CT结合MRI对诊断胸椎黄韧带骨化症硬膜粘连的意义

发布时间：2018-03-05 01:29

本文选题：黄韧带骨化症　切入点：胸椎管狭窄症　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过回顾性分析黄韧带骨化所致胸椎狭窄症(thoracic ossification of the ligamentum flavum,TOLF)CT联合MRI的影像学表现,概括TOLF合并硬脊膜骨化粘连的影像学表现,探讨TOLF致胸椎管狭窄症中CT联合MRI硬脊膜骨化粘连征象的诊断价值,以期指导临床制定最佳手术方案,并探讨硬脊膜粘连对胸椎管狭窄症的影响。方法选取自2010年6月到2016年9月期间于青岛大学附属医院经同一骨科医师实施后路一期手术治疗胸椎黄韧带骨化症患者63名进行随访,采集患者病程、手术时间、术中出血量、术后住院天数、术后并发症情况,运用胸椎管狭窄症改良JOA评分标准对术前及术后末次随访进行评分。对所有患者行X线、CT和MRI检查,观察患者影像学征象,所有患者根据术前一周内行CT联合MRI检查的结果分为2组:研究组和对照组,研究组20例:CT上出现“车轨征”、“逗号征”、“桥洞征”三者之一且MRI存在“锯齿线样征”;对照组43例:不出现或CT和MRI不同时出现影像征象。所有患者所行影像学检查均由我院放射科采集并报告,对于影像学特征性征象已由放射科副主任医师及以上复核无误。以手术中所见硬脊膜与黄韧带粘连作为诊断硬脊膜粘连的“金标准”。术前CT联合MRI检查所见影像征象与之比较,计算特异性和敏感性,并得出阳性似然比(阳性似然比5,表明具有参考价值;阳性似然比10,表明有诊断价值)。所有患者以术中所见为标准分为分粘连组和未粘连组,对比两组手术时间、术中出血量、术后住院天数、术后恢复率及术后脑脊液漏发生情况。结果1.研究组中CT以及MRI均出现特征性征象者20例;对照组中单独出现CT特征性征象者19例,其中“车轨征”11例,“逗号征”5例,“桥洞征”3例,单独出现MRI“锯齿线样征”3例;两者均无21例。2.术中发现共19例患者存在硬脊膜粘连,其中研究组中15例,对照组中4例。3.CT出现“车轨征”或“桥洞征”或“逗号征”且MRI上呈“锯齿线样征”的阳性似然比最高为6.93;单独CT出现“车轨征”的阳性似然比为4.81;单独CT出现“逗号征”的阳性似然比为1.54;单独CT出现“骨桥征”的阳性似然比为1.73;单独MRI出现“锯齿状线征”的阳性似然比为3.22。4.粘连组手术时间为90.9±30.9分钟/每节段,未粘连组手术时间为64.5±23.3分钟/每节段,差别有统计学意义;粘连组术后住院天数为10.44±2.15天,未粘连组术后住院天数为8.84±2.08天,差别有统计学意义。粘连组术后脑脊液漏发生率为57.9%,未粘连组术后脑脊液漏发生率为18.2%。结论1.术前CT联合MRI对黄韧带增厚致胸椎管狭窄患者硬脊膜粘连的诊断具有参考价值。2.硬脊膜发生粘连会延长手术时间,增加大手术及麻醉风险,术后脑脊液漏发生率高,延长术后恢复周期,术前明确诊断对于评估术后及术前交待病情有指导意义。
[Abstract]:Objective to summarize the imaging findings of thoracic spinal stenosis caused by ossification of ligamentum flavum by thoracic ossification of the ligamentum TOLFN combined with MRI, and to summarize the imaging findings of TOLF complicated with ossification of dura dura. To investigate the diagnostic value of CT and MRI epidural ossification in thoracic spinal canal stenosis caused by TOLF in order to guide clinical work out the best operation plan. To explore the effect of dural adhesion on thoracic spinal canal stenosis methods from June 2010 to September 2016, the patients with ossification of ligamentum flavum of thoracic vertebra were treated by one stage operation by the same orthopedic surgeon in the affiliated hospital of Qingdao university. 63 of them were followed up. The course of disease, the time of operation, the amount of intraoperative bleeding, the days of hospitalization after operation, and the postoperative complications were collected. The preoperative and postoperative follow-up were evaluated with modified JOA score of thoracic spinal stenosis. All patients were examined by X-ray CT and MRI. All the patients were divided into two groups according to the results of CT and MRI examination within one week before operation: the study group and the control group. In the study group, 20 cases had "car-track sign", "comma sign", "bridge hole sign" and MRI had "serrated linear sign" in 20 cases of CT, and 43 cases in control group: no sign or CT and MRI were not present at the same time. All the patients underwent imaging examination. All the examinations were collected and reported by the radiology department of our hospital. The imaging characteristic signs have been checked by the deputy chief physician of radiology department and above. The adhesion of dura mater and ligamentum flavum seen during operation was taken as the "golden standard" for the diagnosis of dura mater adhesions. The imaging signs of CT and MRI before operation were compared with them. The specificity and sensitivity were calculated, and the positive likelihood ratio (5 positive likelihood ratio, 5 positive likelihood ratio, 10 positive likelihood ratio) was calculated, indicating diagnostic value. All patients were divided into adhesive group and non-adhesion group according to intraoperative criteria. The operative time, intraoperative bleeding volume, postoperative hospital stay, postoperative recovery rate and cerebrospinal fluid leakage were compared between the two groups. Results 1. In the study group, 20 cases had characteristic signs of CT and MRI. In the control group, there were 19 cases with characteristic CT signs, including 11 cases of "vehicle-track sign", 5 cases of "comma sign", 3 cases of "bridge hole sign" and 3 cases of MRI "sawtooth line sign", none of them had 21 cases of dural adhesion during operation. There were 15 cases in the study group. In the control group, 4 cases. 3. Ct showed "vehicle-track sign" or "bridge hole sign" or "comma sign" and the highest positive likelihood ratio of "serrated linear sign" on MRI was 6.93; the positive likelihood ratio of single CT sign of "vehicle-track sign" was 4.81; and that of CT alone was 4.81. The positive likelihood ratio of "comma sign" was 1.54, the positive likelihood ratio of "bone bridge sign" on CT was 1.73, the positive likelihood ratio of "serrated line sign" on MRI was 3.22.4.The operative time of adhesive group was 90.9 卤30.9 minutes / segment. The postoperative hospitalization time was 10.44 卤2.15 days in the adhesion group and 8.84 卤2.08 days in the non-adhesion group. The incidence of cerebrospinal fluid leakage was 57.9 in adhesion group and 18.2 in non-adhesion group. Conclusion 1. Ct combined with MRI before operation is a diagnostic tool for dural adhesion in patients with thoracic spinal canal stenosis caused by thickening of ligamentum flavum. Have reference value. 2.The dura mater adhesions can prolong the operation time, Increasing the risk of major surgery and anesthesia, high incidence of cerebrospinal fluid leakage, prolonging the postoperative recovery period, preoperative diagnosis for the evaluation of postoperative and preoperative state of the disease has a guiding significance.
【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】：R681.5;R445.2;R816.8

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