正常成人项部肌肉骨骼系统的高频超声检查

发布时间：2019-02-11 14:29

【摘要】：目的：明确正常成人项部肌肉骨骼系统的声像图特征，阐明正常成人项部肌肉骨骼系统的高频超声扫查方法。方法：利用高频超声IE33检查30例（男15例，女15例，左右共60侧）正常成人项部，描述并记录正常成人项部的骨骼、肌肉、血管、神经、韧带的毗邻关系及声像图特征；测量枕大神经入头半棘肌点处横截面积，按照左右侧分组，采取配对样本t检验进行分析，左、右侧对比判断枕大神经入肌点处横截面积差异有无统计学意义；按照男女性别分组，采取独立样本的t检验进行分析，男、女组对比判断枕大神经入肌点处横截面积差异有无统计学意义；测量颈深动脉内径及峰值流速，使用计算机统计学软件得出均数（x）及标准差（s），从而求出颈深动脉内径及峰值流速的95%可信区间（95%CI）；探查枕动脉于项部走行情况，计算出两种类型累计例数所占总样本的百分比。结果：本研究以项部肌肉、骨骼、神经、血管、韧带为解剖标志，得出正常成人项部的多个切面声像图；描述了项部第1颈椎至第2颈椎水平椎枕肌构成枕下三角的声像图特点及枕下三角内枕下神经与椎动脉解剖关系；阐明了项部第3颈椎至第5颈椎水平横突棘肌层次关系；概括了项部第6颈椎至第7颈椎水平夹板肌毗邻关系；具体说明了项部枕大神经走行特点，测量了枕大神经入头半棘肌点处横截面积；明晰了肩胛背神经自中斜角穿出后与肩胛背动脉在背部伴行的声像特征及项部副神经自胸锁乳突肌后缘穿出后走行于肩胛提肌与斜方肌之间的声像特点；明确了项部颈深动脉及枕动脉的走行特点，测得了项部颈深动脉内径及峰值流速，详细地记录了项部枕动脉两种不同走行情况的累计例数；明确了项韧带各部分肌纤维来源的声像特点。统计学结果显示：男、女组对比，枕大神经入肌点处横截面积差异有统计学意义（P0.05）；左右侧对比，，枕大神经入肌点处横截面积差异无显著性（P0.05）；颈深动脉内径的均数±标准差（x±s）为1.51±0.15mm，峰值流速的均数±标准差（x±s）为2.84±0.48m/s；枕动脉走行于头夹肌与头最长肌肌间（46支）占77%，枕动脉走行于头最长肌与头上斜肌肌间（14支）占23%。结论：高频超声可作为正常成人项部的肌肉骨骼系统的首选的无创性检查，值得在临床推广。
[Abstract]:Objective: to identify the sonographic features of the musculoskeletal system in normal adults and to elucidate the method of high frequency ultrasound scanning for the musculoskeletal system in normal adults. Methods: 30 normal adults (15 males, 15 females, 60 sides) were examined by high frequency ultrasound (IE33). The adjacent relationship of bone, muscle, blood vessels, nerves and ligaments were described and recorded. The cross sectional area of the occipital great nerve into the point of the semis spinalis of the occipital nerve was measured and divided into groups according to the left and right sides. The paired t-test was used to analyze the cross-sectional area of the occipital great nerve entering the muscle point. According to the sex group of men and women, the T-test of independent samples was used to analyze the difference of cross-sectional area between male and female groups in the point of occipital great nerve entering the muscle. The internal diameter and peak velocity of the deep carotid artery were measured and the 95% confidence interval (95%CI) of the internal diameter and peak velocity of the deep carotid artery was obtained by using the computer statistical software to obtain the mean (x) and standard deviation (s),. The occipital artery was searched and the percentage of the total samples of the two types of accumulative cases was calculated. Results: in this study, the anatomical signs of nape muscles, bones, nerves, blood vessels and ligaments were used as anatomic markers. This paper describes the sonographic characteristics of the inferior occipital triangle formed by the horizontal occipital muscles of the first to second cervical vertebrae and the anatomical relationship between the suboccipital nerve and the vertebral artery in the suboccipital triangle, and clarifies the relationship between the horizontal transverse spinous muscle of the third cervical vertebra and the fifth cervical vertebrae. The contiguous relationship between the sixth cervical vertebra and the seventh cervical vertebrae was summarized, the characteristics of the great occipital nerve and the cross sectional area of the greater occipital nerve into the point of the semis spinalis were measured. The sonographic characteristics of the dorsal scapular nerve and the dorsal scapular artery accompanying with the dorsal scapular artery in the back were clarified, and the characteristics of the accessory nerve of the nape running from the posterior edge of the sternocleidomastoid muscle through the posterior edge of the sternocleidomastoid muscle between the levator scapularis muscle and the trapezius muscle were clarified. The internal diameter and peak flow velocity of deep carotid artery and occipital artery were measured, and the cumulative cases of two different patterns of occipital artery were recorded in detail. The sonographic characteristics of the source of muscle fibers in various parts of the nape ligament were defined. The results showed that there were significant differences in cross sectional area between male and female groups (P0.05), while there was no significant difference between left and right side (P0.05). The mean 卤standard deviation (x 卤s) of the internal diameter of the deep carotid artery was 1.51 卤0.15 mm, and the mean 卤standard deviation of the peak velocity (x 卤s) was 2.84 卤0.48 m / s; The occipital artery was located between the head clamp muscle and the longest head muscle (46 branches) and the occipital artery between the longest head muscle and the superior oblique head muscle (14 branches), and the occipital artery was located between the longest head muscle and the superior oblique head muscle (14 branches). Conclusion: high frequency ultrasound can be used as the first choice of noninvasive examination of musculoskeletal system in normal adults, and it is worth popularizing in clinic.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R681

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