腰椎神经根冠状位、矢状位和轴位MR扫描定位诊断腰椎椎间孔狭窄症  

Localization diagnosis of lumbar intervertebral foramen stenosis from multi-dimensional MRI scans of lumbar nerve roots

作　　者：赵京元[1] 唐小穗[1] 孙广才[1] 张晓锦[1] 于海涛[1] 

机构地区：[1]北京航天中心医院骨科,100049

出　　处：《中华骨科杂志》2014年第8期839-844,共6页Chinese Journal of Orthopaedics

基　　金：国家人力资源部留学归国人员科研基金（201211008）;航天中心医院科研基金（201109023）

摘　　要：目的探讨腰椎神经根冠状位、矢状位和轴位MR扫描定位诊断腰椎椎间孔狭窄症的可行性和有效性。方法回顾性分析2006年6月至2011年6月共21例腰椎椎间孔狭窄患者的相关资料，男10例，女11例；年龄36-65岁，平均45．6岁。病史6～36个月，平均9．4个月。5例表现为腰痛伴单侧下肢痛，16例为单侧下肢痛。根据腰椎侧位x线片测量椎间隙和椎间孔高度并行腰椎神经根冠状位、矢状位和轴位MR扫描检查，了解神经根周围组织结构的改变，定位诊断神经根受压部位；并通过手术证实影像学诊断的准确性。结果21例患者中9例为椎间盘突出导致椎间孔狭窄，12例为椎问盘弥漫性膨出合并关节突关节增生、肥大导致椎间孔狭窄；21例均为下腰椎椎间孔横向狭窄，20例为L4.5，椎间孔狭窄，造成L4神经根受压；1例为L5S1,椎间孔狭窄，造成L5，神经根受压。经手术探查证实与术前定位诊断完全符合，符合率为100％（21／21）。术后20例患者下肢疼痛症状完全缓解，1例下肢疼痛症状缓解不满意。结论腰椎神经根冠状位、矢状位和轴位MRI扫描方法能准确定位诊断椎间孔狭窄，为确定手术方案提供了准确的影像学依据。Objective To explore the localization diagnosis method of lumbar intervertebral foramen stenosis by multi-di-mensional MRI scans of lumbar nerve roots. Methods Twenty-one patients with lumbar intervertebral foramen stenosis were fol-lowed up from June 2006 to June 2011 postoperatively, 10 cases of male, 11 cases of female ; 36 to 65 years old, average 45.6 years. The medical history is six to thirty six months, an average of 9.4 years; 5 cases have low back pain with unilateral leg pain and 16 cases showed unilateral leg pain only. The height of intervertebral space and foramen intervertebrale were measured on the X-rays of lumbar lateral position. Lumbar nerve roots MR imaging at the position of axial, coronal and sagittal scan were performed separately to the patients who were clinically suspected to suffer from lumbar intervertebral foramen stenosis. A definitive diagno-sis of the location of nerve root compression and structural changes surrounding the nerve root can be obtained. Surgical operation was performed to confirm the accuracy of the MRI imaging diagnosis. Results There were 9 cases of lumbar intervertebral fora- men stenosis caused by lumbar disc herniation. The other 12 cases are caused by zygapophyseal joint hyperplasia. All cases of lumbar intervertebral foramen stenosis located at the low back. By comparing MR images of lumbar intervertebral foramen stenosis with surgical procedure, the surgical observation of 21 patients completely coincided with the preoperative localization diagnosis, coincidence rate was 100% （21/21）. After surgical treatment, 20 cases achieved a complete remission of leg pain and 1 case was not satisfactory. Conclusion MRI imaging at the position of axial, coronal and sagittal scan for lumbar nerve roots were useful to rigorous localization diagnosis of lumbar intervertebral foramen stenosis, and can provide accurate radiological evidence for sur-gery orogram.

关 键 词：腰椎 脊神经根 磁共振成像 椎间孔切开术 

分 类 号：R681.5[医药卫生—骨科学]