CT与MRI在胸椎黄韧带骨化症的诊断价值  

Evaluation of CT and MRI in the Diagnosis of Thoracic Yellow Ligament Ossification

作　　者：李豪刚[1] 郭学军[2] 张昊[3] 刘丽娟[1] 李兴荣[1] 刘海辉[1] 曹火乃[1] 

机构地区：[1]南方医科大学附属深圳市龙华人民医院放射科(深圳市龙华新区人民医院放射科),深圳518109 [2]北京大学深圳医院放射科,深圳518036 [3]南方医科大学附属深圳市龙华人民医院脊柱外科(深圳市龙华新区人民医院脊柱外科),深圳518109

出　　处：《临床放射学杂志》2013年第7期1008-1011,共4页Journal of Clinical Radiology

摘　　要：目的探讨CT与MRI在胸椎黄韧带骨化症(TOLF)的诊断价值。方法回顾性分析自2008年1月至2012年6月15例经手术病理证实TOLF的DR、CT、MRI表现,探讨其在临床诊断、选择手术方式、疗效、术后随访方面的作用,手术后疗效评分与椎管狭窄程度关系比较,最后通过等级评分进行疗效标准评价。结果 15例TOLF影像诊断与临床手术病理诊断相符合,TOLF均发生于下胸段椎管(Th7～12),2例单节段者(Th9～10)为外侧型和结节型;13例为多节段连续性TOLF,均为弥漫型(分别为Th9～10～Th10～11～Th11～126例,Th9～10～Th10～113例,Th7～8～Th9～10～Th10～11～Th11～121例,Th10～11～Th11～123例)。Ⅰ度椎管狭窄5例,Ⅱ度狭窄9例,Ⅲ度狭窄1例。15例均采用经后路椎管减压及选择性椎弓根螺钉内固定术,术后优5例(33%),良6例(40%),可3例(20%),差1例(7%),术后随访(24～36个月)无重要并发症或后遗症。结论 CT、MRI是TOLF的主要诊断方法,它可清楚显示病灶范围、形态、椎管占位与脊髓受压变性情况,在判定手术方式、疗效、术后随访中具有重要价值。Objective To evaluate the diagnostic value of CT and MRI in thoracic yellow ligament ossification （TOLF）. Methods A retrospective analysis of 15 cases with thoracic yellow ligament ossification confirmed by patholo- gy, DR, CT, MRI findings, clinical diagnosis, choice of procedure, the efficacy of surgery follow up were discussed, the relationship between efficacy ratings and spinal stenosis after surgery was compared to evaluate the final grade ratings effica- cy standard. Results Diagnosis of 15 cases with TOLF was consistent with clinical surgery pathological resuhs, TOLF oc- curred in the lower thoracic spinal （Th7 - 12 ）, 2 cases in single segment （Th9 - 10 ） for the outside and nodular type; 13 ca- ses were multisegment continuity yellow ligament ossification, which were diffuse type （ Th9-10～Th10-11～Th11-12 in 6 ca- ses, Th9-10～Th10-11 in 3 cases, Th7-8～Th9-10～Th10-11～Th11-12 in 1 cases, Th10-11～Th11-12 in 3 cases）. I degree of spinal stenosis was seen in 5 cases, ]1 degree of stenosis was seen in 9 cases, Ill degree of stenosis was seen in 1 case. 15 cases were treated by posterior lumbar decompression and selective pedicle screw fixation, among them, excellent in 5 cases （33%） , good in 6 patients （40%） , ordinary in 3 cases （20%） , and poor in 1 case. No major complications or sequelae was found in postoperative follow up of patients （7%） （24 -36 months）. Conclusion CT and MRI are useful diagnostic methods in thoracic yellow ligament ossification, which can clearly depicted lesions range, morphology, canal compromise and spinal cord compression, degeneration of the situation, and it have important role in determining the surgical approach and follow up.

关 键 词：黄韧带骨化 胸椎 体层摄影术 X线计算机 磁共振成像 手术 

分 类 号：R687.3[医药卫生—骨科学]