【摘要】：目的:通過對(duì)腕管綜合征患者進(jìn)行神經(jīng)肌電圖、超聲和MRI檢查,探討三者在腕管綜合征中的應(yīng)用及相關(guān)性。內(nèi)容:對(duì)36例腕管綜合征患者和40例健康對(duì)照者進(jìn)行神經(jīng)肌電圖、超聲和MRI檢查,并將檢查結(jié)果進(jìn)行比較。對(duì)中、晚期腕管綜合征患者進(jìn)行手術(shù),將術(shù)中所見正中神經(jīng)的病變情況與術(shù)前超聲、MRI的檢查結(jié)果進(jìn)行比較。方法:首先采用丹麥KEYPOINT 4型四導(dǎo)肌電誘發(fā)電位儀對(duì)患者及志愿者進(jìn)行檢查,包括肌電圖(EMG)檢查和神經(jīng)電圖檢查,先用同心圓針檢查拇短展肌,觀察靜息狀態(tài)下有無插入電位延長(zhǎng)和自發(fā)電位;小力收縮肌肉時(shí)單個(gè)運(yùn)動(dòng)單位電位的時(shí)限、波幅;大力收縮肌肉時(shí)募集電位的類型以及募集電位的峰-峰值。再進(jìn)行正中神經(jīng)傳導(dǎo)的檢查,測(cè)定的參數(shù)包括:運(yùn)動(dòng)傳導(dǎo)速度、末端運(yùn)動(dòng)潛伏期、復(fù)合肌肉動(dòng)作電位波幅、感覺傳導(dǎo)速度、感覺神經(jīng)動(dòng)作電位波幅。之后按照電生理分期診斷標(biāo)準(zhǔn)分為早、中、晚3期。再采用GE公司生產(chǎn)的Logiq E9型彩色多普勒超聲檢查儀對(duì)3期腕管綜合征患者及志愿者進(jìn)行檢查,先用超聲探頭對(duì)腕管及正中神經(jīng)進(jìn)行縱向掃描,矢狀位觀察腕管內(nèi)正中神經(jīng)的位置、走向及正中神經(jīng)前后徑的變化情況以及受壓的神經(jīng)部位;然后再用超聲探頭橫掃腕管,測(cè)量并記錄豌豆骨平面正中神經(jīng)截面積(CSA)。最后采用GE公司生產(chǎn)的750 3.0T MR成像儀對(duì)3期腕管綜合征患者及志愿者進(jìn)行檢查,所行序列有T1加權(quán)成像及短翻轉(zhuǎn)時(shí)間恢復(fù)T2WI序列,測(cè)量評(píng)定腕管形態(tài)的參數(shù):正中神經(jīng)腫脹率(MNSR)和正中神經(jīng)扁平率(MNFR),將所有檢查結(jié)果進(jìn)行比較。對(duì)中、晚期腕管綜合征患者進(jìn)行手術(shù),并將術(shù)中所見正中神經(jīng)的病變情況與術(shù)前超聲、MRI的檢查結(jié)果進(jìn)行比較。結(jié)果:對(duì)于早期腕管綜合征患者,CSA、MNSR和MNFR與對(duì)照組相比變化不明顯。而對(duì)于中、晚期腕管綜合征患者,CSA、MNSR和MNFR均增大,與對(duì)照組相比兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。神經(jīng)肌電圖與超聲、MRI檢查有相關(guān)性,即正中神經(jīng)的末端運(yùn)動(dòng)潛伏期延長(zhǎng),感覺傳導(dǎo)速度就減慢,而術(shù)中所見正中神經(jīng)越來越粗,CSA、MNSR和MNFR也明顯增大,但正中神經(jīng)的末端運(yùn)動(dòng)潛伏期與CSA,感覺傳導(dǎo)速度與MNFR的相關(guān)性不大。經(jīng)手術(shù)證實(shí),術(shù)中發(fā)現(xiàn)大多數(shù)正中神經(jīng)的卡壓部位是在鉤骨鉤平面,而在豌豆骨平面的正中神經(jīng)有不同程度的增粗、腫脹,這與術(shù)前超聲、MRI檢查結(jié)果相符。結(jié)論:神經(jīng)肌電圖檢查能為早期診斷腕管綜合征提供依據(jù)和最佳治療時(shí)間。對(duì)于中、晚期腕管綜合征患者,超聲和MRI檢查可以對(duì)腕管綜合征的嚴(yán)重程度做出診斷;還可以明確腕部正中神經(jīng)卡壓的部位、原因,在術(shù)前提供了較多形態(tài)學(xué)方面的信息,對(duì)確定手術(shù)方案起著重要作用,因此超聲和MRI對(duì)于腕管綜合征是有價(jià)值的檢查方法。但對(duì)于腕管綜合征的診斷,超聲和MRI檢查不能代替神經(jīng)肌電圖檢查。
[Abstract]:Objective: to investigate the application and correlation of electromyography, ultrasound and MRI in carpal tunnel syndrome. Contents: electromyography, ultrasound and MRI were performed in 36 patients with carpal tunnel syndrome and 40 healthy controls, and the results were compared. Patients with middle and late carpal tunnel syndrome were operated on. Methods: first, the patients and volunteers were examined by KEYPOINT 4 quadrilateral electromyography potentiometer, including electromyography (EMG) and electroneurogram (EMG), and the abductor pollicis brevis muscle was examined with concentric needle. The insertion potential and spontaneous potential were observed in resting state; the time limit and amplitude of single motor unit potential in muscle contraction; the type of recruitment potential and the peak-peak value of recruitment potential in muscle contraction were observed. The parameters included motor conduction velocity, terminal motor latency, compound muscle action potential amplitude, sensory conduction velocity and sensory nerve action potential amplitude. According to the diagnostic criteria of electrophysiological stages, the patients were divided into three stages: early, middle and late. The Logiq E9 color Doppler ultrasound instrument produced by GE Company was used to examine the patients and volunteers with phase 3 carpal tunnel syndrome. The carpal tunnel and median nerve were scanned longitudinally with ultrasonic probe. Sagittal position of the median nerve in the carpal tunnel was observed, and the changes of the anterior and posterior diameter of the median nerve and the compressed nerve were observed. Then the median nerve sectional area (CSA).) of the pea bone plane was measured and recorded by scanning the carpal tunnel with an ultrasound probe. Finally, the 7503.0T Mr imaging instrument produced by GE Company was used to examine the patients and volunteers with phase 3 carpal tunnel syndrome. The sequences included T1 weighted imaging and short flipping time to recover T2WI sequence. Parameters for evaluating carpal tunnel morphology: median nerve swelling rate (MNSR) and median nerve flat rate (MNFR),) were compared. Patients with middle and late carpal tunnel syndrome were operated on. Results: there were no significant changes in MNSR and MNFR in patients with early carpal tunnel syndrome compared with control group. For middle and late carpal tunnel syndrome patients, CSAA MNSR and MNFR were increased, compared with the control group, there was significant difference between the two groups (P0.05). There was a correlation between electromyogram and MRI, that is, the motor latency of the median nerve was prolonged, the sensory conduction velocity was slowed down, and the median nerve was thicker and thicker during the operation. The MNSR and MNFR of the median nerve were also increased obviously. However, the terminal motor latency of median nerve was not correlated with MNFR and sensory conduction velocity. It was proved by operation that most of the median nerve entrapment was located in the hook plane, but the median nerve in the pea bone plane was thickened and swollen to varying degrees, which was consistent with the results of pre-operative ultrasonography and MRI. Conclusion: electromyography can provide basis and best treatment time for early diagnosis of carpal tunnel syndrome. For patients with intermediate and late carpal tunnel syndrome, ultrasound and MRI can diagnose the severity of carpal tunnel syndrome, and can also determine the position of median nerve compression in wrist, which provides more morphological information before operation. Ultrasound and MRI are valuable methods for the diagnosis of carpal tunnel syndrome. However, for the diagnosis of carpal tunnel syndrome, ultrasound and MRI can not replace the nerve electromyography.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R688

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