黄吉军;王静成;冯新民;陶玉平;邵增务;

• 1:江苏省苏北人民医院
• 2:华中科技大学附属协和医院

摘要(Abstract)：

[目的]探讨CT及MRI显示颈椎后纵韧带骨化的价值及临床意义。基于CT平扫、二维及三维成像特点对颈椎后纵韧带骨化患者分型,以指导手术实施及评估对预后的影响;评估术前MRI T2加权图像对患者预后的价值。[方法]回顾性分析37例颈椎后纵韧带手术治疗患者,术前根据CT成像特点,将其分为蕈伞型、山丘型、块状型以及不规则型。对于蕈伞型和山丘型施行前路手术,对块状型和不规则型根据病灶特点施行前路或后路手术。对于前路手术者根据CT成像分为单影征及双影征,以判断与硬脊膜的关系。术后根据JOA评分评估各类型患者脊髓功能恢复情况;同时对每例患者按Yukihiro Matsuyama提出的MRI T2加权图像分类方法,将其分为回旋飞镖型、三角形及水滴型,根据脊髓功能改善情况分析各种类型MRI图像对手术预后评估价值。[结果]本组病例平均随访27个月,CT分型对手术方式的选择及手术实施具有指导价值,CT分型各组均取得满意疗效,无严重并发症发生,但对患者预后缺乏评估意义,术前及术后组间JOA评分无统计学差异(P>0.05)。根据MRI T2加权像术前图像分组,脊髓功能改善率依次为水滴型(65.8±14.0)%、回旋飞镖型(59.3±9.8)%和三角型(49.8±7.1)%(P<0.05)。[结论]CT成像能有效指导颈椎后纵韧带骨化患者手术方案的制定及手术的精确实施;MRI成像对评估患者手术预后具有重要指导价值。

关键词(KeyWords)： 后纵韧带骨化;计算机体层摄影;磁共振成像

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 黄吉军;王静成;冯新民;陶玉平;邵增务;

Email:

DOI:

参考文献(References)：

• [1]Matsuyama Y,Kawakami N,Yanase M,et al.Cervical myelopathydue to OPLL clinical evaluation by MRI and intraoperative spinalsonography[J].J Spinal Disord Tech,2004,5:401-404.
• [2]Ebraheim NA,Xu R,Knight T,et al.Morphometric evaluation oflower cervical pedicle and its projection[J].Spine,1997,1:1-6.
• [3]Chang H,Kong CG,Won HY,et al.Inter-and intra-observer var-iability of a cervical OPLL classification using reconstructed CT ima-ges[J].Clin Orthop Surg,2010,1:8-12.
• [4]Kawaguchi Y,Urushisaki A,Seki S,et al.Evaluation of ossificationof the posterior longitudinal ligament by three-dimensional compu-ted tomography and magnetic resonance imaging[J].Spine J,2011,10:927-932.
• [5]Lin DS,Ding ZQ,Lian KJ.et al.Cervical ossification of the posteriorlongitudinal ligament:anterior versus posterior approach[J].Indian JOrthop,2012,1:92-98.
• [6]Iwasaki M,Okuda S,Miyauchi A,et al.Surgical strategy for cervi-cal myelopathy due to ssification of the posterior longitudinal liga-ment.Part 2:advantages of anterior decompression and fusionoverlaminoplasty[J].Spine,2007,15,6:654-660.
• [7]Takatau T,Ishida Y,Suzuki K,et al.Radiological study of cervicalossification of the posterior longitudinal ligament[J].J Spinal Disord(US),1999,3:271-273.
• [8]曹俊明,李晓明,申勇.颈椎后纵韧带骨化症的手术治疗[J].中国矫形外科杂志,2010,15:1278-1281.
• [9]Son S,Lee SG,Yoo CJ,et al.Single stage circumferential cervicalsurgery(selective anterior cervical corpectomy with fusion and lamin-oplasty)for multilevel ossification of the posterior longitudinal liga-ment with spinal cord ischemia on MRI[J].J Korean Neurosurg Soc,2010,4:335-341.
• [10]Hida K,Iwasaki Y,Koyanagi I,et al.Bone window computed tomo-graphy for detection of dural defect associated with cervical ossifiedposterior longitudinal ligament[J].Neurol Med Chir(Tokyo),1997,2:173-175.
• [11]Epstein N.Diagnosis and surgical management of cervical ossificationof the posterior longitudinal ligament[J].Spine J,2002,6:436-449.
• [12]周珂,祁磊,李牧,等.颈椎后纵韧带骨化症的临床分型及手术方式的选择[J].医学与哲学,2012,5:24-26.