痉挛性斜颈的CT表现及其诊断价值

CT Manifestations and its Value in the Diagnosis of Spasmodic Torticollis

目的:探讨痉挛性斜颈(ST)的颈部CT表现及其诊断价值。方法:25例经临床证实的ST患者,临床分型包括旋转型13例(52%),侧屈型7例(28%)及后仰型5例(20%)。所有患者均行螺旋CT扫描,分析不同分型患者的颈部CT表现及肥大肌群的分布,测量肥大肌群增厚幅度,并与肌电图检查结果进行对照,两组数据用Pearson相关分析进行统计学处理。结果:25例ST的主要CT表现为痉挛肌的增厚肥大,肥大颈肌较对侧同名肌的增厚2.0～11.0mm。CT显示痉挛肥大肌群的分布与斜颈类型密切相关:旋转型肥大肌群主要分布在头旋向侧的后1/4区,少数同时见于对侧前1/4区;侧屈型的肥大肌群主要集中在头屈向侧后1/4区和前1/4区内;后仰型的肥大肌群对称分布在双侧后1/4区。痉挛肥大肌群的增厚程度与肌电图不随意波的波幅增加程度呈正相关(r=0.713～0.963,P<0.01)。结论:CT能准确地显示ST肥大肌群的形态改变及其分布规律,对ST患者痉挛后肥大肌群的定位及定量诊断具有重要价值。

Objective：To discuss the CT manifestations and its clinical value in the diagnosis of spasmodic torticollis （ST）. Methods：20 patients had clinically proved ST including rotational type （n=13,52%）, latero-flexion type （n=7, 28%） and posterio-extension type （n =5,20%）. All of the patients had spiral CT scanning,the CT findings and the distribution of hypertrophic muscle groups were analyzed retrospectively, and the increased thickness of hypertrophic muscle groups were measured and correlated with the results of electromyography （EMG）. Pearson relevant statistical analysis was used. Results：The main manifestations of 25 ST patients were spasmodic muscles hypertrophy and thickening. The thickness of hypertrophy muscle groups ranged 2.0-11.0mm. The distribution of hypertrophic muscle groups could be showed on CT and were closely correlated with the ST subtypes：the hypertrophic muscle group of rotational type mainly distributed in the 1/4 of the postero-lateral area with the head rotated laterally,some located in the 1/4 of the anterior area of the contralateral side simultaneously;the hypertrophy muscle groups of latero-flexion type mainly distributed in the 1/4 of the posterolateral area and the 1/4 of anterolateral area;the hypertrophy muscle group of posterio-extension type distributed in bilateral posterolateral 1 4 area. The increased thickness of the spasmodic hypertrophy muscle groups were in positive correlation with the increase amplitude of involuntary muscle on EMG （r=0. 713-0. 963, P〈0.01）. Conclusion： CT can clearly display the distribution and the shape of hypertrophy muscles of ST, which is important in the localization and quantification of hypertrophy muscle groups of ST in clinical practice.