本文選題：腕管綜合征　切入點(diǎn)：正中神經(jīng)橫截面積　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:腕管綜合征是周圍神經(jīng)卡壓性疾病最常見(jiàn)的一種,手指麻木及腕部腫脹是其主要癥狀,早期診斷�？刹捎帽Ｊ刂委�,預(yù)后良好,如不及時(shí)治療可能會(huì)造成神經(jīng)永久損傷,并且極大的影響工作與生活。目前腕管綜合征的診斷主要依靠病史、臨床表現(xiàn)與神經(jīng)電生理檢查,電生理檢查被認(rèn)為是腕管綜合征的診斷金標(biāo)準(zhǔn),但是電生理檢查只能評(píng)價(jià)正中神經(jīng)的功能受損程度,不能為臨床提供有助于發(fā)現(xiàn)病因和確定手術(shù)方式的相關(guān)解剖學(xué)的信息,所以影像學(xué)檢查是必要的補(bǔ)充。雖然MRI具有良好的軟組織分辨能力,但因?yàn)橘M(fèi)用高昂、耗時(shí)長(zhǎng)等原因并沒(méi)有被廣泛應(yīng)用。近年來(lái)隨著診斷技術(shù)的發(fā)展,超聲在肌骨領(lǐng)域的應(yīng)用越來(lái)越廣泛,高頻超聲也逐漸作為腕管綜合征的非侵入性的可行診斷方法,許多學(xué)者對(duì)此進(jìn)行了相關(guān)研究,涉及的指標(biāo)有正中神經(jīng)橫截面積、膨脹率、扁平率等,研究最多的是正中神經(jīng)橫截面積,然而報(bào)道的診斷準(zhǔn)確性有所不同。本論文運(yùn)用循證醫(yī)學(xué)的研究方法,通過(guò)對(duì)已發(fā)表的超聲診斷腕管綜合征臨床試驗(yàn)的相關(guān)數(shù)據(jù)進(jìn)行匯總分析,評(píng)價(jià)超聲測(cè)量正中神經(jīng)橫截面積對(duì)腕管綜合征的診斷價(jià)值。研究方法:將“腕管綜合征”、“超聲”、“carpal tunnel syndrome”、“ultrasonography”(或“sonography”、“ultrasound”等)為檢索詞,通過(guò)主題詞、關(guān)鍵詞檢索從1990年以來(lái)至2016年12月的Pubmed、medline、Cochrane圖書館、中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)庫(kù)等數(shù)據(jù)庫(kù)收錄的文獻(xiàn),根據(jù)已制定的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),對(duì)符合要求的文獻(xiàn)依據(jù)QUADAS作為標(biāo)準(zhǔn)進(jìn)行質(zhì)量評(píng)價(jià),直接或間接提取出納入研究的特征信息以及真陽(yáng)性值、假陽(yáng)性值、真陰性值、假陰性值以及研究的背景和方法學(xué)信息。使用stata12.0軟件,運(yùn)用雙變量隨機(jī)效應(yīng)模型,利用經(jīng)典Q統(tǒng)計(jì)量進(jìn)行異質(zhì)性檢驗(yàn),并計(jì)算出I2值,如若異質(zhì)性較大,則進(jìn)行meta回歸分析及亞組分析探索異質(zhì)性來(lái)源,隨后進(jìn)行meta分析,匯總合并敏感度、特異度、陰性似然比、陽(yáng)性似然比、診斷優(yōu)勢(shì)比及其95%可信區(qū)間等,繪制SROC曲線并計(jì)算曲線下面積,繪制漏斗圖分析文獻(xiàn)發(fā)表偏倚。研究結(jié)果:經(jīng)過(guò)檢索篩選最終一共納入19篇文章,其中英文16篇,中文3篇,病例組1575例研究對(duì)象(手腕數(shù)),對(duì)照組1065例研究對(duì)象(手腕數(shù)),共計(jì)2640例,進(jìn)行異質(zhì)性檢驗(yàn)得出p=0.000,I2=95(95%CI 92-99),提示異質(zhì)性較高,meta回歸及亞組分析提示,對(duì)照組是健康人群手腕還是患病人群的健康手腕、正中神經(jīng)測(cè)量平面、測(cè)量方法、是否使用盲法、病例數(shù)、探頭頻率等均可能是異質(zhì)性來(lái)源。運(yùn)用雙變量效應(yīng)模型匯總得到的敏感度為0.88(95%CI 0.83-0.91),特異度為0.88(95%CI0.81-0.93),陽(yáng)性似然比為7.6(95%CI4.6-12.3),陰性似然比為0.14(95%CI 0.10-0.19),診斷優(yōu)勢(shì)比為43.66(95%CI25.26-75.47)。繪制SROC曲線,曲線下面積AUC=0.93(95%CI0.91-0.95),說(shuō)明該診斷試驗(yàn)良好。漏斗圖分析顯示納入文獻(xiàn)可能存在發(fā)表偏倚。最終結(jié)論:Meta分析提示,超聲測(cè)量正中神經(jīng)橫截面積診斷腕管綜合征,敏感度和特異度均較高,既經(jīng)濟(jì)、方便、無(wú)創(chuàng),還能提供相關(guān)的解剖信息,作為電生理檢查的有效補(bǔ)充,具備一定的診斷價(jià)值和較高的臨床實(shí)用價(jià)值。然而目前尚缺乏統(tǒng)一的超聲診斷標(biāo)準(zhǔn),許多混雜因素如研究對(duì)象選擇、測(cè)量方法等都會(huì)影響診斷結(jié)果,還需要大規(guī)模的、設(shè)計(jì)嚴(yán)謹(jǐn)?shù)脑\斷試驗(yàn)以進(jìn)一步探討和明確其診斷價(jià)值和診斷標(biāo)準(zhǔn),并制定腕管綜合征的超聲診斷標(biāo)準(zhǔn)。
[Abstract]:Objective: To study the carpal tunnel syndrome is a kind of peripheral nerve compression of the most common diseases, the main symptoms are numbness in the fingers and wrist swelling, early diagnosis can often be treated conservatively, the prognosis is good, if not timely treatment may cause permanent damage to the nervous, and greatly affect the work and life. The diagnosis of wrist tube syndrome mainly depends on medical history, clinical manifestation and electrophysiological examination, electrophysiological examination is considered to be the gold standard for the diagnosis of carpal tunnel syndrome, but the electrophysiological examination can evaluate the median nerve function damage degree, not for clinical provide help to find the cause and determine the relevant anatomical surgical information. So the imaging examination is a necessary supplement. Although MRI has a good soft tissue resolution, but because of the high cost, and no time-consuming reason is widely used. In recent years with the diagnosis technology The development of ultrasound applied in musculoskeletal fields widely, high frequency ultrasound has gradually as a feasible non invasive diagnostic methods of carpal tunnel syndrome, many scholars have carried out relevant research, these indicators are the median nerve cross-sectional area, expansion rate, flat rate, research the most is the median nerve cross the cross-sectional area, however the diagnostic accuracy reported is different. This paper uses the research method of evidence-based medicine, analyze the ultrasound data published tube syndrome clinical trial, to evaluate the diagnostic value of ultrasonic measurement of median nerve cross-sectional area of carpal tunnel syndrome. Methods: "carpal tunnel syndrome", "ultrasound", "carpal tunnel syndrome", "ultrasonography" (or "sonography", "ultrasound") as the search term, through keywords, keyword retrieval from 1990 to 2016 In December, Pubmed, MEDLINE, Cochrane library, China CNKI, Wanfang database database included literature according to the inclusion and exclusion criteria, to meet the requirements of the literature on the basis of QUADAS as a standard to evaluate the quality, directly or indirectly, to extract the feature information into the research and the value of true positive, false positive value, really the negative value of information, false negative value as well as the research background and methods. The use of stata12.0 software, using a bivariate random effects model to test for heterogeneity by using the classical Q statistics, and calculate the I2 value, such as if the heterogeneity, then meta regression and subgroup analysis to explore the sources of heterogeneity, followed by meta analysis of consolidation of sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, diagnostic odds ratio and 95% confidence interval, SROC curve and calculate the area under the curve analysis, funnel plot The publication bias. Results: after screening a total of 19 final retrieval articles, including English 16, Chinese 3, a total of 1575 cases of object (wrist number), 1065 cases in the control group (the research object, a total of 2640 cases of wrist number), heterogeneity test showed p= 0 (95%CI 92-99, I2=95), suggesting higher heterogeneity, meta regression and subgroup analysis showed that the control group is healthy or sick people health wrist wrist median nerve measuring plane, measuring method, the use of blinding, the number of cases, probe frequency can be sources of heterogeneity. Using the double variable effect model get a summary of sensitivity 0.88 (95%CI 0.83-0.91), the specificity was 0.88 (95%CI0.81-0.93), the positive likelihood ratio was 7.6 (95%CI4.6-12.3), negative likelihood ratio was 0.14 (95%CI 0.10-0.19), diagnostic odds ratio was 43.66 (95%CI25.26-75.47). The SROC curve, the area under the curve AUC= 0.93 (95%CI0.91-0.95), indicating that the diagnostic test is good. The funnel plot analysis showed that included the potential publication bias. Conclusion: Meta analysis showed that the median nerve cross-sectional area measured by ultrasound in diagnosis of carpal tunnel syndrome, high sensitivity and specificity, economical, convenient, non-invasive, can provide anatomical information related to as an effective complement, electrophysiological examination, have high diagnostic value and certain clinical value. However, there is still a lack of unified diagnostic standard, many confounding factors such as research object, measurement method will affect the diagnosis results, also need large-scale, rigorous design of diagnostic tests to further explore and clear the diagnostic value and diagnostic criteria, and formulate the ultrasonic diagnostic criteria of carpal tunnel syndrome.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R688

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