磁共振成像在损伤后腰椎间盘突出法医学鉴定中的应用价值研究

发布时间：2018-05-27 04:23

本文选题：腰椎间盘突出 + 腰椎损伤　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:分析损伤后腰椎间盘突出症的MRI征象,量化分析损伤后腰椎间盘突出症的MRI数据,鉴别新鲜与陈旧性椎间盘突出。同时与CT、X线等影像学传统检查方法相对比,探讨MR在法医鉴定中的应用价值,为损伤后腰椎间盘突出症的法医学鉴定中提供客观指标和新方法。材料与方法:收集2012-02~2017-02因腰椎外伤在本院行磁共振检查的患者共120例,回顾性分析其常规MRI检查的影像学表现,并比较其与CT、X线检查的优势。常规MR扫描包括轴位及矢状位TIWI、T2WI和T2脂肪抑制序列,观察损伤后腰椎间盘突出症的MRI征象,包括椎间盘突出的部位、椎间盘突出的方向、MRI各序列信号强度特征、脊髓是否出现压迫症状等,测量腰椎MR椎间盘超过正中矢状线的距离及椎管狭窄程度,根据椎间盘突出的表现对所得数据进行分型、统计。结果:(1)本组120例损伤后腰椎间盘突出症最多发生于腰4/腰5层面及腰5/骶1层面;以中央型数量最多,其次为旁中央型。(2)本组120例损伤后腰椎间盘突出症在MRI上以混杂T1WI、混杂T2WI及混杂T2压脂像信号为主,其次为T1WI、T2WI及T2压脂像等信号。(3)本组120例损伤后腰椎间盘突出症有93例脊髓均存在不同程度的受压改变,61例合并信号改变;120例均存在腰部皮下T1WI低、T2WI高及T2压脂像高信号影。(4)120例损伤后腰椎间盘突出症中,腰椎MR上显示椎间盘超过正中矢状线的距离范围为1.03mm-13.39mm,平均为7.32mm;椎管中央矢状径范围为1.11mm-13.97mm,平均为7.68mm;椎管横径范围为7.68mm-29.90mm,平均为19.83mm。(5)新鲜损伤后的突出椎间盘以混杂信号为主,陈旧性损伤后的突出椎间盘在MRI上信号减弱。结论:(1)损伤后腰椎间盘突出症的发生部位及突出类型类似于一般性腰椎间盘突出,以腰4/腰5层面及腰5/骶1层面为主,以中央型及旁中央型为主,因此,当患者出现一般性腰椎间盘突出症状时,应高度警惕合并外伤、复合伤的可能,此时应进行MR检查或随访复查。(2)损伤后腰椎间盘突出症在MR上多表现为椎间盘的混杂信号或等信号,其中新鲜损伤后的突出椎间盘以混杂信号为主,陈旧性损伤后的突出椎间盘在MRI上信号减弱,若CT、X线上合并有椎间盘内钙化灶,则更提示为陈旧性损伤。(3)当MRI上显示脊髓受压改变的同时,信号改变是合并外伤的有力佐证,腰部皮下脂肪间隙的异常信号常可提示诊断。(4)腰椎MR椎间盘超过正中矢状线的距离的增大、椎管中央矢状径的减小以及椎管横径的减小可协助本病的诊断。
[Abstract]:Objective: to analyze the MRI signs of lumbar disc herniation after injury, and to quantitatively analyze the MRI data of lumbar disc herniation after injury, and to distinguish fresh from old disc herniation. At the same time, compared with traditional imaging methods, such as CTX ray, the application value of Mr in forensic identification was discussed, which provided objective index and new method for forensic identification of lumbar disc herniation after injury. Materials and methods: a total of 120 patients with lumbar spine trauma underwent MRI examination in our hospital from 2012-02 to 2017-02. The imaging findings of conventional MRI were analyzed retrospectively, and the advantages of conventional MRI were compared. Conventional Mr scans included axial and sagittal T2WI and T2 fat suppression sequences. The MRI signs of lumbar disc herniation after injury were observed, including the location of disc herniation, the direction of disc herniation and the signal intensity characteristics of each sequence. Whether the spinal cord appeared compression symptoms or not, the distance of lumbar intervertebral disc exceeding the median sagittal line and the degree of spinal canal stenosis were measured, and the data were classified according to the manifestation of disc herniation. Results (1) 120 cases of lumbar intervertebral disc herniation occurred mostly in lumbar 4 / lumbar 5 and lumbar 5 / sac1, and the number of central type was the most. The second was paracentral type.) in this group, 120 cases of lumbar disc herniation after injury were characterized by mixed T 1WI, mixed T2WI and mixed T 2 compression lipography signal on MRI. In this group of 120 cases of lumbar intervertebral disc herniation after injury, 93 cases have different degree of compression changes of spinal cord, 61 cases with signal changes, 120 cases have lumbar subcutaneous T1WI low T 2WI high and T 2 compression imaging. In 120 cases of lumbar disc herniation after injury, The distance between median sagittal line and median sagittal line of lumbar disc was 1.03mm-13.39mm (mean 7.32mm), central sagittal diameter was 1.11mm-13.97mm (mean 7.68mm), transverse diameter of vertebral canal was 7.68mm-29.90mm (mean 19.83mm.5) The signal intensity of the herniated intervertebral disc decreased on MRI after the old injury. Conclusion 1) the location and type of lumbar disc herniation after injury are similar to those of general lumbar disc herniation. The main types of lumbar disc herniation are lumbar 4 / lumbar 5 and lumbar 5 / sac1, and central and paracentric lumbar disc herniation. When patients have general lumbar disc herniation symptoms, they should be highly alert to the possibility of combined trauma and compound injury. At this time, Mr examination or follow-up examination should be performed. 2) after injury, lumbar disc herniation was mostly presented as mixed signal or isointensity of intervertebral disc on Mr, in which the intervertebral disc after fresh injury was mainly characterized by mixed signal. The signal intensity of the herniated intervertebral disc after the old injury was weakened on MRI. If there is calcification in the intervertebral disc on CTX ray, it is more likely to be the old injury. (3) when the changes of spinal cord compression are shown on the MRI, the signal change is a strong evidence of the complicated injury. Abnormal signals in the lumbar subcutaneous fat space often suggest that the increase of the distance between the median sagittal line of the lumbar intervertebral disc, the reduction of the central sagittal diameter of the spinal canal and the reduction of the transverse diameter of the spinal canal may assist in the diagnosis of the disease.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D919.4

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