转移瘤脊髓压迫症运动功能损害与影像学特征的相关性  

Relationship of motor deficits and imaging features in metastatic epidural spinal cord compression

作　　者：刘蜀彬[1] 刘耀升[1] 李鼎锋[1] 范海涛[1] 槐建业[1] 郭钧[1] 王磊[1] 刘铖[1] 张平[1] 崔秋[1] 姜维浩[1] 曹云岑[1] 江宁[1] 隋佳红[1] 张斌[1] 周举[1] 

机构地区：[1]解放军第三0七医院骨科,北京100071

出　　处：《中华医学杂志》2010年第23期1606-1608,共3页National Medical Journal of China

摘　　要：目的 探讨转移瘤硬膜外脊髓压迫症（MESCC）运动功能损害与影像学特征的相关性.方法 自2006年7月至2008年12月,对连续收治的56例MESCC患者入院后按Frankel分级进行瘫痪状态评估,并进行主要病变脊椎的MRI及CT扫描.主要病变脊椎影像学评估因素包括：病变脊椎节段、侵犯硬膜外间隙、累及椎板、椎体后壁向后突出、病变脊椎连续、累及椎弓根、椎体前柱骨折、椎体后壁骨折、病变脊椎位于上胸椎和（或）颈胸交界.结果 本组56例MESCC患者瘫痪状态与侵犯椎管内硬膜外组织的影像学特征发生状况完全一致.多元回归方程表明MESCC瘫痪状态与累及椎板（X1）、椎体后壁向后突出（X2）、病变脊椎位于颈胸交界处和上胸椎（X7）等影像学特征存在线性回归关系.MESCC瘫痪状态（Y）与影像学特征（X）的最优回归方程为Y=-0.009＋0.639X1＋0.149X2＋0.282X7,其中累及椎板对MESCC瘫痪状态影响最大.结论 影像学特征中累及椎板、椎体后壁向后突出、病变脊椎位于上胸椎和（或）颈胸交界可预测MESCC的瘫痪状态,累及椎板的MESCC患者最易向硬膜外间隙侵犯.Objective To explore the relationship of motor deficits of the lower extremities with the imaging features of malignant spinal cord compression（MESCCs）.Methods From July 2006 through December 2008,56 successive MESCC patients were treated at our department.All were evaluated by magnetic resonance imaging and computed tomography and were scored according to motor deftcits Frankel grading on admission.Imaging assessment factom of main involved vertebrae were level of vertebral metastastic location,epidural space involvement,vertebral body involvement,lamina involvement,posterior protrusion of posterior wall,pedicle involvement,continuity of main involved vertebrae,fracture of anterior column,fracture of posterior wall,location in upper thoracic spine and/or cervicothoracic iunction.Results Occurrence was the same between paralytic state of MESCCs and epidural space involvement of imaging features.Multiple regression equation showed that paralytic state had a linear regression relationshiD with imaging factors of lamina involvement（X1）,posterior protrusion of posterior wall（X2）,location in upper thoracic spine and/or cervicothoracic junction（X7）of main involved vertebrae.The optimal regression equation of paralytic state（Y） and imaging feature （X） was Y=-0.009＋0.639X1＋0.149X2＋0.282X.Lamina involvement of main involved vertebrae has a greatest influence upon paralytic state of MESCC patients.Conclusions Imaging factors of lamina involvement,posterior protrusion of posterior wall,location in upper thoracic spine and/or cervicothoracic junction of main involved vertebrae can predict the paralytic state of MESCC patients.MESCC with lamina involvement is more easily encroached on epidural space.

关 键 词：肿瘤转移 硬膜外肿瘤 运动障碍 

分 类 号：R730.4[医药卫生—肿瘤]