MRA-MRI在椎动脉型颈椎病诊断与治疗中的指导作用  

Value of MRA-MRI in the diagnosis and treatment of cervical spondylotic arteriopathy

作　　者：张小卫[1] 尹战海[1] 刘凯[1] 王金堂[1] 

机构地区：[1]西安交通大学医学院第一附属医院骨科,西安市710061

出　　处：《中国脊柱脊髓杂志》2011年第1期11-15,共5页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学青年基金(30801173);教育部回国留学生启动基金(2009[1001])

摘　　要：目的:探讨椎动脉磁共振造影(MRA)与磁共振成像(MRI)联合应用对椎动脉型颈椎病(CSA)诊断与治疗的指导意义。方法:回顾性分析2004年11月～2009年11月103例CSA患者的临床资料。患者均行MRA和MRI检测,对CSA进行诊断分型,并依据分型选择手术治疗方式或非手术治疗。根据Nagashima疗效评价标准随访临床疗效及MRA及MRI检查。结果:MRA-MRI可将CSA分为局部狭窄型、迂曲型、全程变细(闭塞)型和正常型。MRA局部狭窄型、迂曲型中MRI显示椎动脉狭窄部位存在外在压迫因素者行钩椎关节切除、横突孔切开,术后疗效优良率达86.7%;MRA-MRI判定颈椎不稳导致CSA者行椎体间融合,术后优良率达84.6%;MRA全程变细(闭塞)型和正常型采取非手术治疗,术后优良率77.0%。结论:MRA-MRI分型对CSA治疗方案选择可以提供有价值的参考。Objective：To explore the value of combining magnetic resonance angiography-magnetic resonance imaging（MRA-MRI） combination in the diagnosis and treatment of cervical spondylotic arteriopathy（CSA）.Method：Clinical data of 103 cases of CSA were retrospectively reviewed.CSA patients underwent MRA to determine the morphology and course of the vertebral artery,and MRI to determine the external and internal factors influencing the morphology of vertebral artery.The results were used to classify the pathology of CSA and the treatment protocols were determined based on this classification.Clinical outcomes were evaluated by Nagashima criteria.Results：Based on MRA results,CSA was categorized into 4 types：Ⅰ.Local narrowing,Ⅱ.Tortuous,Ⅲ.Whole range narrowing（obstruction） and Ⅳ.Normal type.Resection of luska joint,enlargement of cervical transverse foramen were performed on type I and II evidenced with external compression on MRA,and the excellent-to-good rate was 86.7%;CSA patients due to cervical spine instability underwent intervertebral fusion with the excellent-to-good rate of 84.6%;while for type III and IV,conservative treatment was indicated with the excellent-to-good rate of 77.0%.Conclusion：MRA-MRI classification is valuable on selection of treatment protocol for CSA.

关 键 词：椎动脉型颈椎病 诊断 治疗 椎动脉磁共振造影 

分 类 号：R681.5[医药卫生—骨科学] R445.2[医药卫生—外科学]