高频超声测量正中神经横截面积评价腕管综合症严重程度的研究

发布时间：2018-06-23 23:26

本文选题：超声 + 腕管综合征　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:利用高频超声测量腕管综合征(carpal tunnel syndrome,CTS)患者豌豆骨水平的正中神经的横截面积及前臂远端旋前方肌水平的正中神经横截面积,并以此两个横截面积为基础计算出两个相关参数,即面积增量和面积比。研究能否根据超声豌豆骨水平正中神经的横截面积、面积增量、面积比三个参数进行CTS的诊断和CTS严重程度的分级,以及其分级结果是否可靠。方法:87例病人,共98个手腕[女73例,有9例是双侧,男14例,有两例是双侧,年龄31-73岁,平均(55.10±9.41)岁作为CTS组,均经临床及神经电生理检查(nerve conduction studies,NSC)证实为CTS患者,并选取志愿者42名作为对照组,均无上肢麻木、疼痛等症状,均进行检查排除CTS。超声测量豌豆骨水平正中神经的横截面积和前臂远端旋前方肌水平正中神经的横截面积(在旋前方肌水平全段正中神经的横截面积变化较小,我们测量选择在旋前方肌的远侧缘),并以两个横截面积测量参数为基础进行面积增量、面积比两个相关参数的计算:面积增量是正中神经豌豆骨水平横截面积与前臂远端旋前方肌水平横截面积之差,面积比是正中神经豌豆骨水平横截面积与前臂远端旋前方肌水平横截面积之比。以NCS分级结果为基础,将超声检测豌豆骨水平正中神经横截面积、面积增量、面积比进行分级。对各组数据进行ANOVE方差分析和独立样本t检验。对相邻两组做ROC曲线分析,求出各级之间的最佳阈值,及其敏感性及特异性。最后将超声豌豆骨水平正中神经横截面积、面积增量、面积比分别与作为金标准的NCS结果进行Kappa一致性分析。结果:根据NCS的分级结果,将CTS病人分为正常、轻度、中度、重度组,超声豌豆骨水平正中神经横截面积,面积增量和面积比,在各组间均有显著差异(P0.05)。豌豆骨水平正中神经的横截面积的(?)±S,正常组、轻度组,中度组,重度组的分别是0.07±0.01cm~2、0.10±0.02 cm~2、0.13±0.01 cm~2、0.18±0.03 cm~2。面积增量的(?)±S,正常组、轻度组、中度组、重度组的分别是0.03±0.01 cm~2、0.06±0.01 cm~2、0.08±0.01 cm~2、0.12±0.03 c m~2。面积比的(?)±S,正常组、轻度组、中度组、重度组的分别是1.78±0.27、2.34±0.26、2.71±0.31、3.13±0.50。通过制作各相邻组之间的ROC,豌豆骨水平横截面积在区分正常、轻、中、重组时的最佳阈值是0.09 cm~2、0.12 cm~2、0.15 cm~2;面积增量在区分正常、轻、中、重组时的最佳阈值是0.05 cm~2、0.08 cm~2、0.10 cm~2;面积比在区分正常、轻、中、重组时的最佳阈值是2.1、2.5、2.9。豌豆骨水平正中神经的横截面积的分级结果与NCS分级结果的Kappa值是0.702,面积增量的分级结果与NCS的分级结果的Kappa值是0.823,面积比的分级结果与NCS的分级结果的Kappa值是结论0.580。结论:超声测量的豌豆骨正中神经水平横截面积、面积增量、面积比有助于CTS的严重程度预测。面积增量对于CTS的诊断及CTS严重程度的分级的鉴别能力最强。面积增量的分级结果与NCS分级结果有较高的一致性,豌豆骨水平正中神经的横截面积及面积比的分级结果与NCS的一致性一般。超声对于CTS的诊断是一种有效的辅助检查方法。
[Abstract]:Objective: to measure the cross sectional area of the median nerve of the carpal tunnel syndrome (CTS) patients with the level of the pea bone and the lateral area of the median nerve of the distal forearm level of the forearm by high frequency ultrasound, and calculate the area increment and area ratio based on the two cross sectional areas. The cross sectional area of the median nerve of the pea bone, area increment, area ratio of three parameters to the diagnosis of CTS and the classification of CTS severity, and the reliability of its classification results. Methods: 87 patients were 98 wrist [female 73 cases, 9 cases with bilateral, 14 men, two were bilateral, age 31-73, and average (55.10 + 9.41) years old as group CTS, " All nerve conduction studies (NSC) were all confirmed as CTS patients, and 42 volunteers were selected as the control group without upper limb numbness and pain. The cross-sectional area of the median nerve of pea bone level and the transverse area of median nerve at the distal forearm level of forearm were all checked out by CTS. ultrasound. The transversal area of the median nerve in the whole segment of the lateral circumflex muscle was smaller. We measured the distal margin of the lateral circumflex muscle. The area increment was based on the two cross sectional area measurements. The area was compared to two related parameters: the area increment was the horizontal cross section of the median nerve pea bone and the water of the forearm forward muscle. The ratio of the area to the horizontal cross section is the ratio of the horizontal cross section of the median nerve pea bone to the horizontal cross section of the forearm. Based on the results of NCS classification, the transversal area, area increment and area ratio of the median nerve of pea bone were measured by ultrasound, and the data of each group were analyzed by ANOVE variance and independent sample t Test the ROC curve of two adjacent groups, and find the best threshold, its sensitivity and specificity between all levels. Finally, the transverse area, area increment, area ratio of the ultrasonic pea bone level, area ratio and the NCS results as the gold standard are analyzed Kappa consistency. Results: according to the NCS classification results, the CTS patients are divided into normal. In the mild, moderate, severe group, the transversal area of the median nerve of the pea bone, the area increment and area ratio, there were significant differences between each group (P0.05). The cross section of the median nerve of the pea bone (?) + S, the normal group, the mild group, the moderate group and the severe group were 0.07 + 0.01cm~2,0.10 + 0.02 cm~2,0.13 + 0.01 cm~2,0.18 + 0.03 cm~2 respectively. The area increment (?) + S, the normal group, the mild group, the moderate group and the severe group were 0.03 + 0.01 cm~2,0.06 + 0.01 cm~2,0.08 + 0.01 cm~2,0.12 + 0.03 C m~2. area ratio (?) + S, the normal group, the mild group, the moderate group, and the severe group were 1.78 + 0.27,2.34 + 0.26,2.71 + 0.31,3.13 + 0.50. through the production of the ROC, pea bone between the adjacent groups The optimal threshold of horizontal cross section area is 0.09 cm~2,0.12 cm~2,0.15 cm~2 when the reorganization is normal, light and medium, and the optimum threshold of area increment is 0.05 cm~2,0.08 cm~2,0.10 cm~2 when it is normal, light and medium. The optimum threshold of area ratio is normal, light and medium, and the optimum threshold is the transverse of the median nerve of the 2.1,2.5,2.9. pea bone level. The Kappa value of the sectional area and the NCS classification result is 0.702, the area increment classification result and the NCS classification result Kappa value is 0.823, the area ratio classification result and the NCS grading result Kappa value is the conclusion 0.580. conclusion: the ultrasonic measuring the pea bone median nerve water flat cross section area, area increment, area ratio help CTS The area increment is the strongest for the diagnosis of CTS and the classification of CTS severity. The results of the area increment are in good agreement with the NCS classification results. The results of the cross section area and area ratio of the median nerve of the pea bone are consistent with the NCS. The diagnosis of CTS is a kind of method. An effective auxiliary examination method.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.1;R688

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