摘要
目的探讨马尾神经根冗余(RNRs)MRI特征、机制及意义。方法搜集MRI诊断为腰椎管狭窄(LSS)患者247例,观察矢状位马尾神经形态,分为RNRs(+)和(-),并测量LSS节段最小硬膜囊面积(DCSA)。LSS平面分腰2~4范围内外单平面和多平面三类;LSS平面椎管前壁突出物形状分圆钝和尖锐两种,其后缘"硬度"分Ⅰ、Ⅱ两级。组间计量资料采用χ~2检验,计数资料采用t检验,等级资料采用单因素方差分析,结果行Kappa一致性检验。结果247例中发现RNRs 49例(19.8%),形态大致分"藤索"型、"葡萄串珠"型和"蛇纹石"型三种。LSS伴与不伴RNRs患者平均年龄分别为(62.72±24.50)岁和(53.70±21.87)岁(t=6.35,P<0.05);最小DCSA分别为(61.70±21.53)mm^2和(86.72±29.50)mm^2(t=9.48,P<0.01)。LSS腰2~4单平面87例、非腰2~4单平面69例和多平面91例,伴RNRs分别为36、9和4例(F=13.89,P<0.01)。LSS平面椎管前壁突出物圆钝和尖锐分别为185例和62例,伴RNRs分别为18例和31例(χ~2=11.84,P<0.01);"硬度"Ⅰ级167例、Ⅱ级80例,伴RNRs分别为20例和29例(χ~2=13.17,P<0.01)。椎体滑脱56例,伴RNRs23例(χ~2=17.69,P<0.01);真假滑脱分别为18例和38例,伴RNRs分别为4例和19例(χ~2=12.04,P<0.01)。结论马尾神经根"藤索"、"葡萄串珠"及"蛇纹石"样改变是RNRs特征性表现;高龄、中间段单平面重度LSS、假性滑脱和突出物尖"硬"压迫是RNRs主要形成因素;RNRs为诊断症状性LSS重要依据,是LSS手术治疗的指征之一。
Objective To investigate MRI features of redundant nerve roots(RNRs)of cauda equina and to discuss its mechanism and significance.Methods A total of 247 patients diagnosed with MRI diagnosis of lumbar spinal stenosis(LSS)were collected.The sagittal cauda equina was observed and divided into RNRs(+)and(-).The minimum dural sac area(DCSA)of LSS segment was measured.The LSS plane is divided into three types:single plane and multiplane in the range of L2 to 4 waist;the shape of the anterior wall protrusion of the LSS plane can be blunt and sharp,and the“hardness”of the posterior edge can be divided into two levels.The measurement data between groups was tested byχ2,the count data was tested by t,and the grade data was analyzed by one-way ANOVA.The results were tested by Kappa consistency.Results 49 cases(19.8%)of RNRs were found in 247 cases.The morphology was roughly divided into three types:“vine rope”type,“grape bead”type and“serpentine”type.The average age of patients with and without RNRs was(62.72±24.50)years and(53.70±21.87)years(t=6.35,P<0.05);the minimum DCSA was(61.70±21.53)and(86.72±29.50)mm2,respectively.(t=9.48,P<0.01).There were 87 cases with LSS 2~4 single plane,69 cases with non-waist 2~4,and 91 cases with multi-plane,with 36,9 and 4 cases with RNRs(F=13.89,P<0.01).The blunt and sharp protrusions of the anterior wall of LSS plane spinal canal were found in 185 cases and 62 cases,and RNRs were found 18 cases and 31 cases respectively(χ2=11.84,P<0.01).“hardness”grade was seen in 167 cases,gradeⅡ80 Cases with RNRs were 20 cases and 29 cases(χ2=13.17,P<0.01).There were 56 cases of vertebral spondylolisthesis,23 cases with RNRs(χ2=17.69,P<0.01);true and false spondylolisthesis were 18 cases and 38 cases,respectively,and RNRs were 4 cases and 19 cases(χ2=12.04,P<0.01).Conclusion The type of“vine”,“grape bead”and“serpentine”of cauda equina was the characteristic MRI manifestion of RNRs;Advancing age、single plane severe LSS in the middle of lumber,spondylolisthesis without pars interarticularis and“hard”compression of protrusion tips are the main causes of the formation of RNRs;which was an important basis for the diagnosis of symptomatic LSS and could be used as an indicator for surgical treatment of LSS.
作者
曹和涛
万娟
侯冬梅
张砚满
刘婷婷
成月
CAO Hetao;WANG Juan;HOU Dongmei(Department of Medical Imaging,the Affiliated Hospital of Nantong University,Nantong,Jiangsu Province 226001,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第4期658-663,共6页
Journal of Clinical Radiology
关键词
腰椎管狭窄
马尾神经
神经根冗余
磁共振成像
Lumbar Spine Stenosis
Cauda Equina
Redundant Nerve Root
Magnetic resonance imaging
