CT及MRI成像对颈椎后纵韧带骨化的评估价值
Evaluation of the cervical posterior longitudinal ligament by the CT and MRI imaging
黄吉军 1王静成 1冯新民 1陶玉平 1邵增务2
作者信息
- 1. 江苏省苏北人民医院,扬州市南通西路100号 225001
- 2. 华中科技大学附属协和医院,武汉市解放大道1277号 430022
- 折叠
摘要
[目的]探讨CT及MRI显示颈椎后纵韧带骨化的价值及临床意义.基于CT平扫、二维及三维成像特点对颈椎后纵韧带骨化患者分型,以指导手术实施及评估对预后的影响;评估术前MRI T2加权图像对患者预后的价值.[方法]回顾性分析37例颈椎后纵韧带手术治疗患者,术前根据CT成像特点,将其分为蕈伞型、山丘型、块状型以及不规则型.对于蕈伞型和山丘型施行前路手术,对块状型和不规则型根据病灶特点施行前路或后路手术.对于前路手术者根据CT成像分为单影征及双影征,以判断与硬脊膜的关系.术后根据JOA评分评估各类型患者脊髓功能恢复情况;同时对每例患者按Yukihiro Matsuyama提出的MRI T2加权图像分类方法,将其分为回旋飞镖型、三角形及水滴型,根据脊髓功能改善情况分析各种类型MRI图像对手术预后评估价值.[结果]本组病例平均随访27个月,CT分型对手术方式的选择及手术实施具有指导价值,CT分型各组均取得满意疗效,无严重并发症发生,但对患者预后缺乏评估意义,术前及术后组间JOA评分无统计学差异(P＞0.05).根据MRI T2加权像术前图像分组,脊髓功能改善率依次为水滴型(65.8±14.0)％、回旋飞镖型(59.3±9.8)％和三角型(49.8±7.1)％(P＜0.05).[结论]CT成像能有效指导颈椎后纵韧带骨化患者手术方案的制定及手术的精确实施;MRI成像对评估患者手术预后具有重要指导价值.
Abstract
[ Objective] The purpose of this study is to investigate the value and clinical significance of CT and MRI in revealing ossification of cervical posterior longitudinal ligament (OPLL) . Base on CT - scan, two - dimensional and three - dimensional in visualizing and classifying OPLL, we implemented different surgical options and assessed the impacts of prognosis, on the other hand , we evaluated the value of preoperative MRI T2 weighted images in determining the prognosis. [ Methods ] We presented a retrospective review of 37 cases. The OPLL were classified in to fungating, hilly, flat and irregular type. The OPLLs with fungating and hilly type were treated by anterior decompression and fixation, with flat and irregular type it were performed anterior decompression or posterior decompression according to characteristics of the foci. The patients with anterior pro-duceror were divided into signal layer and double layer according CT examination, through which we detected dural defects. The spinal cord function recovery was accessed by JOA score postopratively. For another, on T2 -weighted MR images, the patients were clarified into boomerang, teardrop, or triangle type according to Yukihiro Matsuyama classification method. We wanted to determine whether this classification method could predict recovery from compressive myelopathy. The patients were mean followed up for 27 months. The CT classification can guide the choice of surgical approach and surgical implementation. Each group achieved satisfactory effect, and there was no significant complication. However, the CT classification lack the ability to predict the effect of surgery. There was no statistical difference between the groups neither preoperation nor postoperation ( P > 0. 05). According to preoperative MRI T2 - weighted images, the clinical recovery rates were best for those with teardrop - shaped (65. 8 ± 14. 0)% , intermediate for those with boomerang (59. 3 ± 9. 8)% and worst for those with triangle type (49. 8 ± 7.1)% (P<0. 05). [Conclusion] CT visualization of OPLL provide details about foci that facilitate to formulate surgery program can guide surgical exact implementation. The MRI classification has the value to assess the prognosis.
关键词
后纵韧带骨化/计算机体层摄影/磁共振成像Key words
ossification of the posterior longitudinal liga-ment/computed tomography/magnetic resonance images引用本文复制引用
出版年
2013
NETL
NSTL
维普
万方数据