【摘要】：目的探討MRI在診斷臂叢節(jié)后神經(jīng)損傷中的影像表現(xiàn)及其臨床應用價值 材料和方法搜集16例臨床懷疑為臂叢神經(jīng)節(jié)后損傷的患者,均存在不同程度的感覺、運動功能障礙或/和肌肉萎縮等表現(xiàn),術前采用飛利浦Achieva3. OT TX超導型MR掃描儀行臂叢神經(jīng)掃描檢查、神經(jīng)電生理學檢查,同時行手術探查,通過兩種檢查方法與手術探查、術中電生理所見或臨床證實進行比較,分別計算兩種檢查方法診斷臂叢神經(jīng)節(jié)后損傷的準確率,利用統(tǒng)計學方法,比較兩種方法對于節(jié)后損傷的準確率有無差異,同時分別計算每個節(jié)后神經(jīng)根在MRI檢查中的診斷準確率有無差異。 結果MRI檢查對臂叢神經(jīng)節(jié)后損傷靈敏度、特異度、準確度分別為94%、72%、83%。節(jié)后損傷在MRI中的征象：神經(jīng)表現(xiàn)正常,神經(jīng)走形、信號未見明顯異常,與健側(cè)一致；神經(jīng)連續(xù)、變性增粗,伴或不伴周圍高信影或受壓改變；神經(jīng)瘢痕組織形成,走行僵直、結構紊亂,伴或不伴周圍高信號影；神經(jīng)走行區(qū)可見結節(jié),外傷性神經(jīng)瘤的形成；神經(jīng)斷裂、斷端分離消失。臂叢節(jié)后各神經(jīng)根損傷在MRI中的診斷準確率頸5-胸1分別為78%、85%、64%、93%、93%。肌電圖診斷節(jié)后損傷準確率為80%,MRI和肌電圖兩種檢查方法診斷準確率差異無統(tǒng)計學意義。 結論MRI可以清楚的同時顯示臂叢神經(jīng)節(jié)前、后損傷的影像診斷,且無創(chuàng)無輻射,對臂叢神經(jīng)節(jié)后損傷可以提供準確而清晰的定位定性診斷,具有較高的準確率,同時在診斷臂叢神經(jīng)干的診斷效能上是不同的,MRI診斷臂叢節(jié)后損傷與肌電圖檢查結果的準確率差異無統(tǒng)計學意義(P0.05),故MRI可作為嚴重損傷或疾病急性期的首選檢查方法,臨床上術前提供手術區(qū)組織損傷的情況,早期制定手術方案,有助于預后。
[Abstract]:Objective to investigate the imaging features and clinical value of MRI in the diagnosis of postganglionic nerve injury of brachial plexus. Patients with motor dysfunction or / and muscular atrophy were treated with Philips Achieva3 before operation. OT-TX superconducting Mr scanner was used to examine brachial plexus, nerve electrophysiology and surgical exploration. The two methods were compared with operative exploration, intraoperative electrophysiological findings or clinical evidence. The accuracy of the two methods in the diagnosis of postganglionic injury of brachial plexus was calculated, and the statistical method was used to compare the accuracy of the two methods for postganglionic injury. At the same time, the diagnostic accuracy of each postganglionic nerve root in MRI was calculated. Results the sensitivity, specificity and accuracy of MRI for postganglionic injury of brachial plexus were 9472 and 83, respectively. The signs of postganglionic injury in MRI were as follows: the nerve showed normal appearance, the shape of the nerve was normal, the signal was not abnormal, and the signal was consistent with the healthy side; the nerve was continuous, denatured and thickened, accompanied with or without the surrounding hyperbolic or compressed changes; the nerve scar tissue was formed and walked stiffly. Structure disorder, with or without peripheral hyperintense shadow; nodule was seen in the nerve walk area, traumatic neuroma was formed; nerve was broken, and the broken end was separated and disappeared. Diagnostic accuracy of nerve root injury after brachial plexus in MRI: the accuracy of cervical 5-thorax 1 was 78.85, and 93s were 93s. The accuracy of electromyography in the diagnosis of postganglionic injury was not significantly different from that of MRI and electromyography. Conclusion MRI can clearly display the imaging diagnosis of pre- and post-ganglionic injury of brachial plexus at the same time, and it can provide accurate and clear diagnosis of postganglionic injury of brachial plexus with high accuracy. At the same time, in the diagnosis of brachial plexus trunk, there was no significant difference in the accuracy of MRI in the diagnosis of postganglionic injury of brachial plexus and electromyography (P0.05). Therefore, MRI can be used as the first choice in the diagnosis of severe injury or acute stage of disease. It is helpful for prognosis to provide the condition of tissue injury in the operation area before operation and to make the operation plan in the early stage.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R651.3

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