【摘要】：目的：明確正常成人項部肌肉骨骼系統(tǒng)的聲像圖特征，闡明正常成人項部肌肉骨骼系統(tǒng)的高頻超聲掃查方法。 方法：利用高頻超聲IE33檢查30例（男15例，女15例，左右共60側）正常成人項部，描述并記錄正常成人項部的骨骼、肌肉、血管、神經、韌帶的毗鄰關系及聲像圖特征；測量枕大神經入頭半棘肌點處橫截面積，按照左右側分組，采取配對樣本t檢驗進行分析，左、右側對比判斷枕大神經入肌點處橫截面積差異有無統(tǒng)計學意義；按照男女性別分組，采取獨立樣本的t檢驗進行分析，男、女組對比判斷枕大神經入肌點處橫截面積差異有無統(tǒng)計學意義；測量頸深動脈內徑及峰值流速，使用計算機統(tǒng)計學軟件得出均數(shù)（x）及標準差（s），從而求出頸深動脈內徑及峰值流速的95%可信區(qū)間（95%CI）；探查枕動脈于項部走行情況，計算出兩種類型累計例數(shù)所占總樣本的百分比。 結果：本研究以項部肌肉、骨骼、神經、血管、韌帶為解剖標志，得出正常成人項部的多個切面聲像圖；描述了項部第1頸椎至第2頸椎水平椎枕肌構成枕下三角的聲像圖特點及枕下三角內枕下神經與椎動脈解剖關系；闡明了項部第3頸椎至第5頸椎水平橫突棘肌層次關系；概括了項部第6頸椎至第7頸椎水平夾板肌毗鄰關系；具體說明了項部枕大神經走行特點，測量了枕大神經入頭半棘肌點處橫截面積；明晰了肩胛背神經自中斜角穿出后與肩胛背動脈在背部伴行的聲像特征及項部副神經自胸鎖乳突肌后緣穿出后走行于肩胛提肌與斜方肌之間的聲像特點；明確了項部頸深動脈及枕動脈的走行特點，測得了項部頸深動脈內徑及峰值流速，詳細地記錄了項部枕動脈兩種不同走行情況的累計例數(shù)；明確了項韌帶各部分肌纖維來源的聲像特點。統(tǒng)計學結果顯示：男、女組對比，枕大神經入肌點處橫截面積差異有統(tǒng)計學意義（P0.05）；左右側對比，，枕大神經入肌點處橫截面積差異無顯著性（P0.05）；頸深動脈內徑的均數(shù)±標準差（x±s）為1.51±0.15mm，峰值流速的均數(shù)±標準差（x±s）為2.84±0.48m/s；枕動脈走行于頭夾肌與頭最長肌肌間（46支）占77%，枕動脈走行于頭最長肌與頭上斜肌肌間（14支）占23%。 結論：高頻超聲可作為正常成人項部的肌肉骨骼系統(tǒng)的首選的無創(chuàng)性檢查，值得在臨床推廣。
[Abstract]:Objective: to identify the sonographic features of the musculoskeletal system in normal adults and to elucidate the method of high frequency ultrasound scanning for the musculoskeletal system in normal adults. Methods: 30 normal adults (15 males, 15 females, 60 sides) were examined by high frequency ultrasound (IE33). The adjacent relationship of bone, muscle, blood vessels, nerves and ligaments were described and recorded. The cross sectional area of the occipital great nerve into the point of the semis spinalis of the occipital nerve was measured and divided into groups according to the left and right sides. The paired t-test was used to analyze the cross-sectional area of the occipital great nerve entering the muscle point. According to the sex group of men and women, the T-test of independent samples was used to analyze the difference of cross-sectional area between male and female groups in the point of occipital great nerve entering the muscle. The internal diameter and peak velocity of the deep carotid artery were measured and the 95% confidence interval (95%CI) of the internal diameter and peak velocity of the deep carotid artery was obtained by using the computer statistical software to obtain the mean (x) and standard deviation (s),. The occipital artery was searched and the percentage of the total samples of the two types of accumulative cases was calculated. Results: in this study, the anatomical signs of nape muscles, bones, nerves, blood vessels and ligaments were used as anatomic markers. This paper describes the sonographic characteristics of the inferior occipital triangle formed by the horizontal occipital muscles of the first to second cervical vertebrae and the anatomical relationship between the suboccipital nerve and the vertebral artery in the suboccipital triangle, and clarifies the relationship between the horizontal transverse spinous muscle of the third cervical vertebra and the fifth cervical vertebrae. The contiguous relationship between the sixth cervical vertebra and the seventh cervical vertebrae was summarized, the characteristics of the great occipital nerve and the cross sectional area of the greater occipital nerve into the point of the semis spinalis were measured. The sonographic characteristics of the dorsal scapular nerve and the dorsal scapular artery accompanying with the dorsal scapular artery in the back were clarified, and the characteristics of the accessory nerve of the nape running from the posterior edge of the sternocleidomastoid muscle through the posterior edge of the sternocleidomastoid muscle between the levator scapularis muscle and the trapezius muscle were clarified. The internal diameter and peak flow velocity of deep carotid artery and occipital artery were measured, and the cumulative cases of two different patterns of occipital artery were recorded in detail. The sonographic characteristics of the source of muscle fibers in various parts of the nape ligament were defined. The results showed that there were significant differences in cross sectional area between male and female groups (P0.05), while there was no significant difference between left and right side (P0.05). The mean 鹵standard deviation (x 鹵s) of the internal diameter of the deep carotid artery was 1.51 鹵0.15 mm, and the mean 鹵standard deviation of the peak velocity (x 鹵s) was 2.84 鹵0.48 m / s; The occipital artery was located between the head clamp muscle and the longest head muscle (46 branches) and the occipital artery between the longest head muscle and the superior oblique head muscle (14 branches), and the occipital artery was located between the longest head muscle and the superior oblique head muscle (14 branches). Conclusion: high frequency ultrasound can be used as the first choice of noninvasive examination of musculoskeletal system in normal adults, and it is worth popularizing in clinic.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R681

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