脊柱结核的MRI分型系统

A new classification of spinal tuberculosis：based on MRI findings （Southern Medical University classification）

目的 建立脊柱结核MRI的南方医科大学（Southern Medical University,SMU）分型系统,探讨其在脊柱结核诊断、手术适应证明确及术式选择方面的应用.方法 回顾性分析230例脊柱结核患者MRI资料,从椎间盘退变、椎体信号异常、脓肿形成、椎体塌陷、后凸畸形、矢状面指数、稳定性、脊髓或神经根受压及椎管占位等影像学特征进行分型.根据此分型,制定手术预案.结果 230例脊柱结核分为五个类型：信号改变型（Ⅰ型）、脓肿形成型（Ⅱ型）、椎体破坏型（Ⅲ型）、椎管占位型（Ⅳ型）和后凸畸形型（Ⅴ型）.230例患者中,Ⅰ型28例,Ⅱa型13例,Ⅱb型26例,Ⅲ型78例,Ⅳ型46例,Ⅴ型39例（Ⅴa型13例,Ⅴb型26例）.Ⅰ型25例患者获随访：20例采取非手术治疗,复发2例;5例行前路病灶清除术,无复发.Ⅱa型12例患者获得随访：6例行非手术治疗;6例行前路病灶清除术,复发1例.Ⅰ型和Ⅱa型患者手术治疗与非手术治疗复发率差异无统计学意义（P＞0.05）.其余各型脊柱结核,均按照预案进行手术治疗,各治疗组间复发率差异无统计学意义（P＞0.05）.结论 脊柱结核MRI的SMU分型有利于进一步明确手术适应证,便于选择不同术式,在脊柱结核外科治疗干预方面有积极指导意义.

Objective To outline the classification of spinal tuberculosis based on MRI findings （Southern Medical University classification,SMU classification） and explore its use in the diagnosis,surgical protocols.Methods The MRI data from 230 cases with spinal tuberculosis were analyzed retrospectively.Our classification system was based on clinical and radiological criteria （abscess formation,disc degeneration,vertebral collapse,kyphosis,sagittal index,instability and neurological problems）.The surgical strategies were made according with this classification.Results Two hundred and thirty cases with spinal tuberculosis were classified into the 5 types.There were signal change type （type Ⅰ） in 28 cases,abscess formation type （type Ⅱ） in 39,vertebral collapse type （type Ⅲ） in 78,canal compression type （type Ⅳ） in 46 and kyphosis type （type Ⅴ） in 39 respectively.In type I lesion,25 patients had been followed up.Twenty patients were treated medically.Recurrence of tuberculosis was found in 2 cases.Surgical meticulous debridements were done in 5 cases without recurrence.In type Ⅱa lesion,6 patients were treated medically.The other 6 patients underwent surgical meticulous debridement with recurrence occurred in one patient.There was no difference between medical and surgical treatment regarding outcomes in patients with type Ⅰ and Ⅱa lesion.In type Ⅱb-Ⅴ,surgical treatments were carried out according to the pathological changes.There was no difference between medical and surgical treatment regarding outcomes in the patients with type Ⅱb-Ⅴ.Conclusion The SMU classification helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis.We believe that this new classification system can be used as a practical guide in the treatment of spinal tuberculosis.