MSCT与MR联合诊断颈椎外伤

Combination of MSCT and MR in diagnosis of cervical vertebral injury

目的探讨MSCT与MR联合诊断颈椎外伤的价值。方法收集54例经手术证实或脊柱外科及放射科共同确诊为颈椎外伤的病例,回顾性分析比较X线平片、MSCT与MR影像特征。结果①骨性结构损伤:颈椎骨折伴脱位者33例、无脱位骨折者17例、无骨折脱位4例,其中X线平片、MSCT、MR检出率分别为66.67%、98.15%、83.33%,MSCT与MR联合检出率为98.15%。椎管狭窄0级7例、1级32例、2级14例、3级1例,其中X线平片、MSCT、MR检出率分别为21.28%、74.47%、95.75%,MSCT与MRI联合检出率为100%。依据Denis诊断标准,MSCT诊断c柱或包括c柱在内的两柱或三柱联合受累发生率较高,且骨性椎管多发生狭窄,颈椎处于不稳定状态。②椎间盘、韧带、神经损伤:颈间盘外伤性突出者22例、周围韧带损伤21例、神经损伤2例。③脊髓损伤:MR诊断Ⅰ型25例;Ⅱ型28例;Ⅲ型1例。脊髓受压30例;未受压24例。结论MSCT与MR在颈椎外伤的诊断中各具优势,二者联合诊断有益于颈椎外伤诊断与合理治疗方案的制定。

Objective To assess the value of MSCT combined with MR in diagnosis of cervical vertebral injuries. Methods Radiography, MSCT and MR images of 54 cases of cervical vertebral injuries （42 male and 12 female, aged 5--83 years, mean 45.1 years） proved by surgery （n=34） or clinical examinations （n=20） were reviewed retrospectively. Results Dis location without cervical spine fracture was found in 33 cases, while cervical spine fracture without dislocation was found in 17 cases and cervical spine fracture with dislocation in 4 cases. The detection rate of radiography, MSCT and MR was 66. 67%, 98.15% and 83.33%, respectively, and 98.15% with combination of MSCT and MR. Vertebral canal narrow was negative in 7 cases, grade Ⅰ in 32 cases, Ⅱ in 14 cases and Ⅲ in 1 case, with detective rate of 21.28% for plain film, 74.47% for MSCT and 95.75% for MR, respectively, and 100.00% for MSCT combined with MR. The posterior column injuries of vertebral body or two or three columns including posterior column were found most frequently, the vertebral canals of which were usually narrow and the cervical vertebras were unstable. Twenty-two cases with intercalated disc proptosis were found with MR, 17 with ligament injuries and 2 cases with brachial plexus injury. MR diagnosed spinal cord injuries as type Ⅰ in 25 cases, type Ⅱ in 28 cases and type Ⅲ in 1 case, totally 30 cases with spinal cord compression and 24 cases without spinal cord compression. Conclusion Combination of MSCT and MR is of great value in diagnosis of cervical vertebral injuries.