正常青年人群腕管正中神经MR成像的断层解剖测量

发布时间：2018-04-30 21:33

本文选题：腕管 + 正中神经　；参考：《南方医科大学》2015年硕士论文

【摘要】：背景：腕管的核磁共振(MR)研究始于上个世纪,MR的腕管横断面影像所提供的信息最全面,能区分腕部的所有肌腱、神经、韧带、血管,而且能显示腕管各壁轮廓,而腕管冠状面影像则有助于将腕骨区分开来。研究报道显示,腕管平面范围内的正中神经在MR成像上的影像结构与大体及断层解剖基本一致。MR成像也被认为是现阶段诊断腕管综合征最有价值的影像学方法。临床上腕管综合征的传统核磁共振表现多集中在正中神经的研究,且多数停留在大体形态变化这一水平。腕管综合征的MR表现包括正中神经的增粗、变扁及T2WI像上正中神经信号的增高。以往的尸体标本腕管结构的大体解剖和断层解剖基础研究并不能完全代表活体MRI影像解剖,而绝大部分的腕管正中神经解剖学定量研究数据均来源于国外人群,并不能作为我国人群诊断腕管综合征(CTS, carpal tunnel syndrome)的断层影像参考标准。而在国内,针对临床上已明确诊断为CTS患者腕管正中神经的MRI断层定量解剖学研究已有报道,但作为重要参考依据的正常人群形态学定量解剖学研究却鲜有报道。因此,本课题通过采集我国正常青年人群腕部断层MRI影像数据,定量研究正中神经在腕管内的解剖学形态特点,获取正常人群正中神经的膨胀率、扁平率以及弯曲率等数据,为鉴别诊断腕管综合征提供有价值影像解剖依据。目的：临床上CTS患者腕管正中神经的MRI断层定量解剖学研究已有报道,但绝大部分的腕管正中神经解剖学定量研究数据均来源于国外人群,并不能作为我国人群诊断CTS的断层影像参考标准。通过对我国正常青年人群腕管正中神经断层解剖参数的测量,定量研究正中神经在腕管内的解剖学形态特点,为国人腕管正中神经形态学研究以及临床上腕管综合征(CTS)的诊治提供参考依据。方法：本研究共采集32例志愿者,其中4例志愿者仅采集单侧腕部数据。剔除4例不完整双侧腕部数据,剔除单侧腕部数据后统计结果无差异,故最终纳入双侧腕部完整数据28例,共56侧腕部MRI影像数据,其中男性13例,女性15例,年龄21-33岁,平均23.6岁。全部志愿者均无腕部外伤史及相关病史,双侧腕关节活动、感觉功能经骨科专科查体均为正常。采用SIEMENS Avanto1.5T核磁共振扫描仪对志愿者进行扫描,采用膝关节线圈,志愿者取仰卧位,单侧手伸直举过头顶,对侧手放于身体一侧,采用偏中心扫描野。扫描方位：以轴位为主,辅以冠状位和矢状位。通过直接测量尺桡骨远端平面正中神经的长径、短径；正中神经豌豆骨近端平面的长径、短径；钩骨平面正中神经的长、短径,进而计算出这三个腕管层面内正中神经的横截面积、扁平率和膨胀率,其中每个平面的正中神经的横截面积(CSA)为该横截面的正中神经长径×短径,正中神经的扁平率(MNFR)为该平面的正中神经的长径/短径,正中神经的膨胀率(MNSR)为豌豆骨层面的横截面积/桡骨远端层面的横截面积。对于获得的这些影像解剖学测量数据,采用SPSS20.0统计学软件对其进行统计学分析,计量资料用均数±标准差(±SD)表示,两配对样本资料采用两配对样本t检验,两独立样本资料采用两独立样本t检验。探究数据的相关性采用相关性分析,正态分布采用Person方法,非正态资料采用Spearman相关分析方法,显著性水平设置为0.05。将测量指标进行不同性别、不同侧肢体之间比较,并进一步把正中神经的横截面积(CSA)分别与年龄、身高、体重进行相关统计学分析,把正中神经扁平率(MNFR)分别与年龄、身高、体重进行相关统计学分析,把正中神经膨胀率(MNSR)分别与年龄、身高、体重进行相关统计学分析。结果：青年人群中左手和右手的CSA无统计学差异,固定男女性别因素情况下,左右手之间的CSA同样无统计学差异。由此,在合并和均值化双侧腕管的CSA数据基础上比较不同性别的CSA,同样无统计学差异；而在固定左右手因素后,比较男性和女性CSA,均无统计学差异。全部志愿者MNFR左侧1.04-3.75,平均1.82,MNFR右侧1.08-2.26,平均1.77。男性MNFR左侧1.04-2.21,平均1.63,右侧1.04-2.24,平均1.65。女性MNFR左侧1.42-3.75,平均1.98；右侧1.44-2.26；平均1.86。左手和右手的MNFR无统计学差异,固定男女性别因素情况下,左右手之间的MNFR同样无统计学差异。而在均值化双侧腕管后比较男女之间MNFR具有统计学差异(t=-2.126,P=0.043)；在固定左右手因素后,比较男性和女性MNFR,均无统计学差异。全部志愿者MNSR右侧平均1.12,左侧平均为1.09。男性MNSR左侧无论在是否固定男女性别因素的情况下,左右手之间的MNSR均无统计学差异；而左右手均值化后不同性别之间MNSR也无统计学差异；在固定左右手因素后,比较不同性别之间的MNSR无统计学差异；MNFR与身高具有统计学负相关性(r=-0.388, P=0.041), MNFR与体重无统计学相关(r=-0.322,P=0.095),MNFR与年龄无统计学相关(r=-0.071,P=0.720)；对于CSA指标,与年龄的相关性为(r=-0.004,P=0.986),与体重的相关性为(r=0.142,P=0.471),与身高的相关性为(r=0.129,P=0.513),并未发现和年龄、身高和体重之间的统计学相关性；同样对于MNSR,与年龄的相关性为(r=0.137,P=0.486),与体重的相关性为(r=-0.145,P=0.462),与身高的相关性为(r=-0.110,P=0.578)也并未发现和年龄、身高以及体重之间的统计学相关性。结论：综上所述,MRI以其无创性、高软组织分辨力、能综合多种成像序列、能直接任意层面、任意角度扫描成像等优势,能够使腕管内各结构的形态甚至微观组织的形态学变化良好地显示,本研究结果也佐证了MRI是显示肌肉、神经、韧带、肌腱、血管等腕部形态结构的最佳成像方法,可为CTS的诊断及术前、术后评估提供有力的证据支持。此外,根据本研究的结果,国人正中神经扁平率在不同性别之间存在着明显的差异,且国人的扁平率和西方人群存在明显差异,而扁平率和身高之间则存在着负相关性,因此,临床上国人CTS基于MRI诊断标准的建立需与中国人的实际解剖参数相匹配。
[Abstract]:Background: the magnetic resonance (MR) study of the carpal canal began in the last century. The information provided by the transverse section image of the carpal canal in MR is the most comprehensive. It can distinguish all tendons, nerves, ligaments and vessels of the wrist, and can display the contour of the carpal canal wall, while the coronal image of the carpal canal helps to distinguish the carpal bones. The imaging structure of the median nerve in MR imaging is consistent with the gross and fault anatomy..MR imaging is also considered as the most valuable imaging method for the diagnosis of carpal tunnel syndrome at the present stage. The traditional MRI manifestations of the carpal tunnel syndrome are mostly focused on the median nerve, and most of them remain at the level of gross morphological changes. The MR manifestations of carpal tunnel syndrome include the thickening of the median nerve, the flattening of the median nerve and the increase of the median nerve signal on the T2WI image. The general anatomy of the carpal tunnel structure in the past cadavers and the basic study of the sectional anatomy do not fully represent the MRI imaging anatomy of the living body, and the vast majority of the quantitative data of the median neuroanatomy of the carpal tunnel are derived from the country. The external population can not be used as a reference standard for the diagnosis of CTS (carpal tunnel syndrome) in the population of our country. In China, the quantitative anatomical study of the median nerve of the carpal canal, which has been diagnosed clinically as CTS, has been reported, but the morphological quantitative anatomy of the normal population as an important reference is to be used as an important reference. There are few reports on the study. Therefore, by collecting the MRI image data of the wrist fault of the normal young people of our country, we can quantitatively study the anatomical features of the median nerve in the carpal canal, obtain the data of the median nerve expansion rate, flattening rate and the rate of curvature in the normal population, so as to provide valuable image solutions for the differential diagnosis of carpal tunnel syndrome. Objective: the quantitative anatomical study of the MRI fault of the median nerve of the carpal canal in CTS patients has been reported, but the vast majority of the quantitative data of the median neuroanatomy of the carpal canal are derived from the foreign population, and can not be used as a reference for the diagnosis of CTS in the population of our country. Through the wrist Guan Zhengzhong in the normal young people of our country The anatomical morphological characteristics of the median nerve in the carpal canal were measured quantitatively to provide reference for the morphological study of the wrist Guan Zhengzhong nerve and the diagnosis and treatment of the clinical carpal tunnel syndrome (CTS). Methods: 32 volunteers were collected in this study. 4 of the volunteers collected only the unilateral wrist data. 4 cases were eliminated. There was no difference in the data of incomplete bilateral wrist, and the statistical results were no difference after the unilateral wrist data were removed. Therefore, 28 cases were included in the complete data of bilateral wrist. There were 56 MRI images of wrist, including 13 men, 15 women, 21-33 years old and 23.6 years old. All volunteers had no history of wrist injury and related medical history, bilateral wrist movement and sensory function. The volunteers were scanned by the SIEMENS Avanto1.5T NMR scanner, the volunteers were scanned with the knee joint coil, the supine position was taken by the volunteers, the unilateral hand was lifted above the head, the side hand was placed on the side of the body, and the central scan field was adopted. The axis position was the main axis, and the coronal and sagittal position were supplemented by the straight line. Through straight. The length diameter and short diameter of the median nerve of the distal radius of the ruler and radius of the measuring ruler, the length and short diameter of the proximal plane of the median nerve pea bone, the length and the short diameter of the median nerve of the hook bone plane, and then calculate the transverse area of the median nerve in the three carpal canal layers, the flat rate and the expansion rate, and the transverse area of the median nerve at each plane (CSA) is the same The median nerve length diameter * short diameter of the cross section, the median nerve flattening rate (MNFR) is the length / short diameter of the median nerve of the plane, the expansion rate of the median nerve (MNSR) is the cross section area of the pea bone layer / the distal radius of the radius. For these images, the data of the dissection and measurement are obtained by the SPSS20.0 statistics software. Statistical analysis was carried out, and the measurement data were expressed with mean standard deviation (+ SD). Two paired sample t test was used for two paired sample data and two independent sample t test was used for independent sample data. Correlation analysis was used to explore the correlation of data. Normal distribution was used Person method, and non normal data were analyzed by Spearman correlation method. At the level of 0.05., the measurement indexes were compared between different sexes, different sides of limbs, and the correlation between the cross section area (CSA) of the median nerve and the age, height and weight were analyzed, and the median nerve flattening rate (MNFR) was analyzed with age, body height and body weight respectively, and the median nerve expansion rate (M NSR) statistical analysis of age, height and weight respectively. Results: there was no statistical difference between the left hand and the right hand of the young people, and there was no statistical difference between the left and right hands in the CSA of the left and right hands. Therefore, on the basis of the CSA data of the combined and mean bilateral carpal tunnel, the CSA of different sex was compared. There was no statistical difference, but there was no statistical difference between male and female CSA after fixing the left and right hand factors. All volunteers MNFR left 1.04-3.75, average 1.82, MNFR right 1.08-2.26, average 1.77. male MNFR left 1.04-2.21, average 1.63, right 1.04-2.24, average 1.65. female MNFR 1.42-3.75, 1.98. There was no statistical difference between the mean 1.86. left hand and the right hand MNFR. There was no statistical difference between the left and right hands under the condition of fixed sex and sex, while the MNFR between the two men and women was statistically significant (t=-2.126, P=0.043) after the mean of bilateral carpal tunnel (t=-2.126, P=0.043). There was no statistical difference between the male and female MNFR after the fixation of the left and right hand factors. The average right side of MNSR on the right side of all volunteers was 1.12, and the left average was 1.09. male MNSR on the left side, no statistical difference was found between the left and right hands, and there was no statistical difference between the left and right hands, and the MNSR between the left and right hands was no difference between the left and right hands. After the left right hand factor was fixed, the difference between the different sexes was compared. There was no statistical difference in MNSR; MNFR and height had statistical negative correlation (r=-0.388, P=0.041), MNFR had no statistical correlation with weight (r=-0.322, P=0.095), MNFR had no statistical correlation with age (r=-0.071, P=0.720); for CSA index, the correlation with age was (r=-0.004,), and height. The correlation was (r=0.129, P=0.513), and there was no statistical correlation between age, height and weight; also for MNSR, the correlation with age (r=0.137, P=0.486), the correlation with weight (r=-0.145, P=0.462), and the correlation between height and height (r=-0.110, P=0.578) were not found to be between age, height, and weight. Conclusion: To sum up, MRI, with its noninvasive, high soft tissue resolution, can synthesize a variety of imaging sequences, can direct any plane, arbitrary angle scanning imaging and other advantages, can make the morphological changes of the structures and even microstructures of the carpal tube display well. The results of this study also support the evidence that MRI is the display of muscle. The best imaging methods for the morphological structure of the wrist, such as nerve, ligament, tendon and blood vessel, can provide strong evidence for the diagnosis of CTS and the assessment of the preoperative and postoperative evaluation. In addition, there are obvious differences in the median nerve flattening rate between different sexes according to the results of this study, and the flat rate of the people of the country is significantly different from that of the western population. However, there is a negative correlation between flattening and height. Therefore, the establishment of CTS based MRI diagnostic criteria for Chinese people needs to match the actual anatomical parameters of the Chinese people.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R688

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