颈椎病椎间盘突出MRI椎管测量临床意义心得.docVIP

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 (*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 The observation and measurement of MRI of patients with cervical disc protrusion / extrusion. Liu yanqing, Zhang fengshan, Sun yu Abstract Objective: To reveal diagnostic criteria of epidural cervical disc extrusion (ECDE) using retrospective analysis of MRI of 99 patients who had cervical disc protrusion/extrusion and underwent anterior discectomy. Method: The patients were divided into ECDE group and non-ECDE group by the confirmation of disc protrusion or extrusion during the operation. The sagittal diameter of disc, vertebral body, spinal canal and spinal cord were measured. The occupation ratio of spinal canal(OR) and decrease of Torg ratio(DTR) were calculated and analyzed. Result: There were significant differences in OR and DTR between ECDE group and non-ECDE group. In ECDE group, OR﹥0.45, DTR﹥0.23; In non-ECDE group, OR﹤0.58, DTR﹤0.39. Conclusion: Epidural cervical disc extrusion should be considered when OR＞0.45, or DTR＞0.23. The breakage of posterior longitudinal ligament should be detected to find whether epidural disc extrusion exists. Epidural cervical disc extrusion should be diagnosed when OR＞0.58 or DTR＞0.39. The posterior longitudinal ligament must be incised and extruded disc material should be removed completely. Key words: cervical disc protrusion /extrusion, MRI Authors address: Orthopaedics department, Peking University Third Hospital, North Garden Road 49, Haidian District, 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