痉挛性斜颈术前多层螺旋CT的诊断价值  

Diagnostic value of multi-slice CT in the spasmodic torticollis before operation

作　　者：李良才[1] 唐秉航[1] 陈信康[2] 何亚奇[1] 黄德成[1] 吴任国[1] 

机构地区：[1]广东省中山市人民医院CT室,528403 [2]广东省中山市人民医院神经外科

出　　处：《中华神经外科杂志》2009年第2期158-161,共4页Chinese Journal of Neurosurgery

基　　金：广东省中山市科技计划项目（2005A092）

摘　　要：目的探讨痉挛性斜颈（ST）螺旋CT（MSCT）检查方法和临床应用价值。方法ST33例，临床分型：旋转型18例（55％）、侧屈型10例（30％）及头双侧后仰型5例（15％），另设42例健康志愿者作为对照组，均行颈部CT扫描；对两组左右同名肌的肌腹厚度进行测量、比较分析，并检出肥大肌肉的分布；然后把ST组各肥大肌肉的增厚幅度结果与相对应颈肌肌电图（EMG）不随意振幅进行相关分析。结果（1）全部33例CT表现肌肥大分布与临床分型有较密切关系。旋转型肥大肌肉分布在头旋向侧的后1／4区内和对侧前1／4区内；侧屈型的肥大肌肉分布在头屈向侧的后1／4区和前1／4区内；后仰型患者的肥大肌肉分布在双侧后1／4区内。（2）CT轴面图像上可准确测量肌腹的厚度。旋转型和侧屈型病组中左、右两侧各同名肌肌腹厚度均值差异有统计学意义（t=2．482—6．540，P〈0．05）；后仰型病组中，下斜肌、头夹肌及头半棘肌与正常对照组相应同名肌肌腹厚度均值差异有统计学意义（F=4．947～15．713，P〈0．01）；采用相关分析显示CT测量肥大肌肉的增厚幅度与EMG不随意振幅增加幅度之间呈正相关（r=0．713～0．963，P〈0．01）。（3）MSCT和EMG检查结果可作为ST个体手术方案设计的基础，提高手术疗效的保证。结论MSCT能确切地显示ST痉挛后肥大肌肉形态改变，它的分布有一定规律性；可指导进一步EMG检查及协同确定痉挛责任肌肉，是ST首选无创性检查方法。Objective To explore the method and its clinical value of Multi-slice CT （MSCT） in spasmodic torticollis （ST）. Methods Thirty-three cases of spasmodic torticollis , including rotational type （18 cases, 55% ）, lateroeollis（10 cases, 30% ） , bilateral retrocollis（5 cases, 15% ）, and the other 42 cases of normal persons as controls were studied using MSCT. The thickness of each paired cervical muscles in images were measured and compared. If hypertrophied muscles were found in different types of ST, the incrassated values on CT images and amplitude with EMG examination were measured and analyzed using Pearson＇s correlation test. Results （ 1 ） CT features of all 33 eases of ST correlated with its clinical types. The hypertrophied muscles in rotational type were distributed in the 1/4 postero-lateral region of rotational side and the 1/4 antero-lateral region of opposite side. The hypertrophied muscles in laterocollis were mainly distributed in the postero-lateral and antero-lateral region of same side. And the hypertrophied musles in laterocollis were distributed in the 1/4 postero-lateral region of both sides. （2） The thickness of cervical muscles could be measured correctly on axial CT images. The means of thickness of each paired cervical muscles in rotanional type and laterocollis showed significant differences （ t = 2. 482 - 6. 540, P 〈 0. 05 ） The means of thickness of obliquus inferior, splenius eapitis and semispinalis capitis in bilateral retrocollis showed significant differences with that of the normal group（ F =4. 947 - 15. 713, P 〈0. 01 ）The increasing values of thickness of hypertrophied muscles on CT images and its amplitude with EMG examination showed positive correlation（ r = 0. 713 - 0. 963, P 〈 0. 01 ） （3） The results of MSCT and EMG examination could provide a basis of strategy for surgical treatment and improve the curative effect. Conclusions MSCT can clearly and definitely show the morphological change of cervical muscles in ST, and show the h

关 键 词：痉挛性斜颈 体层摄影术 X线计算机 肌电图 

分 类 号：R686[医药卫生—骨科学]