正中神经膨胀率评估腕关节损伤的磁共振成像研究

The swelling rate of median nerve as a magnetic resonance imaging parameter for the evaluation of wrist joint injury

目的探讨临床MR成像腕管正中神经膨胀率对腕关节损伤的诊断价值。方法选取本院2016年10月~2019年3月明确诊断的15例右侧腕关节损伤患者以及15例健康者右侧腕关节的影像学资料,直接测量正中神经豆骨水平和钩骨钩突水平的长径以及短径,并计算出这两个腕管层面内正中神经的横截面积(cross-sectional area,CSA)、扁平率(flatteningrate of the median nerve,MNFR)和膨胀率(swelling rate of the median nerve,MNSR),采用独立样本t检验、配对样本t检验和Spearman秩相关进行统计学分析。结果腕关节损伤患者与健康者豆骨水平正中神经的横截面积CSA差异无统计学意义(P=0.183),扁平率MNFR差异有统计学意义(P=0.004);腕关节损伤患者与健康者钩骨钩突水平层面正中神经的横截面积CSA差异有统计学意义(P=0.028),扁平率MNFR差异无统计学意义(P=0.173)。腕关节损伤患者与健康者腕管层面内正中神经膨胀率MNSR差异有统计学意义(P=0.002)。腕关节损伤患者与健康者CSA、MNFR、MNSR与年龄、身高、体重相关性无统计学意义(P>0.05)。结论MRI能较好地显示腕管正中神经形态的改变,腕管层面内正中神经膨胀率的改变是腕关节损伤的重要影像学诊断依据。

Objective The purpose of this study was to investigate the diagnostic value of the swelling rate of median nerve(MN)in wrist injuries on magnetic resonance imaging(MRI).Methods MR imaging features of 15 patients with right wrist injuries and 15 normal volunteers with no right wrist injury were analyzed retrospectively.Direct measurements of the long and short diameter of the MN on pisiform bone level and the hook of the hamate bone level were recorded and analyzed.Cross sectional area(CSA),median nerve flattening ratio(MNFR),and swelling rate of the median nerve(MNSR)were calculated and compared between the two groups.All of the data were input into a database and analyzed.Results The difference of CSA at the pisiform bone level between the two groups showed no statistical significance(P=0.183).There was a significant difference found on MNFR(P=0.004).Also,there was another significant difference found on CSA at uncinate process of hamate bone plane(P=0.028),and there was no significant difference on MNFR at this level(P=0.173).There was a significant difference on MNSR(P=0.002).Differences of CSA,MNFR and MNSR of the two groups had not been significantly correlated with age,height and weight(P>0.05).Conclusion Magnetic resonance imaging can clearly show the changes of the median nerve of carpal tunnel in patients with wrist injury.The changes of swelling rate of median nerve in carpal tunnel can become an important feature in the diagnosis of wrist injury.