超聲檢查對(duì)腕部正中神經(jīng)損傷的診斷研究
發(fā)布時(shí)間：2018-11-14 20:08
【摘要】：目的:隨著社會(huì)的進(jìn)步,經(jīng)濟(jì)的發(fā)展,人們從事的工作發(fā)生了翻天覆地的變化,腕管正中神經(jīng)損傷的疾病也越來(lái)越多。腕管是由腕部深層骨質(zhì)結(jié)構(gòu)與腕橫韌帶組成的骨纖維結(jié)構(gòu)。其內(nèi)部結(jié)構(gòu)有屈指淺肌腱、正中神經(jīng)、拇長(zhǎng)屈肌腱、屈指深肌腱。正中神經(jīng)在腕管內(nèi)位于拇長(zhǎng)屈肌腱與屈指淺肌腱之間,并緊貼腕橫韌帶深面。其在腕橫韌帶遠(yuǎn)端發(fā)出返支支配拇短展肌、拇短屈肌、拇對(duì)掌肌,它的終支是指神經(jīng),支配拇指、示指、中指和環(huán)指橈側(cè)半掌側(cè)皮膚。腕管綜合征(CTS)的主要發(fā)病原因與手腕部腕管內(nèi)壓力持續(xù)升高有很大關(guān)系,由于腕管的密封骨纖維結(jié)構(gòu),無(wú)論任何原因引起的腕管內(nèi)的軟組織增多,還是腕管內(nèi)的容積減小,都會(huì)引起腕管內(nèi)的壓力升高,正中神經(jīng)在腕管內(nèi)受壓導(dǎo)致神經(jīng)支配區(qū)的功能及感覺(jué)障礙的一組癥狀和體征,其主要表現(xiàn)為拇指、示指、中指和環(huán)指橈側(cè)半掌側(cè)皮膚的感覺(jué)減退,大魚(yú)際肌肌肉萎縮,拇指活動(dòng)不靈活,與其他手指對(duì)捏的力量下降或不能完成對(duì)捏動(dòng)作。是周?chē)窠?jīng)卡壓疾病中最常見(jiàn)的一種。腕管綜合征主要發(fā)病年齡集中在40-60歲,女性的發(fā)病率較男性高。導(dǎo)致腕管內(nèi)壓力持續(xù)升高的原因有很多,在常見(jiàn)的腕管內(nèi)腱周滑膜增生和纖維化因素以外,腕部占位性病變?nèi)缁つ夷[、神經(jīng)纖維囊腫、皮下脂肪瘤和腕管內(nèi)血腫也能使腕管內(nèi)部壓力升高造成腕部正中神經(jīng)受到壓迫。有時(shí)會(huì)有一些少見(jiàn)的原因,例如屈肌群的肌腹過(guò)低,創(chuàng)傷性或退行性病變引起的腕部骨性結(jié)構(gòu)異常,導(dǎo)致正中神經(jīng)受到壓迫。由此可以看出在腕管綜合征(CTS)的診療過(guò)程中,對(duì)于腕管內(nèi)部解剖的變化貫穿整個(gè)疾病的診治過(guò)程。周?chē)窠?jīng)系統(tǒng)由神經(jīng)、神經(jīng)節(jié)、受體、突觸和運(yùn)動(dòng)神經(jīng)末梢構(gòu)成,可以反饋出人體內(nèi)外的感官信息。由于肌電圖的不同電生理學(xué)變化可以判斷出損傷的部位、損傷的性質(zhì)、損傷的程度等多種重要信息,對(duì)神經(jīng)損傷的發(fā)病機(jī)制、臨床診斷及預(yù)后評(píng)估等等有重要的作用,電生理檢查中的肌電圖(EMG)和神經(jīng)傳導(dǎo)功能檢查被認(rèn)為是評(píng)價(jià)外周神經(jīng)功能狀況的金標(biāo)準(zhǔn),但是在神經(jīng)損傷的3-4周內(nèi)及神經(jīng)再生沒(méi)有達(dá)到效應(yīng)器前,神經(jīng)電生理檢查無(wú)法對(duì)神經(jīng)損傷情況及預(yù)后情況進(jìn)行精確的判斷及評(píng)估。并且神經(jīng)電生理檢查無(wú)法對(duì)病變的具體位置及損傷程度做直觀檢查。影像學(xué)中的MRI及超聲檢查可以清晰的顯示腕管內(nèi)軟組織及正中神經(jīng),可以顯示正中神經(jīng)壓迫情況,提供卡壓的病因,對(duì)腕管綜合征提供客觀的影像學(xué)診斷依據(jù)。超聲檢查診斷腕管綜合征(CTS)具有直觀、無(wú)創(chuàng)、省時(shí)、價(jià)廉的優(yōu)點(diǎn),可以清晰的顯示腕管內(nèi)神經(jīng)、血管等內(nèi)容物,提供具體的形態(tài)學(xué)信息,對(duì)手術(shù)方案的確定有很大的指導(dǎo)作用,為神經(jīng)卡壓的診斷研究提供了一種新的研究方法。方法:選取2016年6月-12月本院收治的50例腕管綜合征患者作為觀察組,臨床上排除原發(fā)性雷諾氏綜合征、周?chē)茏枞捌渌麑?duì)實(shí)驗(yàn)結(jié)果影響的相關(guān)疾病。50例排除周?chē)窠?jīng)系統(tǒng)、血管系統(tǒng)有關(guān)的疾病,神經(jīng)系統(tǒng)相關(guān)檢查結(jié)果均為陰性健康志愿者作為對(duì)照組,以鉤骨為標(biāo)志,在該水平進(jìn)行正中神經(jīng)前后徑的大小超聲學(xué)檢查,各個(gè)測(cè)量位置重復(fù)測(cè)量3次取平均數(shù)。觀察腕管綜合征患者與健康志愿者正中神經(jīng)前后徑是否存在差異。結(jié)果:超聲精確顯示了正中神經(jīng)的解剖斷面,觀察組與對(duì)照組正中神經(jīng)前后徑差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:腕管綜合征(CTS)是一種主要以手部正中神經(jīng)支配區(qū)麻木、觸覺(jué)功能減退為主要癥狀,或伴有夜間麻醒史的臨床疾病。超聲學(xué)檢查可以清晰的顯示腕部神經(jīng)的位置、結(jié)構(gòu)及神經(jīng)周?chē)M織的變化,對(duì)臨床上對(duì)個(gè)體病情的研究提供了診斷依據(jù)。本研究通過(guò)對(duì)腕部正中神經(jīng)的超聲學(xué)檢查,可以簡(jiǎn)單、快速、清晰的顯示出腕部正中神經(jīng)卡壓的位置,嚴(yán)重程度,卡壓的范圍,及與周?chē)浗M織的關(guān)系。腕部超聲學(xué)的檢查對(duì)診斷腕管綜合征上有很高的診斷價(jià)值。
[Abstract]:Objective: With the development of society and the development of economy, people's work has changed over and over, and the disease of nerve injury in the middle of the wrist is more and more. The wrist tube is a bone fiber structure composed of the deep bone structure of the wrist and the transverse ligament of the wrist. The internal structure of the tendon refers to a shallow tendon, a median nerve, a long-length flexor tendon, and a flexor tendon. The median nerve is located between the flexor tendon and the flexor tendon in the wrist, and is in close contact with the deep surface of the transverse ligament of the wrist. At the distal end of the transverse ligament of the wrist, the dorsal branch is used to control the short-and short-acting muscles, the short-and-short-flexion muscles and the palm muscles, and the final branch of it is the nerve, the dominant thumb, the finger, the middle finger and the ring refer to the half-palm-side skin of the palm side. The main cause of carpal tunnel syndrome (CTS) is related to the continuous increase of the pressure in the wrist of the wrist, due to the fibrous structure of the sealing bone of the wrist tube, whether the soft tissue in the wrist tube caused by any cause is increased or the volume in the wrist tube is reduced, the pressure in the wrist tube can be raised, The central nervous system is a group of symptoms and signs that result in the function of the innervation zone and the sensory disturbance in the carpal tunnel, which is mainly characterized by a thumb, a finger, a middle finger and a ring, the force of the kneading with the other fingers is reduced or the kneading action cannot be completed. It is one of the most common types of peripheral nerve entrapment. The main incidence of carpal tunnel syndrome is in the range of 40-60 years, and the incidence of female is higher than that of male. There are a number of reasons leading to a continuous increase in the pressure in the wrist tube, in addition to the synovial proliferation and fibrotic factors in the common wrist-tube, the wrist-occupying lesions, such as synovial cyst, nerve fiber cyst, The subcutaneous fat and the intraductal hematoma can also cause the internal pressure of the wrist tube to rise and the median nerve of the wrist is oppressed. There are some rare reasons, such as the low, traumatic or degenerative changes in the wrist-bone structure caused by a low, traumatic or degenerative change in the muscle of the flexor, which leads to the compression of the median nerve. As a result, it can be seen that during the diagnosis and treatment of the carpal tunnel syndrome (CTS), the change in the internal anatomy of the wrist tube penetrates the diagnosis and treatment process of the whole disease. The peripheral nervous system is composed of a nerve, a ganglion, a receptor, a synapse and a moving nerve terminal, and can feed back the sensory information inside and outside the human body. due to the different electrophysiological changes of the electromyography, various important information such as the location of the injury, the nature of the damage, the degree of damage and the like can be judged, the pathogenesis of the nerve injury, the clinical diagnosis and the prognosis evaluation and the like have important effects, Electromyography (EMG) and nerve conduction functional examination in electrophysiology examination were considered to be a gold standard for evaluating peripheral neurological conditions, but within 3-4 weeks of nerve injury and before the nerve regeneration did not reach the effector, The neuroelectrophysiology examination can not accurately judge and evaluate the condition of the nerve injury and the prognosis. and the neuroelectrophysiology examination can not be used for visual inspection on the specific location and the degree of damage of the lesion. The MRI and ultrasonic examination in the image can clearly show the soft tissue and median nerve in the wrist, can show the central nerve compression, provide the cause of the card pressure, and provide an objective imaging diagnosis basis for the carpal tunnel syndrome. The ultrasonic examination and the diagnosis of the carpal tunnel syndrome (CTS) have the advantages of being intuitive, non-invasive, and low in cost, and can clearly display the contents of the nerve and the blood vessel in the wrist, provide specific morphological information, and has a great guiding effect on the determination of the operation scheme, In this paper, a new research method is provided for the diagnosis and study of the nerve card pressure. Methods: 50 cases of carpal tunnel syndrome treated in our hospital from June to December 2016 were selected as the observation group, and the primary and peripheral vascular obstruction and other related diseases which were affected by the experimental results were excluded. The results of the examination of the nervous system were negative healthy volunteers as the control group, with the hook bone as the marker, the size of the median nerve and the anterior and posterior diameter of the median nerve were examined by the ultrasound, and the average number of the measurements was repeated 3 times in each measurement position. To observe the difference of the anterior and posterior diameters of the median nerve in the patients with carpal tunnel syndrome and healthy volunteers. Results: The anatomic cross-section of median nerve was shown by ultrasound, and the difference of the anterior and posterior diameters of the median nerve in the observation group and the control group was statistically significant (P0.05). Conclusion: The syndrome of carpal tunnel syndrome (CTS) is one of the main symptoms, including the numbness of the innervation area of the median nerve of the hand, the hypofunction of the tactile function as the main symptom, or the clinical condition with the history of night anesthesia. The ultrasonic examination can clearly show the position, structure and the change of the surrounding tissues of the wrist, and provide the basis for the clinical study of the individual's condition. In this study, by means of the ultrasonic examination of the median nerve of the wrist, the position, severity, the range of the clamping pressure and the relation with the surrounding soft tissues of the median nerve of the wrist can be displayed in a simple, rapid and clear manner. The examination of wrist ultrasound has a very high diagnostic value in the diagnosis of carpal tunnel syndrome.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R688
本文編號(hào)：2332167
[Abstract]:Objective: With the development of society and the development of economy, people's work has changed over and over, and the disease of nerve injury in the middle of the wrist is more and more. The wrist tube is a bone fiber structure composed of the deep bone structure of the wrist and the transverse ligament of the wrist. The internal structure of the tendon refers to a shallow tendon, a median nerve, a long-length flexor tendon, and a flexor tendon. The median nerve is located between the flexor tendon and the flexor tendon in the wrist, and is in close contact with the deep surface of the transverse ligament of the wrist. At the distal end of the transverse ligament of the wrist, the dorsal branch is used to control the short-and short-acting muscles, the short-and-short-flexion muscles and the palm muscles, and the final branch of it is the nerve, the dominant thumb, the finger, the middle finger and the ring refer to the half-palm-side skin of the palm side. The main cause of carpal tunnel syndrome (CTS) is related to the continuous increase of the pressure in the wrist of the wrist, due to the fibrous structure of the sealing bone of the wrist tube, whether the soft tissue in the wrist tube caused by any cause is increased or the volume in the wrist tube is reduced, the pressure in the wrist tube can be raised, The central nervous system is a group of symptoms and signs that result in the function of the innervation zone and the sensory disturbance in the carpal tunnel, which is mainly characterized by a thumb, a finger, a middle finger and a ring, the force of the kneading with the other fingers is reduced or the kneading action cannot be completed. It is one of the most common types of peripheral nerve entrapment. The main incidence of carpal tunnel syndrome is in the range of 40-60 years, and the incidence of female is higher than that of male. There are a number of reasons leading to a continuous increase in the pressure in the wrist tube, in addition to the synovial proliferation and fibrotic factors in the common wrist-tube, the wrist-occupying lesions, such as synovial cyst, nerve fiber cyst, The subcutaneous fat and the intraductal hematoma can also cause the internal pressure of the wrist tube to rise and the median nerve of the wrist is oppressed. There are some rare reasons, such as the low, traumatic or degenerative changes in the wrist-bone structure caused by a low, traumatic or degenerative change in the muscle of the flexor, which leads to the compression of the median nerve. As a result, it can be seen that during the diagnosis and treatment of the carpal tunnel syndrome (CTS), the change in the internal anatomy of the wrist tube penetrates the diagnosis and treatment process of the whole disease. The peripheral nervous system is composed of a nerve, a ganglion, a receptor, a synapse and a moving nerve terminal, and can feed back the sensory information inside and outside the human body. due to the different electrophysiological changes of the electromyography, various important information such as the location of the injury, the nature of the damage, the degree of damage and the like can be judged, the pathogenesis of the nerve injury, the clinical diagnosis and the prognosis evaluation and the like have important effects, Electromyography (EMG) and nerve conduction functional examination in electrophysiology examination were considered to be a gold standard for evaluating peripheral neurological conditions, but within 3-4 weeks of nerve injury and before the nerve regeneration did not reach the effector, The neuroelectrophysiology examination can not accurately judge and evaluate the condition of the nerve injury and the prognosis. and the neuroelectrophysiology examination can not be used for visual inspection on the specific location and the degree of damage of the lesion. The MRI and ultrasonic examination in the image can clearly show the soft tissue and median nerve in the wrist, can show the central nerve compression, provide the cause of the card pressure, and provide an objective imaging diagnosis basis for the carpal tunnel syndrome. The ultrasonic examination and the diagnosis of the carpal tunnel syndrome (CTS) have the advantages of being intuitive, non-invasive, and low in cost, and can clearly display the contents of the nerve and the blood vessel in the wrist, provide specific morphological information, and has a great guiding effect on the determination of the operation scheme, In this paper, a new research method is provided for the diagnosis and study of the nerve card pressure. Methods: 50 cases of carpal tunnel syndrome treated in our hospital from June to December 2016 were selected as the observation group, and the primary and peripheral vascular obstruction and other related diseases which were affected by the experimental results were excluded. The results of the examination of the nervous system were negative healthy volunteers as the control group, with the hook bone as the marker, the size of the median nerve and the anterior and posterior diameter of the median nerve were examined by the ultrasound, and the average number of the measurements was repeated 3 times in each measurement position. To observe the difference of the anterior and posterior diameters of the median nerve in the patients with carpal tunnel syndrome and healthy volunteers. Results: The anatomic cross-section of median nerve was shown by ultrasound, and the difference of the anterior and posterior diameters of the median nerve in the observation group and the control group was statistically significant (P0.05). Conclusion: The syndrome of carpal tunnel syndrome (CTS) is one of the main symptoms, including the numbness of the innervation area of the median nerve of the hand, the hypofunction of the tactile function as the main symptom, or the clinical condition with the history of night anesthesia. The ultrasonic examination can clearly show the position, structure and the change of the surrounding tissues of the wrist, and provide the basis for the clinical study of the individual's condition. In this study, by means of the ultrasonic examination of the median nerve of the wrist, the position, severity, the range of the clamping pressure and the relation with the surrounding soft tissues of the median nerve of the wrist can be displayed in a simple, rapid and clear manner. The examination of wrist ultrasound has a very high diagnostic value in the diagnosis of carpal tunnel syndrome.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R688
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