3.0T MR对膝关节军事训练伤的诊断价值研究

发布时间：2018-03-14 00:36

本文选题：磁共振　切入点：膝关节　出处：《河北北方学院》2017年硕士论文　论文类型：学位论文

【摘要】：随着磁共振(Magnetic resonance,MR)技术的不断发展与进步,其在膝关节疾病的诊断上已经成为医生的首选。而在军事训练中膝关节损伤发生率较高,常导致骨、半月板、韧带、髌下脂肪垫等的损伤,因此通过MR来对膝关节军事训练伤进行研究较为合理。另一方面,MR功能成像技术的发展更为我们对膝关节神经损伤的诊断带来了新思路。3.0T磁共振新技术——扩散张量成像(diffusion tensor imaging,DTI)技术及扩散张量纤维示踪技术(diffusion tensor tractography,DTT)在中枢神经系统疾病的诊断上已广泛应用,而在周围神经损伤的应用上尚待进一步研究,在膝关节胫神经的损伤研究上,国内更是尚无相关探索。本研究通过收集2014年6月-2015年12月来我院就诊的所有军人膝关节MR检查结果,首先计算膝关节军事训练伤阳性率,随后进一步分析阳性患者各种损伤的分布情况,将总体情况按照骨挫伤、半月板损伤、髌下脂肪垫损伤及韧带损伤进行汇总、整理、统计分析。另外对军人髌下脂肪垫损伤进行了分型及相关分析,以便于进一步加强对该疾病的诊断及及时诊治。而对于临床诊断为胫神经损伤的患者,行常规扫描序列及DTI序列成像,并选取相匹配的健康志愿者作为对照组,行相同检查,测量胫神经各向异性值(fractional anisotropy,FA)及表观弥散系数值(apparent diffusion coefficient,ADC)。采用独立样本t检验对两组病例FA值、ADC值进行统计学分析,P0.05为差异具有统计学意义,并进一步绘制FA值及ADC值的ROC曲线,分析其特异性及敏感性,最后应用DTT显示正常及不同损伤程度的胫神经纤维束。结果显示:2014年6月-2015年12月共768例军人来我院行膝关节MR检查,共823个膝关节,左:340,右:373,双:55;男745例,女23例,年龄18-45岁,平均年龄26.7岁,损伤膝关节共756个,阳性率达91.9%,其中骨挫伤:247例,半月板损伤398例,韧带损伤297例,肌腱及软组织损伤107例,髌下脂肪垫损伤111例,关节腔积液790例,关节囊及滑膜病变29例,神经损伤15例,软骨损伤91例。对20例临床怀疑胫神经损伤患者行DTI检查,结果15例患者有胫神经损伤,测量其ADC值及FA值,损伤组ADC值为1.43±0.07x10-3mm2/s,对照组ADC值为1.35±0.10x10-3mm2/s,损伤组FA值为0.51±0.05,对照组FA值为0.58±0.05,两个值在两组中差别均具有统计学意义;并且FA值的ROC曲线下面积为0.884,ADC值的ROC曲线下面积为0.724,两者均介于0.7~0.9之间,可见其对胫神经损伤的诊断具有一定的价值。通过ROC曲线比较其诊断效能发现,FA值诊断临界点为0.57,约登指数为1.667,敏感性、特异性分别为:0.733、0.934,ADC值诊断临界点为1.35,约登指数为1.467,敏感性、特异性分别为:0.867、0.600。总之,军事训练致膝关节损伤发生率较高,通过MR可以较为准确的对军事训练中骨挫伤、半月板损伤、髌下脂肪垫损伤及韧带损伤进行诊断,并且初步研究表明DTI联合DTT技术在诊断外伤性胫神经损伤上,FA值及ADC值可帮助量化分析胫神经损伤,进而进一步分析其损伤程度,且FA值诊断效能较ADC值高。
[Abstract]:With magnetic resonance (Magnetic resonance MR) development and progress of technology, in the diagnosis of knee joint disease has become the first choice for doctors. While in the military training of knee joint injury in high incidence, often leads to bone, meniscus, ligament, the infrapatellar fat pad injury, therefore MR to the knee joint military training injury research more reasonable. On the other hand, brings a new way of.3.0T magnetic resonance diffusion tensor imaging: a new technique to develop MR functional imaging techniques for our diagnosis of knee joint nerve injury (diffusion tensor, imaging, DTI) and diffusion tensor fiber tractography (diffusion tensor tractography, DTT) has widely used in the diagnosis of diseases of the central nervous system, and in the application of peripheral nerve injury on further research, in the study of knee injuries of the tibial nerve, the country is no exploration. This study collected in June 2014 -2015 December in our hospital, all the soldiers of knee joint MR examination results, first calculate the positive rate of knee joint injury in military training, followed by further analysis of the distribution of positive patients with various injuries, will be in accordance with the overall situation of bone contusion, meniscus injury, analysis of infrapatellar fat pad injury and ligament injury were summarized. Sorting, statistics. In addition to the military injury of infrapatellar fat pad were classified and the correlation analysis, in order to further strengthen the timely diagnosis and diagnosis of the disease. The clinical diagnosis of tibial nerve injury patients underwent conventional scanning sequence and DTI sequence, and selected matched healthy volunteers as the control group. For the same examination, measurement of tibial nerve anisotropy (fractional anisotropy, FA) and apparent diffusion coefficient (apparent diffusion, coefficient, ADC). Recovery test with independent samples t In the two groups, FA value, ADC value were statistically analyzed, P0.05 difference has statistical significance, and further draw the ROC curve of FA value and ADC value, analyze its specificity and sensitivity, finally the application of DTT in normal and tibial nerve fibers with different damage degree of beam. The results showed: June 2014 -2015 year in December a total of 768 cases the soldiers came to our hospital for knee joint MR examination, a total of 823 knees, left: 340, right: 373, double: 55; male 745 cases, female 23 cases, age 18-45 years old, the average age of 26.7 years, a total of 756 knee injuries, the positive rate was 91.9%, of which 247 cases of bone contusion. 398 cases of meniscus injury, ligament injury in 297 cases, 107 cases of tendon and soft tissue injury, the infrapatellar fat pad injury in 111 cases, 790 cases of joint effusion, joint capsule and synovial lesions in 29 cases, 15 cases of nerve injury, 91 cases of cartilage injury. 20 cases of clinically suspected patients with tibial nerve injury DTI examination results 15 patients with tibial nerve damage Injury, measuring its ADC value and FA value, the value is 1.43 + 0.07x10-3mm2/s injury group ADC, group ADC = 1.35 + 0.10x10-3mm2/s = 0.51 + 0.05 group, injury group FA, group FA was 0.58 + 0.05 control, two values in the two groups there were statistically significant difference; ROC curve and FA the value is 0.884, the area of ROC curve of ADC value was 0.724, between the two are between 0.7~0.9, the diagnosis of tibial nerve injury has a certain value. The ROC curves to compare the diagnostic efficacy of FA diagnostic value found at the critical point of 0.57, Youden index was 1.667, the sensitivity and specificity were: the 0.733,0.934 and ADC values in diagnosis of critical point was 1.35, Youden index was 1.467, the sensitivity and specificity of 0.867,0.600. were: in short, caused by military training injuries of knee joint was higher by MR can be more accurately on the military training of bone contusion, meniscus injury, injury of infrapatellar fat pad And ligament injury diagnosis, and preliminary research shows that DTI and DTT technology in diagnosis of traumatic tibial nerve injury, FA value and ADC value can help quantitative analysis of tibial nerve injury, and further analyze the degree of injury, and FA value is higher than that of ADC.

【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R82

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