CT神经重建技术在判断坐骨神经变异中的应用价值  

Application value of CT nerve reconstruction technique in judging the variation of sciatic nerve

作　　者：吕喆[1] 常天静 杨帆[1] 于明川[1] 那曼丽 张滨[1] Lyu Zhe;Chang Tianjing;Yang Fan;Yu Mingchuan;Na Manli;Zhang Bin(Department of Radiology,Peking University Shougang Hosptial,Beijing 100041,China)

机构地区：[1]北京大学首钢医院医学影像科,100041

出　　处：《骨科临床与研究杂志》2020年第5期264-267,共4页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨CT周围神经重建技术在显示坐骨神经穿梨状肌变异中的应用价值及其临床意义。方法顺序选取2018年12月至2019年5月间无明确坐骨神经痛的、并在北京大学首钢医院医学影像科行盆腔CT检查的住院患者50例;男17例,女33例;平均年龄61.8(36~82)岁。对扫描所得的原始CT图像,分别进行常规盆腔重建和双侧坐骨神经重建,按照潘铭紫对国人坐骨神经与梨状肌的关系分型,判断有无坐骨神经穿梨状肌变异,并比较两种重建方法有无差异。结果本组50例患者共计左右两侧梨状肌及坐骨神经100侧,均可完成常规重建及神经重建。常规图像通过梨状肌形态(肌肉间是否出现低密度条片影)判断有无坐骨神经变异,共发现坐骨神经变异27例(27%),其中能确定为Ⅱ型变异的10侧;神经重建图像通过显示坐骨神经形态(坐骨神经是否出现分离)判断,共发现坐骨神经变异32侧(32%),其中能确定为Ⅱ型变异的28侧,能确定为Ⅵ型变异的1侧。常规组与重建组显示异常变异数差异无统计学意义(χ^2=0.601,P=0.438),但是在判断变异类型数方面,重建组明显高于常规组(χ^2=18.767,P<0.001)。结论虽然CT周围神经重建技术和常规重建技术均可发现坐骨神经变异,但CT周围神经重建图像更易判断变异类型,并且在同一层面直接显示坐骨神经自身形态,可以直观、准确地反映坐骨神经有无变异及神经与周围组织关系,为进一步研究坐骨神经痛提供一种新的影像学方法。Objective To explore the application value and clinical significance of peripheral nerve reconstruction with CT in displaying the variation of sciatic nerve penetrating piriformis muscle.Methods A total of 50 inpatients(17 males and 33 females)were selected in sequence,with an average age of 61.8(36-82)years with no definite sciatica and underwent pelvic CT examination in the Department of Medical Imaging,Peking University Shougang Hospital from December 2018 to May 2019.According to Pan Mingzi's classification of the relationship between sciatic nerve and piriformis muscle of Chinese people,whether there is the variation of sciatic nerve penetrating piriformis muscle was judged,and the difference between the two reconstruction methods was compared.Results A total of 100 piriformis muscles and sciatic nerves on both sides were performed in 50 patients.Twenty-seven sides(27%)of sciatic nerve variation were found,including 10 sides of typeⅡvariation;32 sides(32 sides)of sciatic nerve variation were found by displaying the morphology of sciatic nerve(whether the sciatic nerve separated)in nerve reconstruction image.Among them,28 sides could be identified as typeⅡvariation and one side could be identified as typeⅥvariation.There was no significant difference in the number of abnormal variation between the conventional group and the reconstruction group(χ^2=0.601,P=0.438),but the number of abnormal variants in the reconstruction group was significantly higher than that in the conventional group(χ^2=18.767,P<0.001).Conclusion Although both CT peripheral nerve reconstruction technology and conventional reconstruction technology can detect sciatic nerve variation CT peripheral nerve reconstruction image is easier to judge the type of variation,and directly display the shape of sciatic nerve itself at the same level,which can directly and accurately reflect the variation of sciatic nerve and the relationship between nerve and surrounding tissue.It provides a new method for further study of sciatica.

关 键 词：周围神经 坐骨神经 体层摄影术 神经成像 

分 类 号：R65[医药卫生—外科学]