【作者】 陈欣；

【导师】 田德润；

【作者基本信息】 天津医科大学 ， 人体解剖与组织胚胎学， 2015， 硕士

【摘要】 目的:通过对腕管综合征患者进行神经肌电图、超声和MRI检查,探讨三者在腕管综合征中的应用及相关性。内容:对36例腕管综合征患者和40例健康对照者进行神经肌电图、超声和MRI检查,并将检查结果进行比较。对中、晚期腕管综合征患者进行手术,将术中所见正中神经的病变情况与术前超声、MRI的检查结果进行比较。方法:首先采用丹麦KEYPOINT 4型四导肌电诱发电位仪对患者及志愿者进行检查,包括肌电图(EMG)检查和神经电图检查,先用同心圆针检查拇短展肌,观察静息状态下有无插入电位延长和自发电位;小力收缩肌肉时单个运动单位电位的时限、波幅;大力收缩肌肉时募集电位的类型以及募集电位的峰-峰值。再进行正中神经传导的检查,测定的参数包括:运动传导速度、末端运动潜伏期、复合肌肉动作电位波幅、感觉传导速度、感觉神经动作电位波幅。之后按照电生理分期诊断标准分为早、中、晚3期。再采用GE公司生产的Logiq E9型彩色多普勒超声检查仪对3期腕管综合征患者及志愿者进行检查,先用超声探头对腕管及正中神经进行纵向扫描,矢状位观察腕管内正中神经的位置、走向及正中神经前后径的变化情况以及受压的神经部位;然后再用超声探头横扫腕管,测量并记录豌豆骨平面正中神经截面积(CSA)。最后采用GE公司生产的750 3.0T MR成像仪对3期腕管综合征患者及志愿者进行检查,所行序列有T1加权成像及短翻转时间恢复T2WI序列,测量评定腕管形态的参数:正中神经肿胀率(MNSR)和正中神经扁平率(MNFR),将所有检查结果进行比较。对中、晚期腕管综合征患者进行手术,并将术中所见正中神经的病变情况与术前超声、MRI的检查结果进行比较。结果:对于早期腕管综合征患者,CSA、MNSR和MNFR与对照组相比变化不明显。而对于中、晚期腕管综合征患者,CSA、MNSR和MNFR均增大,与对照组相比两组差异有统计学意义(P<0.05)。神经肌电图与超声、MRI检查有相关性,即正中神经的末端运动潜伏期延长,感觉传导速度就减慢,而术中所见正中神经越来越粗,CSA、MNSR和MNFR也明显增大,但正中神经的末端运动潜伏期与CSA,感觉传导速度与MNFR的相关性不大。经手术证实,术中发现大多数正中神经的卡压部位是在钩骨钩平面,而在豌豆骨平面的正中神经有不同程度的增粗、肿胀,这与术前超声、MRI检查结果相符。结论:神经肌电图检查能为早期诊断腕管综合征提供依据和最佳治疗时间。对于中、晚期腕管综合征患者,超声和MRI检查可以对腕管综合征的严重程度做出诊断;还可以明确腕部正中神经卡压的部位、原因,在术前提供了较多形态学方面的信息,对确定手术方案起着重要作用,因此超声和MRI对于腕管综合征是有价值的检查方法。但对于腕管综合征的诊断,超声和MRI检查不能代替神经肌电图检查。更多还原

【Abstract】 Research purpose: to discuss the application of neural EMG examination, ultrasonic examination and MRI examination in the carpal tunnel syndrome(CTS) and their correlation through the neural EMG examination, ultrasonic examination and MRI examination of CTS patients.Research content: conduct neural EMG examination, ultrasonic examination and MRI examination of 36 CTS patients and 40 healthy controls and then compare the examination results. The intermediate and late CTS patients undergo surgery and the pathological changes of median nerve found during surgery are compared with the examination results of preopreative ultrasonic and MRI examination.Research method: use KEYPOINT 4 four-pillar EMG evoked ppotentiometer for examination of patients and volunteers, including EMG examination and ENoG examination. First, use concentric needle to check the abductor pollicis brevis muscle and observe whether there is delay of insertion potential and spontaneous potential under the quiescent condition; time limit and amplitude of potential of single motor unit upon small muscle contraction; type and peak-peak value of recruitment potential upon strong muscle contraction. Then, conduct median nerve conduction examination and the parameters measured include motor nerve conduction velocity, distal motor latency, sensory nerve conduction velocity and sensory nerve action potential amplitude. Next, divide CTS into early、intermediate and late three stages according to the electrophysiological staging diagnostic criteria. Use Logiq E9 color Doppler ultrasonography of GE for the examination of three stages CTS patients and volunteers: conduct longitudinal scan of carpal canal and median nerve with ultrasonic probe and observe the location, trend of median nerve in the carpal canal, changes of anteroposterior diameter of median nerve and compressed nerve part from the sagittal view; then, conduct horizontal scan of carpal canal with ultrasonic probe, and measure and record the cross-sectional area(CSA) of median nerve of pisiform bone. Finally, use 750 3.0T MR imager of GE for the examination of three stages CTS patients and volunteers, with T1 weighted imaging and short-switching time restoration T2 WI sequence, measure the parameters of carpal canal: median nerve swelling rate(MNSR) and median nerve flatness ratio(MNFR) and compare the examination results. The intermediate and late CTS patients undergo surgery and the pathological changes of median nerve found during surgery are compared with the examination results of preopreative ultrasonic and MRI examination.Research result: for early CTS patients, CSA, MNSR and MNFR have no obvious change compared with the control group. However, for intermediate and late CTS patients, CSA, MNSR and MNFR increase and the difference is of statistical significance compared with the control group(P<0.05). Neural EMG is related to ultrasonic examination and MRI examination, that is, the distal motor latency of median nerve increases obviously, the sensory nerve conduction velocity is obviously slower, the median nerve is thicker and thicker and CSA, MNSR and MNFR increase obviously; however,there was no correlation between the distal motor latency and CSA,no correlation between the sensory nerve conduction velocity of median nerve and MNFR.It is verified by surgery that the compression part of most median nerve is the hamate bone and the median nerve of pisiform bone has different degree of thickening and swelling, which are consistent with the preoperative ultrasonic examination and MRI examination results.Research conclusion: neural EMG examination can provide basis and the best treatment time for the early diagnosis of CTS. For intermediate and late CTS patients, ultrasonic examination and MRI examination can make a diagnosis of the severity of CTS; they can also identify the compression part and reason of median nerve of carpal canal and provide more morphological information before operation, which are important to the determination of operation plan. Therefore, ultrasonic examination and MRI examination are valuable examination methods for CTS. However, for the diagnosis of CTS, ultrasonic examination and MRI examination cannot replace neural EMG examination.更多还原