骶管内囊肿的诊断及其发生机制的探讨

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1、中国矫形外科杂志　2002年4月第9卷第4期　OrthopJChin,Vol.9,No.4April2002·325··论　著·骶管内囊肿的诊断及其发生机制的探讨陶惠人　王全平　李新奎　李明全　刘继中　　　摘　要　目的:探讨骶管内蛛网膜囊肿的影像学特点发生机制。方法:观察24例手术证实的骶管内蛛网膜囊肿病人的X线片、CT、造影后CT、MRI等影像资料,分析其临床特点及术中的病理特点。结果:5例X线片显示骶骨侵蚀性改变,5例CT显示骶骨侵蚀性改变及骶管内囊肿,1例造影后CT囊肿内造影剂显影,22例MRI显示囊肿呈长T1及T2信号,信号强度与脑脊液一致。临床症

2、状以骶管内神经受压表现为主,囊肿与硬膜囊一般有交通孔。交通孔为瓣膜样。结论:MRI是最好的影像学诊断方法;骶管内蛛网膜囊肿的发生是由于先天的硬膜缺陷所致;瓣膜样交通孔是病程进展的结果。关键词　骶尾部;　蛛网膜;　囊肿;　医学影像学;　临床诊断学+中图分类号　R681.57文献标识码　A文章编号　1005-8478(2002)04-0325-04ImagingandClinicalFeaturesofArachnoidCystsinSacralCanal:Analysisof24Cases∥TAOHui2ren,WANGQuan2ping,LIXin2kui

3、,etal.DepartmentofOrthopedics,XijingHospital,theFourthMilitaryMedicalUniversity,Xi’an710032AbstractObjective:Tostudycharacteristicsoftheimagesandclinicalfeaturesofarachnoidcystinthesacralcanalandimproveourabilityofdiagnosis;Tostudyitsdevelopingmechanisminordertodirecttreatment.Met

4、hod:ChangesintheimagingmaterialsincludingX2ray,CT,CTfollowingmyelographyandMRIof24patientswhohadreceivedoperationshavebeenasses2sed,andtheirclinicalbehaviorsandpathologieswereanalyzed.Result:Sometimes,boneerosioncouldbeobservedinX2ray,ofteninCTandMRI.CTaftermyelographydemonstrated

5、contrastfillingofthearachnoidcystinsacralcanal.LongT1andT2signalofthecystscouldbeclearlyshowedinMRI,andthesignaldensitywasthesameasthatofcerebrospinalfluid.Clinicalsymptomswerecausedbycompressionofsacralnerve.Generally,therewerecommunicatingholesbetweencystsandthecalsacs.Thecommun

6、icatingholesarevalve2likeholes.Conclusion:MRIisbettertopredictthearachnoidcystinsacralcanal,andthecystseemstoariseasaresultofcongenitaldefectofthecaldura.Formationofvalve2likecommunicatingholeisduetothedev2elopmentofdiseaseKeywordsSacrococcygealregion;Arachnoid;Cyst;Imagingmedicin

7、e;Clinicaldiagnosis　　骶管内蛛网膜囊肿临床上少见,以往文献都是个分析患者的主诉,临床症状及体征,特别是有无4～7,9～11案报道。我们对1989年以来诊治的24例骶神经根受压症状,如会阴部疼痛,大小便障碍等。患者影像学资料进行了分析,以提高该病的诊断和鉴24例病人术前均行骶骨正侧位X线片,腰椎CT检别诊断水平。查;5例病人行骶骨CT检查;1例病人行椎管内造影1　对象和方法后CT检查;22例病人行MRI检查。观察骶骨形态1.1　对象的改变,囊肿的部位,数目,形态及大小,并与手术中自1989年,经椎管造影,CT,MRI诊断并经手术所见比较,

8、手术中切除的囊壁送病理检查,分析骶管证实的骶管内囊肿24例,男8例