【作者】 孟治国；

【导师】 余庆阳；

【作者基本信息】 福建中医学院 ， 中医骨伤科学， 2003， 硕士

【摘要】 背景：前斜角肌综合征（Sclenus anticus syndrome）是指各种原因引起前斜角肌水肿、增生，痉挛并上提第一肋，导致斜角肌间隙狭窄，卡压穿行其间的臂丛神经及锁骨下动静脉而引起相应临床症状的疾患。近年来，随着国内外对前斜角肌病变与颈臂痛相关性研究的不断深入，逐渐发现相当一部分颈臂痛是由该肌病变所致。由于该征诊断多以临床症状为主，易受患者主观感觉影响，且缺乏有特异性的客观指标，仅少数病例通过手术得到确诊，因此该征极易被误诊为颈椎病、颈椎管狭窄等其他疾患，以致延误治疗。由此可见应用影像学对前斜角肌在前斜角肌综合征中的变化进行研究，确立其在影像学上的改变是有必要的，而且通过对患者的测定，建立该征临床客观诊断标准，将有助于该征的正确诊治。 目的：1测定C₆上缘-C₇上缘水平前斜角肌模断面面积及CT值的正常值，作为本课题及相关研究的客观依据；2比较分析前斜角肌综合征患者与无症状者前斜角肌变化，确立该征的影像学诊断标准，初步探索软组织影像学的研究方法；3进一步确定手法配合功能锻炼是治疗该征的有效疗法。 方法：无症状组选取不同年龄组无颈臂痛病史者100人，男女各半；CT平扫其C₆上缘-C₇上缘，测量前斜角肌横断面面积及CT值，统计后作为正常值参照；治疗组取确诊的无并发骨性改变及椎管内病变的前斜角肌综合征患者32人，CT平扫其同一平面，测量其患侧前斜角肌横断面面积及CT值，进行对比分析；采用手法进行治疗；1疗程后按近、远期进行随访，分析疗效。 结果：1无症状者前斜角肌横断面形态双侧对称，成近椭圆形，轮廓清晰，与周围组织界限清楚，两侧横断面面积及CT值相近，C₆上缘-C₇上缘水平正常前斜角肌横断面面积为：1.3793±0.0948cm²，CT值为：54.594±2.0106；2前斜角肌综合征患者患侧前斜角肌横断面形态不规则，与周围组织粘连，界限不清，统计显示患侧横断面面积较正常值增大，P＜0.01，差异非常显著，CT值较正常值增大，P＜0.01，差异非常显著；3手法治疗1疗程后，随访显示近期优良率87.5％，有效率100％，远期优良率71.8％，有效率93.75％。 结论：1正常成人前斜角肌在C₆上缘-C₇上缘水平横断面面积为：1.3793±0.0948cm²，CT值为：54.594±2.0106；2颈臂痛患者CT平扫示前斜角 肌横断面面积>1.4741cm2，可诊断为前斜角肌综合征;3手法是治疗前 斜角肌综合征的有效方法，但有其局限性。更多还原

【Abstract】 Background: Sclenus anticus syndrome is a disease caused by scalene anterior muscle edema, proliferation and spasm, lifted the first rib, resulted in scalenus muscle interspaces constriction, crushed the brachial plexus and subclavicalar A.V. In recent years, followed by the study of the correlation between scalene anterior muscle and cervicobrachialgia is profound, we have learned a great extent that cervicobrachialgia is caused by this muscle lesion. Because diagnosis of this syndrome is mostly based on clinical symptom that was influenced by subjective sensation of patient, absence of objective criterion, only a few cases are final diagnosis by operation. So this syndrome is often misdiagnosed by cervical syndrome and cervical spinal stenosis other diseases, resulted in delaying to therapy. Thus it is necessary to study changes of scalene anterior muscle in sclenus anticus syndrome by image, establish changes and create objective diagnosis criterion on image of this syndrome.Objective: 1 Measured and statisticsed areas of cross section and CT value of scalene anterior muscle on plan from superior border of C6 to C7, as a objective basement of this topic and other correspond research; 2 Compared and analysed changes between normal and patient, established diagnosis criterion on image and explored new research methods of soft tissues by image; 3 Confirmed maneuver and functional exercise are utility methods.Methods: Symptomless group consist of 100 adults without cervicobrachialgia history, male female equalization. Scan by CT, measuring cross section and CT value of scalene anterior muscle, as normal contrast; 32 final diagnosis cases in treat group, by means of same method, statistics and comparison, analysis. Adopt maneuver to therapy. Analysis was done after one course followed by short-term and long-term.Results:1 CT demonstrated clear boundary and homogenous density in symptomless, near oval and symmetry. Normal cross section areas of scalene anterior muscle is 1.3793 0.0948cm2, normal CT value is 54.594 2.0106; 2 Cross section form of patient anterior scalene muscle is irregulation, adherence to tissue around, boundary not pure. Statistics display this area and CT value has obvioussignificant difference in symptomless group and patient group(P<0.01); 3 After one course, it shows 87.5%/100% of success rate and valid rate respectively in the short-term, as well as 71.8%/93.75% in the long-term.Conclusion: 1 Normal cross section areas of scalene anterior muscle is 1.3793 0.0948cm2, normal CT value is 54.594 2.0106; 2 Cervicobrachialgia cross section areas of scalene anterior muscle which is above 1.4741 cm2 leads to diagnoses sclenus anticus syndrome; 3 Maneuver is utility method to therapy sclcnus anticus syndrome, but it has limitation.更多还原