动态MRI测量颈椎管内容、椎体及椎间盘的动态变化在过伸颈椎损伤发生中的意义

摘要

目的 探讨动态MRI测量颈椎管内容、椎体及椎间盘的动态变化在过伸颈椎损伤发生中的应用价值,为临床诊治过伸颈椎损伤提供有效依据.方法 选取2014年1月到2015年12月期间接受治疗的过伸颈椎损伤患者44例,对患者先进行MRI扫描检查,再进行过伸、过屈位扫描.观察患者动态测量不同位置C3-7节段的脊髓、硬膜囊中矢径、硬膜囊前间隙及椎体、椎管矢径.结果 高位颈椎(C4以上)脊髓、硬膜囊中矢径在三位置下差异无统计学意义(P=0.095).C4以下脊髓、硬膜囊中矢径的差异有统计学意义(P=0.024).在椎体水平在三位置中测得的中矢径数值大小排列次序为:过伸位>中立位>过屈位;因突出或膨出椎间盘、退行性变及黄韧带等因素的影响在椎间隙水平三位置中测得的中矢径数值大小则相反为:过屈位>中立位>过伸位,且差异有统计学意义(P=0.018).而硬膜囊前间隙三位置中测得的中矢径数值大小无显著性差异(P=0.082).结论 对于过伸颈椎损伤诊断,动态MRI扫描具有快速、有效、分辨率高及特异性好的临床效果,能为手术提供帮助,具有较高的临床应用价值.%Objective To explore the application value of the dynamic MRI in the hyperextension cervical spine injury to measure the dynamic changes on the cervical vertebra tube, the vertebral body and the intervertebral disc, providing the effective basis for the clinical diagnosis and treatment of hyperextension cervical spine injury.Methods A total of 44 cases with hyperextension cervical spine injury who were treated in the hospital from Jan.2014 to Dec.2015 were recruited as the study objects.The patients were examined by MRI firstly, and then examined by dynamic MRI on the cervical vertebra tube.To observe the dynamic measurement in patients with different location on the C3-7 segment for the radius vector of spinal and epidural, the epidural gap before sac, the radius vector of vertebral body and sedation.Results The difference was not statistical significance on the radius vector of the high cervical spine (above C4) spinal and epidural (P=0.095), the difference was statistical significance on the radius vector of the under C4 spinal and epidural (P=0.024).The numerical size of the radius vector were measured on vertebral levels of three position were in order as: hyperextension position > neutral position> flexion position, Because of the outstanding or bulging intervertebral disc degeneration and the factors of yellow ligament, the numerical size of the radius vector were measured on intervertebral disc levels of three positionin were on the other hand : flexion position > neutral position > hyperextension position, and the difference was statistically significant (P=0.018).And the numerical size of the radius vector were measured on vertebral levels of three position in the epidural gap before sac were not significant difference (P=0.082).Conclusion For the preoperative diagnosis of hyperextension cervical spine injury, the clinical effect of dynamic MRI had the characteristics of fast, efficient, high resolution and good specificity, with high clinical value.