MRI在腕管综合征临床治疗中的应用价值
摘要
目的：研究MRI在腕管综合征临床诊断与治疗中的应用价值.
方法：对山西医科大学第二临床医学院2005年1月-2009年12月五年期间具有完整资料且术前行腕管MRI检查(以横断面为主)的13例腕管综合征患者进行研究与分析。其中男性3例,女性10例,年龄33-63岁,平均41.6岁,单侧病变10例,双侧病变3例,病程1月-5年。手术方式均采用开放式腕横韧带切开术,比较术前MRI检查与术中所见的异同。
结果：13例腕管综合征患者的MRI表现均为①正中神经在进入腕管时增粗、肿胀,在T,WI、T2WI均可观察到,正中神经肿胀率(MNSR)为1.34-3.23,平均为2.61。②正中神经在腕管内变扁,正中神经扁平率(MNFR)为2.76-5.11,平均为3.91。③正中神经在T2W1有不同程度的高信号改变。
结论：MRI对腕管内容物有较高的分辩力,能清楚显示腕管内的解剖结构。能提供极好的软组织对比,对信号改变非常敏感,能发现轻度正中神经压迫,在发现腕管综合征病因的同时可观察周围骨性结构的情况,对于腕部因素所致的腕管综合征,MRI有明确诊断的意义。
Objective:To evaluate the diagnosis and clinical value of MRI in carpal tunnel syndrome
Methods:13 cases of carpal tunnel syndrome with MRI were analyzed, and the images were mainly aquired in transaxial planes at The Second Clinical Medical College of Shanxi Medical University, from January 2005 to December 2009.3 patients were male and 10 female,aged 22-60 years, average 41.6 years.10 cases with unilateral lesions,3 cases with bilateral lesions, duration 1 month-5 years. The operation was amputation of transverse carpal ligament.Then the difference of MRI with findings of surgery be compared.
Results:MRI findings of carpal tunnel syndrome included:①the median nerve become thickening and swelling that can be observed in T1WI, T2WI when entering in the carpal tunnel, the median nerve swelling ratio (MNSR) was 1.34-3.23, average 2.61.②when the median nerve in the carpal tunnel become flat, median nerve flattening ratio (MNFR) was 2.76-5.11, average 3.91.③different levels of high signal changes with median nerve in T2W1 can be observed.
Conclusion:MRI can distinguish the contents of carpal tunnel very well, clearly show the anatomy of the carpal tunnel. MRI provides excellent soft tissue contrast and which is very sensitive to the signal change.The mild median nerve compression also can be found in MRI.
The circumstances surrounding bone structure
can be observed while finding the cause of carpal tunnel syndrome. MRI has a clear diagnosis for carpal tunnel syndrome caused by the wrist factors.
方法：对山西医科大学第二临床医学院2005年1月-2009年12月五年期间具有完整资料且术前行腕管MRI检查(以横断面为主)的13例腕管综合征患者进行研究与分析。其中男性3例,女性10例,年龄33-63岁,平均41.6岁,单侧病变10例,双侧病变3例,病程1月-5年。手术方式均采用开放式腕横韧带切开术,比较术前MRI检查与术中所见的异同。
结果：13例腕管综合征患者的MRI表现均为①正中神经在进入腕管时增粗、肿胀,在T,WI、T2WI均可观察到,正中神经肿胀率(MNSR)为1.34-3.23,平均为2.61。②正中神经在腕管内变扁,正中神经扁平率(MNFR)为2.76-5.11,平均为3.91。③正中神经在T2W1有不同程度的高信号改变。
结论：MRI对腕管内容物有较高的分辩力,能清楚显示腕管内的解剖结构。能提供极好的软组织对比,对信号改变非常敏感,能发现轻度正中神经压迫,在发现腕管综合征病因的同时可观察周围骨性结构的情况,对于腕部因素所致的腕管综合征,MRI有明确诊断的意义。
Objective:To evaluate the diagnosis and clinical value of MRI in carpal tunnel syndrome
Methods:13 cases of carpal tunnel syndrome with MRI were analyzed, and the images were mainly aquired in transaxial planes at The Second Clinical Medical College of Shanxi Medical University, from January 2005 to December 2009.3 patients were male and 10 female,aged 22-60 years, average 41.6 years.10 cases with unilateral lesions,3 cases with bilateral lesions, duration 1 month-5 years. The operation was amputation of transverse carpal ligament.Then the difference of MRI with findings of surgery be compared.
Results:MRI findings of carpal tunnel syndrome included:①the median nerve become thickening and swelling that can be observed in T1WI, T2WI when entering in the carpal tunnel, the median nerve swelling ratio (MNSR) was 1.34-3.23, average 2.61.②when the median nerve in the carpal tunnel become flat, median nerve flattening ratio (MNFR) was 2.76-5.11, average 3.91.③different levels of high signal changes with median nerve in T2W1 can be observed.
Conclusion:MRI can distinguish the contents of carpal tunnel very well, clearly show the anatomy of the carpal tunnel. MRI provides excellent soft tissue contrast and which is very sensitive to the signal change.The mild median nerve compression also can be found in MRI.
The circumstances surrounding bone structure
can be observed while finding the cause of carpal tunnel syndrome. MRI has a clear diagnosis for carpal tunnel syndrome caused by the wrist factors.
引文
[1]Mesgarzadeh M,Schneck CD,Bonakdarpour A.Carpal tunnel:MR imaging part Ⅰ. normal anatomy.Radiology,1989,171 (3):743-748
[2]Mesgarzadeh M,Schneck CD,Bonakdarpour A.Carpal tunnel:MR imaging part Ⅱ. normal anatomy.Radiology,1989,171 (3):749-754
[3]Dalinka MK.MR imaging of the wrist.AJR 1995;164:1-9
[4]Brahme SK, Gundry CR, Resnick D. Advanced imaging of the wrist. Radiol Clin North Amercia,1990,28(2):307-320.
[5]Healy C,Watson JD, Longstaff A, et al. Magnetic resonance imaging of the carpal tunnel.J Hand surg,1990,15(2):243-248
[6]Feinstein PA. Endoscopic carpal tunnel release in a comnunity-based series. J.Hand Surg,1993,18(3):451-454
[7]雷英,金先跃,韦敏克,等.非手术治疗腕管综合征及功能评定 J.中国临床康杂志,2004,8(2)：355.
[8]田光磊,张胜友.腕管切开松解减压J.中华创伤骨科杂志,2004,6(9)： 1042-1047
[9].Yoshioke SK, Okuda Y, Taai K, et al. Changes in carpal tunnel shapeduring wrist joint motion MRIevalution of normal volunteers. J.Hand Surg,1993,18(5):620-623.
[10].Richmam JA,Calif SD, Gelberman RH,et al. carpal tunnel syndrome:Morphologic changes after releaseof the transverse carpal ligament, J. hand surg,1989,14(5):853-857
1.Mortimer PS. American Cancer Society Lymphedema Workshop:the pathophysiology of lymphedema. [J] Cancer,1998;83(12):2798-2802.
2.Mortimer PS. Managing lymphedema. [J] Clin Dermatol,1995;13,pp:499-505.
3. Foldi M, Foldi E, Kubik S. Textbook of lymphology. [J] European Journal of Plastic Surgery, 2004;27,pp:267
4. Ely JW, Osheroff JA, Chambliss ML. Approach toleg edema of unclear etiology. [J] Am Board Fam Med,2006;19:148-160.
5.Tiwari A, Cheng K, Button M. Differentialdiagnosis, investigation, and current treatment of lower limblymphedema. [J] Arch Surg,2003;138(2):152-61.
6. Durr HR, Pellengahr C, Nerlich A. Stewart-Treves syndrome as a rare complication of a hereditary lymphedema. [J] Vasa,2004;33(1):42-45.
7. Nakazono T, Kudo S, Matsuo Y. Angiosarcoma associated with chronic lymphedema (Stewart-Treves syndrome) of the leg:MR imaging. [J] Skeletal Radiol,2000;29(7):413-416.
8. Danz B, Hellmann A, Helmbold P. Radiotherapy in multilocalized lymphedema-associated angiosarcoma. [J]Eur Dermatol,2005;15(6):474-477.
9. Weissleder, H, Schuchhardt, C. Lymphedema diagnosis and therapy.2nd ed. Bonn, Germany: Kagerer Kommunikation; 1997.
10. Ko DS, Lerner R, Klose G. Effective treatment of lymphedema of the extremities. [J] Arch Surg,1998;133(4):452-458
11. Foldi M. Treatment of lymphedema. [J] Lymphology,1994;27(4):1-5
12. Hinrichs CS, Gibbs JF, Driscoll D, etal. The effectiveness of complete decongestive physiotherapy for the treatment of lymphedema following groin dissection for melanoma. [J] Surg Oncol,2004;85(4):187-192
13. Vignes SPorcher R, Champagne A, et al. Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment:a cohort study. [J] Breast Cancer Research and Treatment,2006;98(1):1-6
14. Ritsu Yamamoto,Terumi Yamamoto.Effectiveness of the treatment-phase of two-phase complex decongestive physiotherapy for the treatment of extremity lymphedema. [J] Int J Clin Oncol,2007; 12(6):463-468
15.张涤生,慢性肢体淋巴水肿烘绑疗法1045例报告.[J]中华外科杂志,1985；23：13-16.
16.李圣利,张涤生,干季良.微波对慢性肢体淋巴水肿组织巨噬细胞胞嘧啶单核苷酸酶的影响.[J]中华理疗杂志,2000：23(3)：166-167
17.祁光裕,刘浩,刘珊珊,et al.正负气压按摩治疗肢体淋巴水肿.[J]中华物理医学与康复,2004：26(8)：486-487
18.吕晓霞,尹至,金星,et al.自体骨髓干细胞移植治疗肢体淋巴水肿27例.[J]中国组织工程研究与临床康复,2008：12(34)：6653-6656
19. Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. [J] Scand J Plast Reconstr Surg Hand Surg,1997; 31 (2):137-143
20. Brorson H, Svensson H, Norrgren K, et al. Liposuction reduces arm lymphedema without significantly altering the already impaired lymph transport. [J] Lymphology, 1998:31(4):156-172
21. Brorson H, Svensson H. Skin blood flow of the lymphedematous arm before and after liposuction. [J] Lymphology,1997;30(4):165-172
22. Brorson H, Olin K, Olsson G, et al. Long term cosmetic and functional results following liposuction for arm lymphedema:An eleven year study. [J] Lymphology, 2007;40 (4):253-255
23. Brorson H. Liposuction gives complete reduction of chronic large arm lymphedema after breast cancer. [J] Acta Oncologica,2000; 39 (3):407-420
24. Brorson H. Liposuction in Arm Lymphedema Treatment, [J] Scand J Surg, 2003:92(4):287-295
25.亓发芝,杨燕文,顾建英,et al.负压抽吸法治疗肢体淋巴水肿的远期疗效分析.[J]中国临床医学杂志,2008：15(1)：89-91
26. Charles H. Elephantiasis of the leg. In:Latham A, English T, ds. A System of Treatment. London:Churchill; 1912
27. Gloviczki P. Principles of surgical treatment of chronic lymphoedema. [J] Int Angiol,1999:18(1):42-16
28. Denese C. Experimental anastomoses of Lymphatics. [J] Arch Surg,1962;84:6-9
29. O'Brien BM, Sykes PJ, Threlfall GN, et al. Microlymphaticovenous anastomoses for obstructive lymphedema. [J] Plast Reconstr Surg,1977:60(2):197-211
30. Kinjo 0, Kusaba A. Lymphatic vessel-to-isolated-vein anastomosis for secondary lymphedema in a canine model. [J] Surgery Today,1995:25(7):633-639
31. Yamamoto Y, Sugihara T. Microsurgical lymphaticovenous implantaton for the treatment of chronic lymphedema. [J] Plast Reconstr Surg,1998;101(1):157-159
32. Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. [J] World J Surg,2004;28(6):609-613
33. Matsubara S, Sakuda H, Nakaema M, et al. Long-Term Results of Microscopic Lymphatic Vessel-Isolated Vein Anastomosis for Secondary Lymphedema of the Lower Extremities. [J] Surg Today,2006;36(10):859-864
34. Damstra RJ, Voesten HG, van Schelven WD, et al. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. [J] Breast Cancer Res Treat,2009;113(2):199-206
35.孙沣,张涤生,曹卫刚,et al.静脉-淋巴管-脂肪筋膜瓣移植治疗阻塞性淋巴水肿的实验研究.[J]中华显微外科杂志,2003：26(3)：201-203
36.孙沣,张涤生,曹卫刚,et al静脉-淋巴管-脂肪筋膜瓣移植治疗阻塞性淋巴水肿的实验研究.[J]中华显微外科杂志,2003：26(3)：201-203
37.施越冬,张学军,徐剑炜,et al.静脉淋巴管复合组织瓣移植在治疗下肢继发性淋巴水肿中的作用.[J]中国临床医学杂志,2005；12(5)：831-834
38. Baumeister RG, Siuda S.Treatment of lymphedema by microsurgical lymphatic grafts:what is proved? [J] Plast Reconstr Surg,1990;85(1):64-74
39. Weiss M, Baumeister RG, Hahn K. Post-therapeutic Lymphedema:Scintigraphy Before and After Autologous Lymph Vessel Transplantation 8 Years of Long-Term Follow-up, [J] Clin Nucl Med,2002;27(11):788-792
40.曹卫刚,黄文义,傅凯丁,et al.吻合浅深淋巴管治疗下肢淋巴水肿.[J]中国修复重建外科杂志,1994,8(3)：137-138
41. Chen HC, O'Brien BM, Rogers IW, et al. Lymph node transfer for the treatment of obstructive lymphoedema in the canine mode. Br J Plast Surg,1990;43 (5):578-586
42. Fu K, Izquierdo R, Vandevender D, et al. Transplanta tion of lymph node fragments in a rabbit ear lymphedema model:a new method for restoring the lymphatic pathway. J Plast Reconstr Surg,1998;101(1):134-141
43.蔡仁祥李圣利.淋巴结复合皮瓣治疗实验性肢体淋巴水肿的研究.中华整形外科杂志,2000：16(2)：94-95
44. Becker C, Assouad J, Riquet M, et al. Postmastectomy lymphedema:long-term results following microsurgical lymph node transplantation. [J] Ann Surg, 2006;243(3):313-315
45. Lin CH, Ali R, Chen SC, et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. [J] Plast Reconstr Surg,2009;123(4):1265-1275
46. Benoit L, Boichot C, Cheynel N, et al. Preventing lymphedema and morbidity with an omentum flap after ilioinguinal lymph node dissection. [J] Ann Surg Oncol, 2005:12(10):793-799
47. Nakajima E, Nakajima R, Tsukamoto S, et al. Omental transposition for lymphedema after a breast cancer resection:report of a case. [J] Surg Today,2006;36(2):175-179
[2]Mesgarzadeh M,Schneck CD,Bonakdarpour A.Carpal tunnel:MR imaging part Ⅱ. normal anatomy.Radiology,1989,171 (3):749-754
[3]Dalinka MK.MR imaging of the wrist.AJR 1995;164:1-9
[4]Brahme SK, Gundry CR, Resnick D. Advanced imaging of the wrist. Radiol Clin North Amercia,1990,28(2):307-320.
[5]Healy C,Watson JD, Longstaff A, et al. Magnetic resonance imaging of the carpal tunnel.J Hand surg,1990,15(2):243-248
[6]Feinstein PA. Endoscopic carpal tunnel release in a comnunity-based series. J.Hand Surg,1993,18(3):451-454
[7]雷英,金先跃,韦敏克,等.非手术治疗腕管综合征及功能评定 J.中国临床康杂志,2004,8(2)：355.
[8]田光磊,张胜友.腕管切开松解减压J.中华创伤骨科杂志,2004,6(9)： 1042-1047
[9].Yoshioke SK, Okuda Y, Taai K, et al. Changes in carpal tunnel shapeduring wrist joint motion MRIevalution of normal volunteers. J.Hand Surg,1993,18(5):620-623.
[10].Richmam JA,Calif SD, Gelberman RH,et al. carpal tunnel syndrome:Morphologic changes after releaseof the transverse carpal ligament, J. hand surg,1989,14(5):853-857
1.Mortimer PS. American Cancer Society Lymphedema Workshop:the pathophysiology of lymphedema. [J] Cancer,1998;83(12):2798-2802.
2.Mortimer PS. Managing lymphedema. [J] Clin Dermatol,1995;13,pp:499-505.
3. Foldi M, Foldi E, Kubik S. Textbook of lymphology. [J] European Journal of Plastic Surgery, 2004;27,pp:267
4. Ely JW, Osheroff JA, Chambliss ML. Approach toleg edema of unclear etiology. [J] Am Board Fam Med,2006;19:148-160.
5.Tiwari A, Cheng K, Button M. Differentialdiagnosis, investigation, and current treatment of lower limblymphedema. [J] Arch Surg,2003;138(2):152-61.
6. Durr HR, Pellengahr C, Nerlich A. Stewart-Treves syndrome as a rare complication of a hereditary lymphedema. [J] Vasa,2004;33(1):42-45.
7. Nakazono T, Kudo S, Matsuo Y. Angiosarcoma associated with chronic lymphedema (Stewart-Treves syndrome) of the leg:MR imaging. [J] Skeletal Radiol,2000;29(7):413-416.
8. Danz B, Hellmann A, Helmbold P. Radiotherapy in multilocalized lymphedema-associated angiosarcoma. [J]Eur Dermatol,2005;15(6):474-477.
9. Weissleder, H, Schuchhardt, C. Lymphedema diagnosis and therapy.2nd ed. Bonn, Germany: Kagerer Kommunikation; 1997.
10. Ko DS, Lerner R, Klose G. Effective treatment of lymphedema of the extremities. [J] Arch Surg,1998;133(4):452-458
11. Foldi M. Treatment of lymphedema. [J] Lymphology,1994;27(4):1-5
12. Hinrichs CS, Gibbs JF, Driscoll D, etal. The effectiveness of complete decongestive physiotherapy for the treatment of lymphedema following groin dissection for melanoma. [J] Surg Oncol,2004;85(4):187-192
13. Vignes SPorcher R, Champagne A, et al. Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment:a cohort study. [J] Breast Cancer Research and Treatment,2006;98(1):1-6
14. Ritsu Yamamoto,Terumi Yamamoto.Effectiveness of the treatment-phase of two-phase complex decongestive physiotherapy for the treatment of extremity lymphedema. [J] Int J Clin Oncol,2007; 12(6):463-468
15.张涤生,慢性肢体淋巴水肿烘绑疗法1045例报告.[J]中华外科杂志,1985；23：13-16.
16.李圣利,张涤生,干季良.微波对慢性肢体淋巴水肿组织巨噬细胞胞嘧啶单核苷酸酶的影响.[J]中华理疗杂志,2000：23(3)：166-167
17.祁光裕,刘浩,刘珊珊,et al.正负气压按摩治疗肢体淋巴水肿.[J]中华物理医学与康复,2004：26(8)：486-487
18.吕晓霞,尹至,金星,et al.自体骨髓干细胞移植治疗肢体淋巴水肿27例.[J]中国组织工程研究与临床康复,2008：12(34)：6653-6656
19. Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. [J] Scand J Plast Reconstr Surg Hand Surg,1997; 31 (2):137-143
20. Brorson H, Svensson H, Norrgren K, et al. Liposuction reduces arm lymphedema without significantly altering the already impaired lymph transport. [J] Lymphology, 1998:31(4):156-172
21. Brorson H, Svensson H. Skin blood flow of the lymphedematous arm before and after liposuction. [J] Lymphology,1997;30(4):165-172
22. Brorson H, Olin K, Olsson G, et al. Long term cosmetic and functional results following liposuction for arm lymphedema:An eleven year study. [J] Lymphology, 2007;40 (4):253-255
23. Brorson H. Liposuction gives complete reduction of chronic large arm lymphedema after breast cancer. [J] Acta Oncologica,2000; 39 (3):407-420
24. Brorson H. Liposuction in Arm Lymphedema Treatment, [J] Scand J Surg, 2003:92(4):287-295
25.亓发芝,杨燕文,顾建英,et al.负压抽吸法治疗肢体淋巴水肿的远期疗效分析.[J]中国临床医学杂志,2008：15(1)：89-91
26. Charles H. Elephantiasis of the leg. In:Latham A, English T, ds. A System of Treatment. London:Churchill; 1912
27. Gloviczki P. Principles of surgical treatment of chronic lymphoedema. [J] Int Angiol,1999:18(1):42-16
28. Denese C. Experimental anastomoses of Lymphatics. [J] Arch Surg,1962;84:6-9
29. O'Brien BM, Sykes PJ, Threlfall GN, et al. Microlymphaticovenous anastomoses for obstructive lymphedema. [J] Plast Reconstr Surg,1977:60(2):197-211
30. Kinjo 0, Kusaba A. Lymphatic vessel-to-isolated-vein anastomosis for secondary lymphedema in a canine model. [J] Surgery Today,1995:25(7):633-639
31. Yamamoto Y, Sugihara T. Microsurgical lymphaticovenous implantaton for the treatment of chronic lymphedema. [J] Plast Reconstr Surg,1998;101(1):157-159
32. Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. [J] World J Surg,2004;28(6):609-613
33. Matsubara S, Sakuda H, Nakaema M, et al. Long-Term Results of Microscopic Lymphatic Vessel-Isolated Vein Anastomosis for Secondary Lymphedema of the Lower Extremities. [J] Surg Today,2006;36(10):859-864
34. Damstra RJ, Voesten HG, van Schelven WD, et al. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. [J] Breast Cancer Res Treat,2009;113(2):199-206
35.孙沣,张涤生,曹卫刚,et al.静脉-淋巴管-脂肪筋膜瓣移植治疗阻塞性淋巴水肿的实验研究.[J]中华显微外科杂志,2003：26(3)：201-203
36.孙沣,张涤生,曹卫刚,et al静脉-淋巴管-脂肪筋膜瓣移植治疗阻塞性淋巴水肿的实验研究.[J]中华显微外科杂志,2003：26(3)：201-203
37.施越冬,张学军,徐剑炜,et al.静脉淋巴管复合组织瓣移植在治疗下肢继发性淋巴水肿中的作用.[J]中国临床医学杂志,2005；12(5)：831-834
38. Baumeister RG, Siuda S.Treatment of lymphedema by microsurgical lymphatic grafts:what is proved? [J] Plast Reconstr Surg,1990;85(1):64-74
39. Weiss M, Baumeister RG, Hahn K. Post-therapeutic Lymphedema:Scintigraphy Before and After Autologous Lymph Vessel Transplantation 8 Years of Long-Term Follow-up, [J] Clin Nucl Med,2002;27(11):788-792
40.曹卫刚,黄文义,傅凯丁,et al.吻合浅深淋巴管治疗下肢淋巴水肿.[J]中国修复重建外科杂志,1994,8(3)：137-138
41. Chen HC, O'Brien BM, Rogers IW, et al. Lymph node transfer for the treatment of obstructive lymphoedema in the canine mode. Br J Plast Surg,1990;43 (5):578-586
42. Fu K, Izquierdo R, Vandevender D, et al. Transplanta tion of lymph node fragments in a rabbit ear lymphedema model:a new method for restoring the lymphatic pathway. J Plast Reconstr Surg,1998;101(1):134-141
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