颈椎病椎间盘突出mri椎管测量临床意义

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1、颈椎病椎间盘突出MRI椎管测量的临床意义刘延青*第一作者：主治医师，骨科博士，01062017691－2544张凤山*孙宇*(*北京大学第三医院骨科100083)[摘要]目的：采用MRI椎管测量，探讨硬膜外型颈椎间盘突出的术前诊断方法，指导手术治疗。方法：分析99例颈椎病前路椎间盘摘除病例，根据术中所见，分为硬膜外型椎间盘突出组18例和非硬膜外型椎间盘突出组81例。测量MRI横断面椎间盘突出层面的椎间盘前后径、椎体前后径、椎管前后径、椎管最小径，算出椎管侵占率和椎管比减小值，对硬膜外型椎间盘突出和非硬膜外型椎间盘突出的两组病例行统计学分析。结果：两组数值间有统计学差异，硬膜外型椎间盘突

2、出椎管侵占率﹥0.45,椎管比减小值﹥0.23,非硬膜外型椎间盘突出椎管侵占率﹤0.58,椎管比减小值﹤0.39。结论：椎管侵占率﹥0.45,椎管比减小值﹥0.23,怀疑硬膜外型椎间盘突出，术中应充分暴露后纵韧带，检查有无裂口；椎管侵占率＞0.58,椎管比减小值＞0.39，诊断硬膜外型椎间盘突出，术中应切除后纵韧带，取出突入后纵韧带的椎间盘。关键词：颈椎椎间盘突出，磁共振成像TheobservationandmeasurementofMRIofpatientswithcervicaldiscprotrusion/extrusion.Liuyanqing,Zhangfengshan,Su

3、nyuAbstractObjective:Torevealdiagnosticcriteriaofepiduralcervicaldiscextrusion(ECDE)usingretrospectiveanalysisofMRIof99patientswhohadcervicaldiscprotrusion/extrusionandunderwentanteriordiscectomy.Method:ThepatientsweredividedintoECDEgroupandnon-ECDEgroupbytheconfirmationofdiscprotrusionorextrusi

4、onduringtheoperation.Thesagittaldiameterofdisc,vertebralbody,spinalcanalandspinalcordweremeasured.Theoccupationratioofspinalcanal(OR)anddecreaseofTorgratio(DTR)werecalculatedandanalyzedmeasuredd

5、.Result:ThereweresignificantdifferencesinORandDTRbetweenECDEgroupandnon-ECDEgroup.InECDEgroup,OR﹥0.45,DTR﹥0.23;Innon-ECDEgroup,OR﹤0.58,DTR﹤0.39.Conclusion:EpiduralcervicaldiscextrusionshouldbeconsideredwhenOR＞0.45,orDTR＞0.23.Thebreakageofposteriorlongitudinalligamentshouldbedetectedto

6、findwhetherepiduraldiscextrusionexists.EpiduralcervicaldiscextrusionshouldbediagnosedwhenOR＞0.58orDTR＞0.39.Theposteriorlongitudinalligamentmustbeincisedandextrudeddiscmaterialshouldberemovedcompletely.Keywords:cervicaldiscprotrusion/extrusion,MRIAuthorsaddress:Orthopaedicsdepartment,PekingUniver

7、sityThirdHospital,NorthGardenRoad49,HaidianDistrict,Beijing,100083,China.通过MRI对颈椎病椎间盘突出进行分型可细化诊断,指导手术治疗，预测减压范围，减压区域，是否保留后纵韧带。硬膜外型椎间盘突出（epiduralcervicaldiscextrusionECDE）指椎间盘突破后纵韧带，进入椎管内。切除后纵韧带探查椎管内是必要的，否则会残留椎间盘压迫脊髓或神经根。对颈椎MR