腰椎间盘突出症磁共振脊髓造影成像的特点

摘要

目的：观察巨大腰椎间盘突出症患者磁共振脊髓造影成像（M R M）变化，作为初步判定其是否符合手法治疗，以及巨大突出对马尾神经造成伤害可能性的影像学检查手段。方法选取巨大腰椎间盘突出症39例，观察MRI及MRM资料并进行分析。结果确诊巨大腰椎间盘突出症39例的MRM表现可分为3种类型：①硬膜囊、神经根袖大致正常，无明显突出髓核的压迹5例；②神经根袖内脑脊液充盈减少，出现压迹，甚至神经根袖中断、消失24例；③硬膜囊内脑脊液受髓核突出压迫硬膜囊中断或明显缺损，硬膜囊终末段消失10例。结论①M R M显示硬膜囊、神经根袖受到突出髓核压迫后充盈改变，反应了两者之间的力学关系；②MRM显示部分具有巨大髓核突出腰椎间盘突出症患者其硬膜囊、神经根袖并未受到突出髓核明确的压迫，说明即便巨大髓核突出椎管对其仍有可能容纳；③根据MRM显示硬膜囊、神经根袖受到突出髓核压迫影像表现，可以初步判定巨大腰椎间盘突出症的患者是否符合手法治疗适应证，以及对马尾神经造成伤害可能性。%Objective Observe the MRM changes in patients with huge lumbar intervertebral disc protrusion, and make it as a preliminarily determination whether patients with huge lumbar intervertebral disc protrusion are in line with the indications of manual therapy, and imaging examination method with harm possibility of huge protrusion on the horsetail nerve. Methods Select 39 cases of patients with huge lumbar intervertebral disc. Observe the data of MRI and the MRM data then analyze it. Results The performance of MRM in 39 patients who has been confirmed with huge lumbar intervertebral disc protrusion can be divided into three types:①A total of 5 cases showed that dural sac and nerve root sleeve displayed as roughly normal, no obvious pressure trace of nucleus pulposus. ②A total of 24 cases showed that patients with lumbar disc prolapse MRM appeared pressure mark, even interruption of nerve root sleeve, due to the decrease of cerebrospinal fluid filling in the nerve root sleeve. ③A total of 10 cases showed that the dural sac has been broken or obvious defect and the terminal of dural sac disappeared, because the cerebrospinal fluid in dural sac has been pressed by the herniation of the nucleus pulposus. Conclusions ①The MRM display that dural sac and nerve root sleeve was changed to be turgor after oppressed by herniation of the nucleus pulposus, which reflect the mechanical relationship between the two parts. ②The MRM display that the dural sac and nerve root sleeve of most patients who suffered herniated lumbar intervertebral disc protrusion has not been oppressed obviously by the herniation of the nucleus pulposus, indicating that even huge herniated vertebral canal can accommodate it. ③According to the imaging finding of MRM which displayed that the dural sac and nerve root sleeve was oppressed by herniation of the nucleus pulposus, it can preliminarily determine whether patients with huge lumbar intervertebral disc protrusion are in line with the indications of manual therapy, and the possibility of the horsetail nerve damage caused by huge protrusion.