左右手之間的MNFR同樣無統(tǒng)計學(xué)差異。而在均值化雙側(cè)腕管后比較男女之間MNFR具有統(tǒng)計學(xué)差異(t=-2.126,P=0.043)；在固定左右手因素后,比較男性和女性MNFR,均無統(tǒng)計學(xué)差異。全部志愿者M(jìn)NSR右側(cè)平均1.12,左側(cè)平均為1.09。男性MNSR左側(cè)無論在是否固定男女性別因素的情況下,左右手之間的MNSR均無統(tǒng)計學(xué)差異；而左右手均值化后不同性別之間MNSR也無統(tǒng)計學(xué)差異；在固定左右手因素后,比較不同性別之間的MNSR無統(tǒng)計學(xué)差異；MNFR與身高具有統(tǒng)計學(xué)負(fù)相關(guān)性(r=-0.388, P=0.041), MNFR與體重?zé)o統(tǒng)計學(xué)相關(guān)(r=-0.322,P=0.095),MNFR與年齡無統(tǒng)計學(xué)相關(guān)(r=-0.071,P=0.720)；對于CSA指標(biāo),與年齡的相關(guān)性為(r=-0.004,P=0.986),與體重的相關(guān)性為(r=0.142,P=0.471),與身高的相關(guān)性為(r=0.129,P=0.513),并未發(fā)現(xiàn)和年齡、身高和體重之間的統(tǒng)計學(xué)相關(guān)性；同樣對于MNSR,與年齡的相關(guān)性為(r=0.137,P=0.486),與體重的相關(guān)性為(r=-0.145,P=0.462),與身高的相關(guān)性為(r=-0.110,P=0.578)也并未發(fā)現(xiàn)和年齡、身高以及體重之間的統(tǒng)計學(xué)相關(guān)性。結(jié)論：綜上所述,MRI以其無創(chuàng)性、高軟組織分辨力、能綜合多種成像序列、能直接任意層面、任意角度掃描成像等優(yōu)勢,能夠使腕管內(nèi)各結(jié)構(gòu)的形態(tài)甚至微觀組織的形態(tài)學(xué)變化良好地顯示,本研究結(jié)果也佐證了MRI是顯示肌肉、神經(jīng)、韌帶、肌腱、血管等腕部形態(tài)結(jié)構(gòu)的最佳成像方法,可為CTS的診斷及術(shù)前、術(shù)后評估提供有力的證據(jù)支持。此外,根據(jù)本研究的結(jié)果,國人正中神經(jīng)扁平率在不同性別之間存在著明顯的差異,且國人的扁平率和西方人群存在明顯差異,而扁平率和身高之間則存在著負(fù)相關(guān)性,因此,臨床上國人CTS基于MRI診斷標(biāo)準(zhǔn)的建立需與中國人的實(shí)際解剖參數(shù)相匹配。
[Abstract]:Background: the magnetic resonance (MR) study of the carpal canal began in the last century. The information provided by the transverse section image of the carpal canal in MR is the most comprehensive. It can distinguish all tendons, nerves, ligaments and vessels of the wrist, and can display the contour of the carpal canal wall, while the coronal image of the carpal canal helps to distinguish the carpal bones. The imaging structure of the median nerve in MR imaging is consistent with the gross and fault anatomy..MR imaging is also considered as the most valuable imaging method for the diagnosis of carpal tunnel syndrome at the present stage. The traditional MRI manifestations of the carpal tunnel syndrome are mostly focused on the median nerve, and most of them remain at the level of gross morphological changes. The MR manifestations of carpal tunnel syndrome include the thickening of the median nerve, the flattening of the median nerve and the increase of the median nerve signal on the T2WI image. The general anatomy of the carpal tunnel structure in the past cadavers and the basic study of the sectional anatomy do not fully represent the MRI imaging anatomy of the living body, and the vast majority of the quantitative data of the median neuroanatomy of the carpal tunnel are derived from the country. The external population can not be used as a reference standard for the diagnosis of CTS (carpal tunnel syndrome) in the population of our country. In China, the quantitative anatomical study of the median nerve of the carpal canal, which has been diagnosed clinically as CTS, has been reported, but the morphological quantitative anatomy of the normal population as an important reference is to be used as an important reference. There are few reports on the study. Therefore, by collecting the MRI image data of the wrist fault of the normal young people of our country, we can quantitatively study the anatomical features of the median nerve in the carpal canal, obtain the data of the median nerve expansion rate, flattening rate and the rate of curvature in the normal population, so as to provide valuable image solutions for the differential diagnosis of carpal tunnel syndrome. Objective: the quantitative anatomical study of the MRI fault of the median nerve of the carpal canal in CTS patients has been reported, but the vast majority of the quantitative data of the median neuroanatomy of the carpal canal are derived from the foreign population, and can not be used as a reference for the diagnosis of CTS in the population of our country. Through the wrist Guan Zhengzhong in the normal young people of our country The anatomical morphological characteristics of the median nerve in the carpal canal were measured quantitatively to provide reference for the morphological study of the wrist Guan Zhengzhong nerve and the diagnosis and treatment of the clinical carpal tunnel syndrome (CTS). Methods: 32 volunteers were collected in this study. 4 of the volunteers collected only the unilateral wrist data. 4 cases were eliminated. There was no difference in the data of incomplete bilateral wrist, and the statistical results were no difference after the unilateral wrist data were removed. Therefore, 28 cases were included in the complete data of bilateral wrist. There were 56 MRI images of wrist, including 13 men, 15 women, 21-33 years old and 23.6 years old. All volunteers had no history of wrist injury and related medical history, bilateral wrist movement and sensory function. The volunteers were scanned by the SIEMENS Avanto1.5T NMR scanner, the volunteers were scanned with the knee joint coil, the supine position was taken by the volunteers, the unilateral hand was lifted above the head, the side hand was placed on the side of the body, and the central scan field was adopted. The axis position was the main axis, and the coronal and sagittal position were supplemented by the straight line. Through straight. The length diameter and short diameter of the median nerve of the distal radius of the ruler and radius of the measuring ruler, the length and short diameter of the proximal plane of the median nerve pea bone, the length and the short diameter of the median nerve of the hook bone plane, and then calculate the transverse area of the median nerve in the three carpal canal layers, the flat rate and the expansion rate, and the transverse area of the median nerve at each plane (CSA) is the same The median nerve length diameter * short diameter of the cross section, the median nerve flattening rate (MNFR) is the length / short diameter of the median nerve of the plane, the expansion rate of the median nerve (MNSR) is the cross section area of the pea bone layer / the distal radius of the radius. For these images, the data of the dissection and measurement are obtained by the SPSS20.0 statistics software. Statistical analysis was carried out, and the measurement data were expressed with mean standard deviation (+ SD). Two paired sample t test was used for two paired sample data and two independent sample t test was used for independent sample data. Correlation analysis was used to explore the correlation of data. Normal distribution was used Person method, and non normal data were analyzed by Spearman correlation method. At the level of 0.05., the measurement indexes were compared between different sexes, different sides of limbs, and the correlation between the cross section area (CSA) of the median nerve and the age, height and weight were analyzed, and the median nerve flattening rate (MNFR) was analyzed with age, body height and body weight respectively, and the median nerve expansion rate (M NSR) statistical analysis of age, height and weight respectively. Results: there was no statistical difference between the left hand and the right hand of the young people, and there was no statistical difference between the left and right hands in the CSA of the left and right hands. Therefore, on the basis of the CSA data of the combined and mean bilateral carpal tunnel, the CSA of different sex was compared. There was no statistical difference, but there was no statistical difference between male and female CSA after fixing the left and right hand factors. All volunteers MNFR left 1.04-3.75, average 1.82, MNFR right 1.08-2.26, average 1.77. male MNFR left 1.04-2.21, average 1.63, right 1.04-2.24, average 1.65. female MNFR 1.42-3.75, 1.98. There was no statistical difference between the mean 1.86. left hand and the right hand MNFR. There was no statistical difference between the left and right hands under the condition of fixed sex and sex, while the MNFR between the two men and women was statistically significant (t=-2.126, P=0.043) after the mean of bilateral carpal tunnel (t=-2.126, P=0.043). There was no statistical difference between the male and female MNFR after the fixation of the left and right hand factors. The average right side of MNSR on the right side of all volunteers was 1.12, and the left average was 1.09. male MNSR on the left side, no statistical difference was found between the left and right hands, and there was no statistical difference between the left and right hands, and the MNSR between the left and right hands was no difference between the left and right hands. After the left right hand factor was fixed, the difference between the different sexes was compared. There was no statistical difference in MNSR; MNFR and height had statistical negative correlation (r=-0.388, P=0.041), MNFR had no statistical correlation with weight (r=-0.322, P=0.095), MNFR had no statistical correlation with age (r=-0.071, P=0.720); for CSA index, the correlation with age was (r=-0.004,), and height. The correlation was (r=0.129, P=0.513), and there was no statistical correlation between age, height and weight; also for MNSR, the correlation with age (r=0.137, P=0.486), the correlation with weight (r=-0.145, P=0.462), and the correlation between height and height (r=-0.110, P=0.578) were not found to be between age, height, and weight. Conclusion: To sum up, MRI, with its noninvasive, high soft tissue resolution, can synthesize a variety of imaging sequences, can direct any plane, arbitrary angle scanning imaging and other advantages, can make the morphological changes of the structures and even microstructures of the carpal tube display well. The results of this study also support the evidence that MRI is the display of muscle. The best imaging methods for the morphological structure of the wrist, such as nerve, ligament, tendon and blood vessel, can provide strong evidence for the diagnosis of CTS and the assessment of the preoperative and postoperative evaluation. In addition, there are obvious differences in the median nerve flattening rate between different sexes according to the results of this study, and the flat rate of the people of the country is significantly different from that of the western population. However, there is a negative correlation between flattening and height. Therefore, the establishment of CTS based MRI diagnostic criteria for Chinese people needs to match the actual anatomical parameters of the Chinese people.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R688

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