神经根型颈椎病的影像学特点和分型

Imaging characteristics and classification of cervical spondylotic radiculopathy

[目的]分析并找出神经根型颈椎病的X线片、MRI特点以及其相关性,为神经根型颈椎病的诊治提供参考依据。[方法]收集自2005年4月～2011年7月门诊及住院的神经根型颈椎病560例患者的X线片、MRI及临床相关数据。对患者临床的表现特点,影像学(X线、MRI)检查结果进行对比和相关性分析。[结果]在引起症状的责任椎间隙,颈椎侧位X线片发现椎体后缘向后增生216例,占38.57%;斜位X线片发现椎间孔增生、狭窄187例,占33.39%;侧位及斜位均发现增生75例,占13.39%;正位X线片发现钩椎关节增生19例,占3.39%,无增生表现63例,占11.25%。颈椎MRI显示单纯椎间盘突出63例,占11.25%;椎间盘突出合并骨质增生者497例,占88.75%。结合X线片和MRI可将神经根型颈椎病分为5型,其骨质增生的部位发现率依次为侧位X线片向后>斜位X线片向外>侧位、斜位X线片向后外>骨质无增生>合并正位X线片向外侧增生型。[结论]通过对神经根压迫因素的X线和MRI综合诊断与分析,找出责任椎间隙神经压迫的部位和原因;针对骨质增生最常见的颈椎间盘后外侧骨质进行减压,是治疗神经根型颈椎病的关键。

[Objective] To analyze the correlation of X ray examination （radiology） and magnetic resonance imaging （MRI） in the diagnosis of cervical spondylotie radicnlopathy （CSR） . [ Methods] Totally 560 cases of CSR from April 2005 to July 2011 were retrospectively analyzed. Clinical manifestation, imaging results of radiology and MRI were compared and correlatively analyzed. [ Results] In the responsible intervertebral space, 216 cases （38.57%） of posterior hyperstosis from vertebral body were observed on lateral view of radiology, 187 cases （33.39%） of hyperstosis and stenosis of intervertebral foramen were observed on oblique view of radiology, 75 cases （ 13.39% ） of hyperstosis were observed both on lateral and oblique view of radiology, 19 cases （3.39%） of hyperstosis of Lusehka joint were observed on A - P view of radiology, 63 cases （ II. 25% ） without obvious hyperstosis were noticed in X ray examination. Accompanied intervertebral disc herniation was discerned in 497 cases （88.75%） by MRI. According to the correlation analysis of radiology and MRI, CSR was classified into 5 types. The incidence of hyperstosis was highest at posterior region of intervertebral space on lateral view of X ray examination, then lateral on oblique view, posterior and lateral on lateral and oblique view, no obvious hyperstosis on both view and accompanying lateral bony hyperplasia on A - P view sequentially. [ Conclusion] It is advisable to analyze the location and factor of nerve root compression in i＇esponsible＂ intervertebral space through correlative analysis of radiology and MRI. Posterolateral intervertebral discectomy and decompression of hyperstosis of nerve root canal is the key point of treatment of CSR according to the correlative imaging observation.