腰椎间盘脱出髓核碎片游走方向与破裂口位置关系的MRI研究  

MRI in the study of the relation between the migrating direction of lumbar disk material fragment and the position of the opening in anulus fibrosus

作　　者：李云启 林立勋 乙胜 郑群怡 刘玉霞 

机构地区：[1]山东省寿光市中医医院MRI室,山东寿光262700

出　　处：《中国中西医结合影像学杂志》2017年第2期149-152,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的 :探讨腰椎间盘脱出髓核碎片游走方向与破裂口位置的关系。方法 :收集我院术前MRI诊断腰椎间盘脱出患者61例(63个椎间盘),均经手术证实且资料完整。2位资深MRI医师采用双盲法对61例术前MRI图像进行读片,重点观察腰椎间盘脱出髓核碎片游走方向与破裂口位置的关系。结果:61例(63个椎间盘)中18例(20个椎间盘)破裂口位于纤维环上部,髓核碎片均在前硬膜外间隙(AES)内向上游走;19例(19个椎间盘)破裂口位于纤维环下部,脱出髓核碎片均在AES内向下游走;24例(24个椎间盘)破裂口位于纤维环体部,脱出髓核碎片均向后突破纤维环和后纵韧带(PLL)进入硬膜外腔(ES)。破裂口在MRI所有序列均表现为纤维环低信号的局部缺损,T2WI脂肪抑制像显示破裂口63个,其中48个破裂口内侧缘呈斑点状或小点片略高信号区。24例PLL破裂MRI表现为PLL低信号线中断、缺损,21例破裂口处PLL呈结节状增粗,12例可见"双线征"。MRI增强扫描63个脱出髓核碎片均无强化,其边缘环以线条状强化,18个远距离游走的髓核碎片所经过的游走轨迹呈条带状强化。结论:腰椎间盘脱出髓核碎片游走方向与破裂口的位置有关,MRI增强扫描能显示髓核碎片的游走轨迹。Objective：To study the relation between the migrating direction of lumbar disk material fragment and the position of the opening in anulus fibrosus. Methods：MRI findings before operation in 61 patients with lumbar disk extrusion （63 lumbar disk） were proved by operation,and analyzed retrospectively. Two senior MRI physicians not knowing the outcome of the opera-tion observed all the MRI images,focusing on the relation between the migrating direction of lumbar disk material fragment and the position of the opening in anulus. Results：31.75% disk openings （20/63 disks）,in 18 cases,were located in the upper part of anulus fibrosus,all the disk material fragments migrate upward in the anterior epidural space （AES）;30.16% disk openings （19/63 disks）,in 19 cases,were located in the inferior part of anulus fibrosus,all the disk material fragments migrate downward in the anterior AES;38.10% disk openings （24/63 disks）,in 24 cases,were located in the caudomedial part of anulus fibrosus, all the disk material fragments passed through anulus fibrosus and posterior longitudinal ligament and got into the epidural space （ES）. Openings in all MRI sequence showed low-signal defect in anulus fibrosus;there were 63 openings showing in T2WI fat suppression images. Medial edge of 48 openings showed slightly punctate or small patchy high signal area. 24 cases of rup-tured PLL showed low signal defects in MRI,21 cases showing nodular thickening in the ruptured area,while 12 cases ＆quot;double line sign＆quot;. Enhanced MRI scanning showed none of the disk material fragments were strengthened in 63 cases,and the boarder of them showed line-like enhancement. The pathway of 18 disk material fragments migrating long distance showed strip-like en-hancment. Conclusion：The migrating direction of lumbar disk material fragment is related to the position of the opening in an-ulus fibrosus;Enhanced MRI scanning shows the migrating pathway.

关 键 词：椎间盘移位 髓核脱出 游走方向 破裂口位置 磁共振成像 

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