痉挛性斜颈的CT表现及其诊断价值

CT Manifestations of Spasmodic Torticollis and Its Diagnostic Value

目的：探讨痉挛性斜颈（ST）的多排螺旋CT（MSCT）检查方法及其对痉挛责任肌群的定位诊断价值。方法回顾性分析18例ST患者临床及CT资料，临床分型：旋转型10例，侧屈型8例；另选取年龄及性别匹配的健康志愿者18名作为对照组，均行颈部CT正位及斜位扫描。分别对两组左、右同名颈肌肌腹的横截面积进行测量及比较，分析不同类型ST痉挛肥大肌肉的分布特征。结果18例ST患者CT主要表现为颈部痉挛肌肉肌腹横截面积增大，且与斜颈临床分型相关，旋转型肥大肌群主要分布在头旋向侧的后1/4区及对侧前1/4区，正位CT显示痉挛肥大肌肉与对侧同名肌（胸锁乳突肌、头夹肌、肩胛提肌）肌腹横截面积均值差异有统计学意义（P＜0.05）；侧屈型肥大肌群主要分布在头屈向侧的后1/4区和前1/4区，正位CT显示痉挛肥大肌肉与对侧同名肌（胸锁乳突肌、肩胛提肌、斜方肌）肌腹横截面积均值差异有统计学意义（P＜0.05）。结论 MSCT能明确显示ST痉挛肥大肌肉形态改变及其分布规律，有助于确定痉挛责任颈肌并进行针对性治疗，是ST首选无创性检查方法。

Objective To investigate the multi-slice spiral CT scan （MSCT） inspection methods of spasmodic torticollis （ST） and its clinical diagnosis value of spasm muscle responsibility positioning. Methods 18 cases with ST were retrospectively analyzed. Clinical types include rotational type （10 cases） and laterocollis （8 cases）. Additionally, we set up 18 cases of healthy volunteers as control group, the same muscle body areas were measured and compared for left and right of cross-section, detecting distribution of hypertrophy muscle. Results 18 cases with ST mainly shows spasms muscles of neck were hypertrophied and muscle body area increased and related with torticollis clinical classification. The hypertrophied muscles in rotational type were distributed in the 1/4 posterolateral region of rotational side and the 1/4 anterolateral region of opposite side. Anteroposterior shows muscle body areas between hypertrophy spasms muscle and same contralateral muscles （sternocleidomastoid, splenius capitis muscle, levator scapulae muscle） were statistically significantly different in cross-section （P〈0.05）;The hypertrophied muscles in laterocollis were mainly distributed in the posterolateral and anterolateral region of same side. Anteroposterior showing muscle body areas between hypertrophy spasms muscle and same contralateral muscles （sternocleidomastoid, levator scapulae muscle, trapezius） were statistically significantly different in cross-section （P〈0.05）. Conclusion MSCT can show the shape change and distribution of hypertrophy muscle of ST. It helps to determine the responsibility muscle of spasm and targeted therapy, and it is the preferred noninvasive method.