棘突基底部与硬膜之间脂肪沉积对隐匿性腰椎峡部裂的诊断价值  

Diagnostic value of the fat deposition between the base of spinous process and dura mater for occult pars interarticularis defect

作　　者：赵娜[1] 黄智 赵兴[1] 范顺武[1] Zhao Na;Huang Zhi;Zhao Xing;Fan Shunwu(Department of Orthopaedics,Sir Run Run Shaw Hospital,Medical College of Zhejiang University,Hangzhou 310016,China;Department of Orthopaedics,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 750306,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016 [2]内蒙古医科大学附属第二医院骨科,呼和浩特750306

出　　处：《中华骨科杂志》2022年第18期1230-1235,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨腰椎MRI正中矢状面T1WI图像中棘突基底部与硬膜之间出现脂肪沉积对诊断隐匿性腰椎峡部裂的价值。方法回顾性分析2015年1月至2019年12月经MR检查在棘突基底部与硬膜之间出现脂肪沉积伴或不伴椎管内其余部位脂肪沉积的32例腰腿痛患者资料,男20例、女12例;年龄(28.5±6.2)岁(范围18~57岁)。应用螺旋CT扫描多平面重建技术判断发生峡部裂的位置、节段、数量(单侧/双侧)等。上述影像学资料的观察和测量由两位骨科医生独立完成。结果32例患者经螺旋CT扫描多平面重建后确认存在隐匿性峡部裂患者24例、单纯硬膜外脂肪增多患者8例。24例隐匿性峡部裂患者中男18例、女6例;年龄(27.3±5.3)岁(范围18~45岁);其中L4棘突基底部与硬膜之间出现脂肪沉积2例、L5棘突基底部与硬膜之间出现脂肪沉积22例,均不伴椎管内其余部位脂肪沉积;所有24例均为双侧峡部裂,腰椎正侧位X线片均未能作出诊断;患者均表现为不同程度的机械性腰痛;其中腰椎间盘突出6例,无一例出现间歇性跛行。8例单纯硬膜外脂肪增多患者中男2例、女6例;年龄(38.4±6.7)岁(范围32~55岁);L3棘突基底部与硬膜之间出现脂肪沉积4例、L4棘突基底部与硬膜之间出现脂肪沉积3例、L5棘突基底部与硬膜之间出现脂肪沉积1例,均在上位和(或)同位节段出现椎板与硬膜外间隙脂肪增多,脂肪呈半弧形向腹侧挤压硬脊膜;8例患者腰痛程度不一,无明显局部叩击痛;其中腰椎间盘突出2例,出现间歇性跛行1例。结论棘突基底部与硬膜之间的脂肪沉积征对隐匿性腰椎峡部裂的诊断有一定的特异性,有助于早期诊断峡部裂。Objective To observe the diagnostic value of the fat deposition between the base of spinous process and dura mater in the mid-sagittal T1WI image of lumbar spine MRI for occult pars interarticularis defect,and to discuss the its mechanism.Methods From January 2015 to December 2019,32 cases with low back and leg pain were confirmed by MR scanning that the fat deposition between the dura mater and the base of spinous process with or without fat deposition in the rest of the spinal canal,including 20 males and 12 females were included.The age was 28.5±6.2 years(range,18-57 years).Spiral CT scanning and multiplanar reconstruction were used to judge the integrity of the isthmus,levels of defect,and unilateral or bilateral defect.The observation of the above imaging data were independently completed by two orthopaedic doctors.Results In 32 patients with epidural fat deposition,there were 24 patients with occult isthmus and 8 patients with simple epidural lipomatosis,confirmed by spiral CT multiplanar reconstruction.In 24 cases of isthmus,there were 18 males and 6 females.The age was 27.3±5.3 years(range,18-45 years).There were 2 cases between the base of L4 spinous process and dura mater,and 22 cases between the base of L5 spinous process and dura mater,without fat deposition in the rest of the spinal canal.All 24 cases were bilateral isthmus,and the anterior and lateral X-ray could not be diagnosed.All patients complained of different degrees of mechanical low back pain.6 cases with disc herniation,and no case with intermittent claudication.In 8 patients with simple epidural lipomatosis,there were 2 males and 6 females.The age ranged from 32 to 55 years,with an average of 38.4±6.7 years.There were 4 cases between the base of L3 spinous process and dura mater,3 cases between the base of L4 spinous process and dura mater,and 1 case between the base of L5 spinous process and dura mater.All 8 patients had fat deposition between the lamina and dura mater in the upper and/or the same level,and the dura mater was compress

关 键 词：腰椎 硬膜 磁共振成像 

分 类 号：R687.3[医药卫生—骨科学]