超声检查对腕部正中神经损伤的诊断研究

发布时间：2018-11-14 20:08

【摘要】：目的:随着社会的进步,经济的发展,人们从事的工作发生了翻天覆地的变化,腕管正中神经损伤的疾病也越来越多。腕管是由腕部深层骨质结构与腕横韧带组成的骨纤维结构。其内部结构有屈指浅肌腱、正中神经、拇长屈肌腱、屈指深肌腱。正中神经在腕管内位于拇长屈肌腱与屈指浅肌腱之间,并紧贴腕横韧带深面。其在腕横韧带远端发出返支支配拇短展肌、拇短屈肌、拇对掌肌,它的终支是指神经,支配拇指、示指、中指和环指桡侧半掌侧皮肤。腕管综合征(CTS)的主要发病原因与手腕部腕管内压力持续升高有很大关系,由于腕管的密封骨纤维结构,无论任何原因引起的腕管内的软组织增多,还是腕管内的容积减小,都会引起腕管内的压力升高,正中神经在腕管内受压导致神经支配区的功能及感觉障碍的一组症状和体征,其主要表现为拇指、示指、中指和环指桡侧半掌侧皮肤的感觉减退,大鱼际肌肌肉萎缩,拇指活动不灵活,与其他手指对捏的力量下降或不能完成对捏动作。是周围神经卡压疾病中最常见的一种。腕管综合征主要发病年龄集中在40-60岁,女性的发病率较男性高。导致腕管内压力持续升高的原因有很多,在常见的腕管内腱周滑膜增生和纤维化因素以外,腕部占位性病变如滑膜囊肿、神经纤维囊肿、皮下脂肪瘤和腕管内血肿也能使腕管内部压力升高造成腕部正中神经受到压迫。有时会有一些少见的原因,例如屈肌群的肌腹过低,创伤性或退行性病变引起的腕部骨性结构异常,导致正中神经受到压迫。由此可以看出在腕管综合征(CTS)的诊疗过程中,对于腕管内部解剖的变化贯穿整个疾病的诊治过程。周围神经系统由神经、神经节、受体、突触和运动神经末梢构成,可以反馈出人体内外的感官信息。由于肌电图的不同电生理学变化可以判断出损伤的部位、损伤的性质、损伤的程度等多种重要信息,对神经损伤的发病机制、临床诊断及预后评估等等有重要的作用,电生理检查中的肌电图(EMG)和神经传导功能检查被认为是评价外周神经功能状况的金标准,但是在神经损伤的3-4周内及神经再生没有达到效应器前,神经电生理检查无法对神经损伤情况及预后情况进行精确的判断及评估。并且神经电生理检查无法对病变的具体位置及损伤程度做直观检查。影像学中的MRI及超声检查可以清晰的显示腕管内软组织及正中神经,可以显示正中神经压迫情况,提供卡压的病因,对腕管综合征提供客观的影像学诊断依据。超声检查诊断腕管综合征(CTS)具有直观、无创、省时、价廉的优点,可以清晰的显示腕管内神经、血管等内容物,提供具体的形态学信息,对手术方案的确定有很大的指导作用,为神经卡压的诊断研究提供了一种新的研究方法。方法:选取2016年6月-12月本院收治的50例腕管综合征患者作为观察组,临床上排除原发性雷诺氏综合征、周围血管阻塞及其他对实验结果影响的相关疾病。50例排除周围神经系统、血管系统有关的疾病,神经系统相关检查结果均为阴性健康志愿者作为对照组,以钩骨为标志,在该水平进行正中神经前后径的大小超声学检查,各个测量位置重复测量3次取平均数。观察腕管综合征患者与健康志愿者正中神经前后径是否存在差异。结果:超声精确显示了正中神经的解剖断面,观察组与对照组正中神经前后径差异存在统计学意义(P0.05)。结论:腕管综合征(CTS)是一种主要以手部正中神经支配区麻木、触觉功能减退为主要症状,或伴有夜间麻醒史的临床疾病。超声学检查可以清晰的显示腕部神经的位置、结构及神经周围组织的变化,对临床上对个体病情的研究提供了诊断依据。本研究通过对腕部正中神经的超声学检查,可以简单、快速、清晰的显示出腕部正中神经卡压的位置,严重程度,卡压的范围,及与周围软组织的关系。腕部超声学的检查对诊断腕管综合征上有很高的诊断价值。
[Abstract]:Objective: With the development of society and the development of economy, people's work has changed over and over, and the disease of nerve injury in the middle of the wrist is more and more. The wrist tube is a bone fiber structure composed of the deep bone structure of the wrist and the transverse ligament of the wrist. The internal structure of the tendon refers to a shallow tendon, a median nerve, a long-length flexor tendon, and a flexor tendon. The median nerve is located between the flexor tendon and the flexor tendon in the wrist, and is in close contact with the deep surface of the transverse ligament of the wrist. At the distal end of the transverse ligament of the wrist, the dorsal branch is used to control the short-and short-acting muscles, the short-and-short-flexion muscles and the palm muscles, and the final branch of it is the nerve, the dominant thumb, the finger, the middle finger and the ring refer to the half-palm-side skin of the palm side. The main cause of carpal tunnel syndrome (CTS) is related to the continuous increase of the pressure in the wrist of the wrist, due to the fibrous structure of the sealing bone of the wrist tube, whether the soft tissue in the wrist tube caused by any cause is increased or the volume in the wrist tube is reduced, the pressure in the wrist tube can be raised, The central nervous system is a group of symptoms and signs that result in the function of the innervation zone and the sensory disturbance in the carpal tunnel, which is mainly characterized by a thumb, a finger, a middle finger and a ring, the force of the kneading with the other fingers is reduced or the kneading action cannot be completed. It is one of the most common types of peripheral nerve entrapment. The main incidence of carpal tunnel syndrome is in the range of 40-60 years, and the incidence of female is higher than that of male. There are a number of reasons leading to a continuous increase in the pressure in the wrist tube, in addition to the synovial proliferation and fibrotic factors in the common wrist-tube, the wrist-occupying lesions, such as synovial cyst, nerve fiber cyst, The subcutaneous fat and the intraductal hematoma can also cause the internal pressure of the wrist tube to rise and the median nerve of the wrist is oppressed. There are some rare reasons, such as the low, traumatic or degenerative changes in the wrist-bone structure caused by a low, traumatic or degenerative change in the muscle of the flexor, which leads to the compression of the median nerve. As a result, it can be seen that during the diagnosis and treatment of the carpal tunnel syndrome (CTS), the change in the internal anatomy of the wrist tube penetrates the diagnosis and treatment process of the whole disease. The peripheral nervous system is composed of a nerve, a ganglion, a receptor, a synapse and a moving nerve terminal, and can feed back the sensory information inside and outside the human body. due to the different electrophysiological changes of the electromyography, various important information such as the location of the injury, the nature of the damage, the degree of damage and the like can be judged, the pathogenesis of the nerve injury, the clinical diagnosis and the prognosis evaluation and the like have important effects, Electromyography (EMG) and nerve conduction functional examination in electrophysiology examination were considered to be a gold standard for evaluating peripheral neurological conditions, but within 3-4 weeks of nerve injury and before the nerve regeneration did not reach the effector, The neuroelectrophysiology examination can not accurately judge and evaluate the condition of the nerve injury and the prognosis. and the neuroelectrophysiology examination can not be used for visual inspection on the specific location and the degree of damage of the lesion. The MRI and ultrasonic examination in the image can clearly show the soft tissue and median nerve in the wrist, can show the central nerve compression, provide the cause of the card pressure, and provide an objective imaging diagnosis basis for the carpal tunnel syndrome. The ultrasonic examination and the diagnosis of the carpal tunnel syndrome (CTS) have the advantages of being intuitive, non-invasive, and low in cost, and can clearly display the contents of the nerve and the blood vessel in the wrist, provide specific morphological information, and has a great guiding effect on the determination of the operation scheme, In this paper, a new research method is provided for the diagnosis and study of the nerve card pressure. Methods: 50 cases of carpal tunnel syndrome treated in our hospital from June to December 2016 were selected as the observation group, and the primary and peripheral vascular obstruction and other related diseases which were affected by the experimental results were excluded. The results of the examination of the nervous system were negative healthy volunteers as the control group, with the hook bone as the marker, the size of the median nerve and the anterior and posterior diameter of the median nerve were examined by the ultrasound, and the average number of the measurements was repeated 3 times in each measurement position. To observe the difference of the anterior and posterior diameters of the median nerve in the patients with carpal tunnel syndrome and healthy volunteers. Results: The anatomic cross-section of median nerve was shown by ultrasound, and the difference of the anterior and posterior diameters of the median nerve in the observation group and the control group was statistically significant (P0.05). Conclusion: The syndrome of carpal tunnel syndrome (CTS) is one of the main symptoms, including the numbness of the innervation area of the median nerve of the hand, the hypofunction of the tactile function as the main symptom, or the clinical condition with the history of night anesthesia. The ultrasonic examination can clearly show the position, structure and the change of the surrounding tissues of the wrist, and provide the basis for the clinical study of the individual's condition. In this study, by means of the ultrasonic examination of the median nerve of the wrist, the position, severity, the range of the clamping pressure and the relation with the surrounding soft tissues of the median nerve of the wrist can be displayed in a simple, rapid and clear manner. The examination of wrist ultrasound has a very high diagnostic value in the diagnosis of carpal tunnel syndrome.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R688

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