神经肌电图、超声和MRI在腕管综合征中的相关性研究
发布时间：2018-08-14 18:32
【摘要】：目的:通过对腕管综合征患者进行神经肌电图、超声和MRI检查,探讨三者在腕管综合征中的应用及相关性。内容:对36例腕管综合征患者和40例健康对照者进行神经肌电图、超声和MRI检查,并将检查结果进行比较。对中、晚期腕管综合征患者进行手术,将术中所见正中神经的病变情况与术前超声、MRI的检查结果进行比较。方法:首先采用丹麦KEYPOINT 4型四导肌电诱发电位仪对患者及志愿者进行检查,包括肌电图(EMG)检查和神经电图检查,先用同心圆针检查拇短展肌,观察静息状态下有无插入电位延长和自发电位;小力收缩肌肉时单个运动单位电位的时限、波幅;大力收缩肌肉时募集电位的类型以及募集电位的峰-峰值。再进行正中神经传导的检查,测定的参数包括:运动传导速度、末端运动潜伏期、复合肌肉动作电位波幅、感觉传导速度、感觉神经动作电位波幅。之后按照电生理分期诊断标准分为早、中、晚3期。再采用GE公司生产的Logiq E9型彩色多普勒超声检查仪对3期腕管综合征患者及志愿者进行检查,先用超声探头对腕管及正中神经进行纵向扫描,矢状位观察腕管内正中神经的位置、走向及正中神经前后径的变化情况以及受压的神经部位;然后再用超声探头横扫腕管,测量并记录豌豆骨平面正中神经截面积(CSA)。最后采用GE公司生产的750 3.0T MR成像仪对3期腕管综合征患者及志愿者进行检查,所行序列有T1加权成像及短翻转时间恢复T2WI序列,测量评定腕管形态的参数:正中神经肿胀率(MNSR)和正中神经扁平率(MNFR),将所有检查结果进行比较。对中、晚期腕管综合征患者进行手术,并将术中所见正中神经的病变情况与术前超声、MRI的检查结果进行比较。结果:对于早期腕管综合征患者,CSA、MNSR和MNFR与对照组相比变化不明显。而对于中、晚期腕管综合征患者,CSA、MNSR和MNFR均增大,与对照组相比两组差异有统计学意义(P0.05)。神经肌电图与超声、MRI检查有相关性,即正中神经的末端运动潜伏期延长,感觉传导速度就减慢,而术中所见正中神经越来越粗,CSA、MNSR和MNFR也明显增大,但正中神经的末端运动潜伏期与CSA,感觉传导速度与MNFR的相关性不大。经手术证实,术中发现大多数正中神经的卡压部位是在钩骨钩平面,而在豌豆骨平面的正中神经有不同程度的增粗、肿胀,这与术前超声、MRI检查结果相符。结论:神经肌电图检查能为早期诊断腕管综合征提供依据和最佳治疗时间。对于中、晚期腕管综合征患者,超声和MRI检查可以对腕管综合征的严重程度做出诊断;还可以明确腕部正中神经卡压的部位、原因,在术前提供了较多形态学方面的信息,对确定手术方案起着重要作用,因此超声和MRI对于腕管综合征是有价值的检查方法。但对于腕管综合征的诊断,超声和MRI检查不能代替神经肌电图检查。
[Abstract]:Objective: to investigate the application and correlation of electromyography, ultrasound and MRI in carpal tunnel syndrome. Contents: electromyography, ultrasound and MRI were performed in 36 patients with carpal tunnel syndrome and 40 healthy controls, and the results were compared. Patients with middle and late carpal tunnel syndrome were operated on. Methods: first, the patients and volunteers were examined by KEYPOINT 4 quadrilateral electromyography potentiometer, including electromyography (EMG) and electroneurogram (EMG), and the abductor pollicis brevis muscle was examined with concentric needle. The insertion potential and spontaneous potential were observed in resting state; the time limit and amplitude of single motor unit potential in muscle contraction; the type of recruitment potential and the peak-peak value of recruitment potential in muscle contraction were observed. The parameters included motor conduction velocity, terminal motor latency, compound muscle action potential amplitude, sensory conduction velocity and sensory nerve action potential amplitude. According to the diagnostic criteria of electrophysiological stages, the patients were divided into three stages: early, middle and late. The Logiq E9 color Doppler ultrasound instrument produced by GE Company was used to examine the patients and volunteers with phase 3 carpal tunnel syndrome. The carpal tunnel and median nerve were scanned longitudinally with ultrasonic probe. Sagittal position of the median nerve in the carpal tunnel was observed, and the changes of the anterior and posterior diameter of the median nerve and the compressed nerve were observed. Then the median nerve sectional area (CSA).) of the pea bone plane was measured and recorded by scanning the carpal tunnel with an ultrasound probe. Finally, the 7503.0T Mr imaging instrument produced by GE Company was used to examine the patients and volunteers with phase 3 carpal tunnel syndrome. The sequences included T1 weighted imaging and short flipping time to recover T2WI sequence. Parameters for evaluating carpal tunnel morphology: median nerve swelling rate (MNSR) and median nerve flat rate (MNFR),) were compared. Patients with middle and late carpal tunnel syndrome were operated on. Results: there were no significant changes in MNSR and MNFR in patients with early carpal tunnel syndrome compared with control group. For middle and late carpal tunnel syndrome patients, CSAA MNSR and MNFR were increased, compared with the control group, there was significant difference between the two groups (P0.05). There was a correlation between electromyogram and MRI, that is, the motor latency of the median nerve was prolonged, the sensory conduction velocity was slowed down, and the median nerve was thicker and thicker during the operation. The MNSR and MNFR of the median nerve were also increased obviously. However, the terminal motor latency of median nerve was not correlated with MNFR and sensory conduction velocity. It was proved by operation that most of the median nerve entrapment was located in the hook plane, but the median nerve in the pea bone plane was thickened and swollen to varying degrees, which was consistent with the results of pre-operative ultrasonography and MRI. Conclusion: electromyography can provide basis and best treatment time for early diagnosis of carpal tunnel syndrome. For patients with intermediate and late carpal tunnel syndrome, ultrasound and MRI can diagnose the severity of carpal tunnel syndrome, and can also determine the position of median nerve compression in wrist, which provides more morphological information before operation. Ultrasound and MRI are valuable methods for the diagnosis of carpal tunnel syndrome. However, for the diagnosis of carpal tunnel syndrome, ultrasound and MRI can not replace the nerve electromyography.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R688
本文编号：2183744
[Abstract]:Objective: to investigate the application and correlation of electromyography, ultrasound and MRI in carpal tunnel syndrome. Contents: electromyography, ultrasound and MRI were performed in 36 patients with carpal tunnel syndrome and 40 healthy controls, and the results were compared. Patients with middle and late carpal tunnel syndrome were operated on. Methods: first, the patients and volunteers were examined by KEYPOINT 4 quadrilateral electromyography potentiometer, including electromyography (EMG) and electroneurogram (EMG), and the abductor pollicis brevis muscle was examined with concentric needle. The insertion potential and spontaneous potential were observed in resting state; the time limit and amplitude of single motor unit potential in muscle contraction; the type of recruitment potential and the peak-peak value of recruitment potential in muscle contraction were observed. The parameters included motor conduction velocity, terminal motor latency, compound muscle action potential amplitude, sensory conduction velocity and sensory nerve action potential amplitude. According to the diagnostic criteria of electrophysiological stages, the patients were divided into three stages: early, middle and late. The Logiq E9 color Doppler ultrasound instrument produced by GE Company was used to examine the patients and volunteers with phase 3 carpal tunnel syndrome. The carpal tunnel and median nerve were scanned longitudinally with ultrasonic probe. Sagittal position of the median nerve in the carpal tunnel was observed, and the changes of the anterior and posterior diameter of the median nerve and the compressed nerve were observed. Then the median nerve sectional area (CSA).) of the pea bone plane was measured and recorded by scanning the carpal tunnel with an ultrasound probe. Finally, the 7503.0T Mr imaging instrument produced by GE Company was used to examine the patients and volunteers with phase 3 carpal tunnel syndrome. The sequences included T1 weighted imaging and short flipping time to recover T2WI sequence. Parameters for evaluating carpal tunnel morphology: median nerve swelling rate (MNSR) and median nerve flat rate (MNFR),) were compared. Patients with middle and late carpal tunnel syndrome were operated on. Results: there were no significant changes in MNSR and MNFR in patients with early carpal tunnel syndrome compared with control group. For middle and late carpal tunnel syndrome patients, CSAA MNSR and MNFR were increased, compared with the control group, there was significant difference between the two groups (P0.05). There was a correlation between electromyogram and MRI, that is, the motor latency of the median nerve was prolonged, the sensory conduction velocity was slowed down, and the median nerve was thicker and thicker during the operation. The MNSR and MNFR of the median nerve were also increased obviously. However, the terminal motor latency of median nerve was not correlated with MNFR and sensory conduction velocity. It was proved by operation that most of the median nerve entrapment was located in the hook plane, but the median nerve in the pea bone plane was thickened and swollen to varying degrees, which was consistent with the results of pre-operative ultrasonography and MRI. Conclusion: electromyography can provide basis and best treatment time for early diagnosis of carpal tunnel syndrome. For patients with intermediate and late carpal tunnel syndrome, ultrasound and MRI can diagnose the severity of carpal tunnel syndrome, and can also determine the position of median nerve compression in wrist, which provides more morphological information before operation. Ultrasound and MRI are valuable methods for the diagnosis of carpal tunnel syndrome. However, for the diagnosis of carpal tunnel syndrome, ultrasound and MRI can not replace the nerve electromyography.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R688
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相关期刊论文 前3条
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3 汤晓芙;腕管综合征(CTS)的电生理诊断要点[J];临床神经电生理学杂志;2003年01期
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