动态MRI对臂丛根性损伤和颈髓损伤的鉴别诊断意义  

Significance of dynamic MRI in the differential diagnosis between brachial plexus root injuries and cervical spinal cord injuries

作　　者：滕红林[1] 王健[1] 王美豪[2] 王汛[3] 黎金林[2] 林利兴[4] 叶澄宇[1] 

机构地区：[1]温州医学院附属第一医院骨科,325000 [2]温州医学院附属第一医院MRI室,325000 [3]温州医学院附属第一医院肌电图室,325000 [4]温州医学院附属第三医院骨科

出　　处：《中华创伤杂志》2007年第9期695-698,共4页Chinese Journal of Trauma

摘　　要：目的探讨动态MRI诊断臂丛神经根性损伤的影像学表现及其诊断价值，以及在与颈髓损伤的鉴别诊断中的临床意义。方法对8例臂丛神经根性损伤患者行动态MRI检查，结合CT薄层扫描和肌电图随访；所有8例患者均手术证实为臂丛根性损伤。结果本组患者在伤后早期1～2d内均无位于椎间孔及椎间孔外的创伤性脊膜囊肿、神经根断裂等支持臂丛根性损伤的MRI异常表现；4例患者有颈椎骨折或颈髓损伤的MRI表现。伤后7～15d（平均10d）后，再次行颈椎MRI检查，出现典型的MRI臂丛根性损伤表现：椎间孔及椎孔外臂丛神经走行处T2WI高信号的创伤性脊膜囊肿、脊髓移位和神经根缺失及走行异常等。结论动态MRI检查对臂丛根性神经损伤具有损伤节段定位准确、椎管外部分同样能够显示、无创、操作简单、准确性高等特点；其短期内特征性的动态变化易于诊断臂丛根性损伤，同时又能与颈髓损伤相鉴别。Objective To study the diagnostic value and image manifestations of dynamic MRI in examination of brachial plexus root injuries and the differential value from cervical spinal cord injuries. Methods Eight cases with brachial plexus root injuries underwent dynamic MRI examination in combination with CT scanning and EMG follow-up. All cases were confirmed having brachial plexus root injuries by intraoperative exploration. Results No signs of brachial plexus root injuries such as traumatic spinal meningocele in or outside of the intervertebral foramen and nerve root lesion were found in the first MRI scanning within one or two days after injuries. MRI manifestations of cervical vertebrae fractures or spinal cord injuries were present in 4 cases. At 7-15 days （ average 10 days） after injury, in the second MRI scanning were found typical evidence of brachial plexus root avulsion, including traumatic spinal meningocele of high-intensity signal on T2WI of the brachial plexus in the intervertebral foramen and external intervetebral foramen, displacement of the spinal cord, absence and abnormal conduction of the nerve roots, etc. Conclusions This study suggests that dynamic MRI examination is characterized by accurate location of the injured brachial plexus root nerve segments, clear image of brachial plexus injuries outside of the foramen, noninvasion, easy operation and high accuracy. Its instant specific dynamic changes ease the diagnosis of brachial plexus avulsion injuries and differential diagnosis from cervical cord injuries .

关 键 词：臂丛 脊髓损伤 磁共振成像 

分 类 号：R686[医药卫生—骨科学]