MR质子加权成像对翼状韧带损伤程度评价的临床价值  

Evaluation of alar ligament injury with MR proton-weighted imaging

作　　者：陈建强[1] 战跃福[2] 韩贵宾[3] 韩向君[2] 郭子义[2] 王维[1] 

机构地区：[1]中南大学湘雅医学院附属三医院放射科,长沙410013 [2]中南大学湘雅医学院附属海口医院放射科 [3]中南大学湘雅医学院附属海口医院骨科

出　　处：《中华放射学杂志》2015年第5期376-379,共4页Chinese Journal of Radiology

基　　金：海南省卫生厅重点项目（琼卫2010重点-06）

摘　　要：目的探讨经MRI判断翼状韧带损伤程度，并以此作为制定治疗方案依据的可行性。方法（1）患者入组标准：有明确的颅颈交界区外伤史，并且受伤时间在1周以内。无颅底及颈部手术史，无MRI检查禁忌证。共计109例患者入组。（2）影像检查：采用3.0 T超导MR，在翼状韧带ROI内行高分辨率质子密度加权成像（proton density weighted image, PDWI）。根据MR影像特点将韧带损伤分3度。Ⅰ度损伤MR主要表现为韧带出现局限性条状或斑片状高信号，异常信号未及韧带边缘，Ⅱ度损伤MR表现为韧带内出现斜行或横行高信号，异常信号达韧带边缘，Ⅲ度损伤表现为韧带撕裂大于韧带横径的1/2或完全断裂。（3）治疗：Ⅰ度损伤采用保守治疗，Ⅱ、Ⅲ度损伤采取手术治疗。（4）随访：分别于治疗后3、6个月对患者的临床症状改善情况进行随访，同时行影像复查。其间患者如有不适随时就诊。保守治疗者，随访期内临床症状渐进性缓解，6个月时MR成像病灶不同程度缩小或消失，认为恢复良好，随访期内临床症状渐进性加重，认为病情进展；手术治疗效果主要通过患者临床症状、颈部运动功能恢复情况及DR寰枢关节情况判定。临床症状渐进性缓解，6个月时DR成像寰枢椎关节对位良好，认为恢复良好。结果（1）高分辨MR PDWI成像显示78患者韧带无损伤，31例翼状韧带不同程度损伤，其中Ⅰ度损伤18例、Ⅱ度损伤9例、Ⅲ度损伤4例。（2）Ⅰ度损伤患者采取保守治疗，随访均恢复良好。6例Ⅱ度损伤者进行手术治疗，随访均恢复良好；3例保守治疗者，2例临床症状渐进性加重，于保守治疗3个月时行手术治疗，术后恢复良好。4例Ⅲ度损伤患者均采用手术治疗，1例术中出现呼吸衰竭，抢救无效死亡；余3例手术顺利，术后恢复良好。结论高分辨PDWI是一种评价翼状韧带损伤程度Objective To investigate the imaging features of alar ligament and its extent, and provide the basis forclinical treatment.Methods 3.0 T superconducting MRI was used to scan the alar ligament with high resolution PDWI sequence （Proton density weighted imaging, PDWI）in 109 patients of emergency admissions due to head and neck trauma. Based on imaging features, ligamentous injury was classified into three degrees（Ⅰ to Ⅲ degrees）.Patients with Ⅰ degree ligamentous injury were treated conservatively, andⅡtoⅢdegree injury patients were treated with surgery, then follow-up was performed with MRI for the recovery of ligaments and clinical evaluation for symptoms （6 months follow-up period）. Results High-resolution PDWI showed 78 patients with no ligament injury.On follow-up, patients recovered well （atlantoaxial joint motor function and clinical symptoms）. Thirty one patients had alar ligament injury in varying degrees, of which 18 patients had grade Ⅰ injury, nine patients had degree Ⅱinjury, and four patients had degreeⅢinjury .All gradeⅠinjury patients received conservative treatment. Follow-up of patients showed good recovery, MR revealed the lesions shrank in varying degrees or disappear. 〈br〉 Six gradeⅡinjury patients had surgical treatment, and three received conservative treatment. On follow-up, seven patients had a good recovery, two patients underwent surgical treatment within 3 months after injury and recovered well.Three gradeⅢpatients treated by surgery, and all with good recovery postoperative, and a patient died of respiratory failure. Conclusions High resolution PDWI is an effective tool to evaluate the extent of the alar ligament injury. Grade Ⅰ ligamentous injury patients treated conservatively can achieve good results, GradeⅡandⅢligamentous injury patients should receive surgical treatment early.

关 键 词：颈部外伤 翼状韧带 磁共振成像 质子加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R686.5[医药卫生—诊断学]