A型胸腰段骨折椎体邻近椎间盘在磁共振T2加权像上的影像学特点

Characters on MRI T2W images of the adjacent intervertebral discs in type A thoracolumbar vertebrae fracture

目的:总结A型(AO分型)胸腰段骨折椎体邻近椎间盘MRI影像学表现及其特点。方法:分析2008年1月～2010年6月收治的148例胸腰段骨折患者MRI资料,观察骨折椎体邻近椎间盘在T2WI上的信号及形态学变化,总结其特点。结果:148例患者中,共累及154个椎体,302个椎间盘,其中椎间盘信号有改变者共183个,上位146个,下位37个。表现为:(1)椎间盘信号明显改变,纤维环、终板及椎间隙无影像学变化者32个,占17.5%;(2)椎间盘信号明显改变,伴有椎间隙的改变(增宽或者变窄),无纤维环和终板损伤者53个,占29.9%;(3)椎间盘信号明显改变,椎间隙前1/3变窄,前纵韧带损伤或者断裂,伴有或不伴有椎间盘组织向前膨出或突出者20个,占10.9%;(4)椎间盘信号明显改变,终板骨折,椎间盘组织疝入骨折椎体,椎间隙变窄者64个,35.0%;(5)椎间盘信号明显改变,椎间隙后1/3变窄,后纵韧带损伤或者断裂,伴有或者不伴有椎间盘组织向后膨出或突入椎管,相应平面椎管狭窄者14个,占7.7%;(6)椎间盘信号和形态正常者131个。结论:胸腰段骨折椎体邻近椎间盘在MRI T2加权像上有六种表现形式,术前MRI上椎间盘信号和形态的改变可作为选择治疗方法的重要参考因素之一。

Objective：To summarize the characters of adjacent intervertebral discs of the thoracolumbar vertebrae fracture on MRI.Method：From January 2008 to June 2010,148 consecutive patients suffered from type A thoraeolumbar fracture were examined by MRl,the T2W signal changes and morphological changes of the adjacent intervertebral discs were analyzed,and all the characters were summarized.Result： 154 fractured vertebral bodies and 302 adjacent intervertebral discs were observed in 148 patients.The abnormal T2W signals and morphological changes were observed in 183 discs（146 cranial discs and 37 caudal discs）.（1）The obvious T2W signal changes were observed in 32 discs （17.5%）,without annular fibrosus and endplate changes,and the intervertebral spaces maintained normal as well.（2）The obvious T2W signal and intervertebral space changes were observed in 53 discs （29.9%）,without annular fibrosus and endplate changes. （3）The obvious T2W signal changes were observed in 20 discs （10.9%）,that the anterior 1/3 of intervertebral spaces lost height,and the anterior longitudinal ligaments were damaged or collapsed,at the same time,the discs or the nucleus pulposus of the discs were bulged or herniated. （4）The obvious T2W signal and intervertebral space changes were observed in 64 discs （35.0%）,that nucleus pulposus of the discs were herniated into the fractured thoracolumbar vertebrae,and the endplates were damanged.（5）The obvious T2W signal changes were observed in 14 discs （7.7%）,with the posterior 1/3 of intervertebral spaces were observed loss height,and the posterior longitudinal ligaments were damaged or collapsed,at the same time,the discs or the nucleus pulposus of the discs were bulged or herniated that resulted in the spinal canal stenosis.（6）The others had no signal and morphological changes.Conclusion：The adjacent intervertebral discs to fractured thoracolumbar vertebrae on MRI have six forms.Preoperatively,the signal changes and the morphological changes of the adjacent intervertebral discs to fractured thoracolumbar vertebrae on MRI maybe served as an important reference factor for choosing treatment plan.