脊髓纵裂128例影像学表现与神经症状的相关性

目的:探讨脊髓纵裂(DM)影像学与临床神经症状的关系.方法:对我院1975-05/2007-01收治的128例DM患者对其影像学特征、临床神经症状及随访情况进行回顾分析和总结.结果:双管型98例,影像学表现为脊髓纵裂不对称、有间隔、位于胸腰段及腰段、合并脊髓水囊肿大,出现临床神经功能症状重;单管型30例,影像学表现为脊髓纵裂对称性分布、无间隔或稍有纤维性间隔、位于颈段及颈胸段、合并脊髓水囊肿小,出现临床神经功能症状轻,两者均与病变部位脊髓纵裂长度无明显关系.结论:DM的影像学表现与临床神经症状关系密切,治疗应根据DM分型、影像学特征和神经症状综合考虑.     

Clay-shoveler＇s骨折合并颈髓损伤的诊断与治疗

目的 探讨Clay-shoveler＇s骨折合并颈椎脊髓损伤的临床表现、影像学特点、诊断及治疗方法.方法 回顾性分析2005年4月至2011年3月收治的8例Clay-shoveler＇s骨折合并颈椎脊髓损伤患者的临床资料并复习相关文献,总结该骨折合并颈髓损伤的特点.结果 所有患者术前均有颈胸段疼痛,特点是卧床休息时疼痛明显减轻或消失,坐或行走时疼痛复发.X线或CT检查可见颈胸段棘突骨折.MRI显示颈椎间盘突出压迫相应节段脊髓.术后患者疼痛均明显减轻或消失,神经损伤症状明显好转.结论 虽然Clay-shoveler＇s骨折发病率较低,但是患者可合并出现颈椎脊髓或神经根损伤的情况.若保守治疗无效常需要手术干预,颈后路棘突固定重建术是较好的治疗方法之一.根据患者的临床表现和影像学特点,决定是否联合颈前路减压植骨融合内固定术.     

脊髓海绵状血管畸形的显微外科治疗

目的 探讨脊髓海绵状血管畸形的临床、影像学、病理学特点和显微手术方法.方法 对28例脊髓海绵状血管畸形患者进行了MRI检查,其中1例术前未能明确诊断,术后证实为海绵状血管畸形.全组患者均经后背正中直切口显微手术治疗,其中22例行全脊髓血管造影,均无染色.结果 28例均为单发,8例位于颈段,12例位于颈胸段,4例位于胸段,2例位于腰段,2例位于圆锥马尾部位.MRI检查显示团块状短T1长,12信号,中间由点条状长T1短T2信号分隔而形成桑葚状混杂信号团,周边绕以低信号团,尤以T2WI显著.随访3个月～6年,全组均未见复发,16例术后功能明显恢复.结论 MRI是脊髓海绵状血管畸形术前最可靠的诊断方法.显微手术切除是脊髓海绵状血管畸形的优选治疗方法,术中精细的显微操作是手术成功的关键.全脊髓血管造影可以排除其他脊髓血管畸形.     

神经电生理及核磁共振检查对平山病的诊断价值

目的：探讨神经电生理及核磁共振检查对平山病的诊断价值。方法：对14例确诊的平山病患者的临床特点、神经电生理特征及影像学表现进行回顾性分析。结果：所有患者有症状侧上肢正中神经和尺神经感觉运动传导速度及正中神经复合肌肉动作电位（compound motor active potentials,CMAPs）均正常,8条尺神经CMAPs降低超过正常值20%。14例患者有症状侧下颈段脊髓前角细胞支配肌肉均出现神经源性损害（C7~8、T1水平）;其中4例呈有症状侧上肢肌肉神经源性损害;7例呈双侧上肢肌肉神经源性损害（其中2例仅有单侧上肢肌肉无力萎缩表现）;3例呈广泛神经源性损害（1例为单侧上肢2例为双上肢肌肉无力萎缩）。常规颈椎生理位MRI平扫10例未见异常或略变细;4例提示颈胸段脊髓萎缩变细。颈椎前屈位MRI扫描提示14例患者均有颈胸段椎管后方硬膜前移,脊髓呈明显受压变形、变细改变。结论：大多数平山病患者肌电图检查呈节段性下颈段脊髓前角损害的特征性异常,因而神经电生理检查在平山病的诊断中有重要作用。平山病患者肌电图检查亦可能出现广泛神经源性损害,因而疑诊平山病患者均应行颈段脊髓生理位及前屈位MRI扫描。     

转移瘤脊髓压迫症运动功能损害与影像学特征的相关性

目的 探讨转移瘤硬膜外脊髓压迫症(MESCC)运动功能损害与影像学特征的相关性.方法 自2006年7月至2008年12月,对连续收治的56例MESCC患者入院后按Frankel分级进行瘫痪状态评估,并进行主要病变脊椎的MRI及CT扫描.主要病变脊椎影像学评估因素包括:病变脊椎节段、侵犯硬膜外间隙、累及椎板、椎体后壁向后突出、病变脊椎连续、累及椎弓根、椎体前柱骨折、椎体后壁骨折、病变脊椎位于上胸椎和(或)颈胸交界.结果 本组56例MESCC患者瘫痪状态与侵犯椎管内硬膜外组织的影像学特征发生状况完全一致.多元回归方程表明MESCC瘫痪状态与累及椎板(X1)、椎体后壁向后突出(X2)、病变脊椎位于颈胸交界处和上胸椎(X7)等影像学特征存在线性回归关系.MESCC瘫痪状态(Y)与影像学特征(X)的最优回归方程为Y=-0.009+0.639X1+0.149X2+0.282X7,其中累及椎板对MESCC瘫痪状态影响最大.结论 影像学特征中累及椎板、椎体后壁向后突出、病变脊椎位于上胸椎和(或)颈胸交界可预测MESCC的瘫痪状态,累及椎板的MESCC患者最易向硬膜外间隙侵犯.     

MRI对脊髓亚急性联合变性的诊断价值

目的探讨MRI检查对脊髓亚急性联合变性的诊断价值。方法回顾性分析8例脊髓亚急性联合变性的MRI资料,分析该病的MRI表现特征。结果 8例患者均因神经系统损害体征起病,6例患者行血清维生素B12检查,3例表现为维生素B12值升高,3例正常。8例患者MRI检查能直观地显示病灶,表现为颈胸段脊髓后、侧索的对称性T1WI等或稍低信号和T2WI高信号,其中2例合并脊髓肿胀、增粗。患者经B族维生素治疗后,7例病情稳定、症状改善,1例无明显改善。结论 MRI检查能准确显示病变部位,且病灶形态具有一定影像学特征,是目前唯一能直接显示脊髓亚急性联合变性的影像学检查方法,对其诊断有辅助作用。     

脊椎术后感染MRI诊断价值

目的分析脊椎术后感染的MRI表现,以提高对其认识。方法回顾性分析32例经临床证实的脊椎术后感染病例,其中行MRI平扫检查24例,平扫和增强扫描检查7例,直接增强扫描检查1例,观察椎间盘炎、脊椎骨髓炎、硬膜外脓肿及软组织感染MRI平扫和增强扫描的表现。结果椎间盘炎(20例):椎间盘破坏、髓核裂隙消失、终板破坏及椎间隙变窄,MRI平扫呈等(长)T1、长T2信号17例,等T1、短T2信号1例,椎间盘信号正常1例;增强扫描5例,斑点状强化1例,不规则强化4例。骨髓炎(22例):20例为脊椎骨髓炎并椎间盘炎,2例为单纯脊椎骨髓炎,平扫病变呈长(短)T1、长T2信号4例(6个椎体),呈长T1、长T2信号17例(39个椎体);增强扫描6例(12个椎体)病变区均有强化。硬膜外脓肿(15例):呈等T1、长T2信号,增强扫描明显强化,5例有脓腔形成,呈长T1、长T2信号,增强扫描无强化;2例脊髓内有斑片状水肿信号。软组织感染(10例):6例有脓肿形成,周围伴广泛软组织水肿,4例为蜂窝组织炎;增强扫描脓肿壁、周围软组织水肿及蜂窝组织炎有强化。结论脊椎术后椎间盘炎、骨髓炎、硬膜外脓肿和软组织感染MRI表现较有特征性,MRI能早期发现病变,对改善病人预后具有重要的临床意义。     

椎管内硬膜外海绵状血管瘤的MRI表现及鉴别诊断

目的:探讨椎管内硬膜外海绵状血管瘤的MRI表现及鉴别诊断价值。方法:将经手术病理证实的6例椎管内硬膜外海绵状血管瘤的MRI表现与硬膜外其他病变进行鉴别。结果:6例T1加权像呈等或略高信号,T2WI为高信号,增强扫描均匀一致强化。5例位于胸段椎管内,1例位于颈胸段,均沿脊髓长轴生长。2例位于脊髓背侧,呈钳状包绕脊髓,4例位于脊髓侧后方,沿相邻椎间孔向外生长,并使椎间孔扩大。结论:椎管内硬膜外海绵状血管瘤是罕见的良性病变,并有其特征性表现。MRI是目前最为可靠的术前检查手段,但最终确诊仍需结合临床及病理。     

脊髓亚急性联合变性的临床和MRI影像学分析

目的：探讨脊髓亚急性联合变性（SCD）的临床和MRI影像学特点。方法回顾性分析12例SCD患者的MRI影像图像及临床诊治资料。结果12例患者均因神经系统损害体征起病,血清维生素B12降低6例,升高2例,正常4例。1例MRI检查未见明显异常。11例患者MRI检查能直观地显示病灶,其中1例表现为脊髓萎缩,其余10例表现为颈胸段脊髓后、侧索的对称性T1WI等或稍低信号和T2WI高信号,其中1例合并颅内异常信号。患者经维生素B12治疗后,11例症状有明显改善,1例无明显改善。结论 MRI检查能准确显示病变部位,且病灶形态具有一定影像学特异性,对SCD的诊断有辅助作用。     

全椎板减压治疗伴炎性肉芽组织形成的长节段胸椎硬膜外脓肿1例报道

报道1例全椎板减压治疗伴炎性肉芽组织形成的长节段胸椎硬膜外脓肿病例。该例患者以腰痛及双下肢无力为主诉入院后,迅速出现双下肢运动及感觉障碍。磁共振成像检查发现多段胸椎硬膜外占位并压迫脊髓。急行单节段椎板切除脓液引流后,发现长条状炎性肉芽组织仍然粘连压迫脊髓,改行多节段椎板切除术,顺利清除炎性肉芽组织。患者术后脊髓功能恢复良好,脊柱稳定性良好。椎管内分隔状高T2W信号影像提示大量炎性肉芽组织形成,脓肿引流术效果差,多节段椎板切除术是有效的治疗方法。     

Rheumatoid Arthritis—Atlanto-Axial Subluxation and Its Clinical Presentation

The clinical picture, radiological findings and treatment of 22 patients with atlantoaxial subluxation and rheumatoid arthritis are described. This lesion, untreated, may result in damage to the spinal cord, paresis or sudden death. Occipital headache, present in 13 of 22 patients, was often aggravated by working with the head in forward flexion. Paresthesias were present in six patients. The spine of the axis was often prominent. In three patients there was objective evidence of cord compression with sensory and/or pyramidal signs. In eight the lesion was asymptomatic and discovered by routine lateral radiography in flexion, the position of maximum subluxation.

Conservative treatment involved the continuous use of a cervical collar to limit neck flexion. This usually relieved subjective symptoms including headaches. Successful surgical fixation was performed in two individuals. Surgical indications included acute or chronic cord compression or severe symptoms unrelieved by a collar.

     

转移性肿瘤致脊髓压迫征急诊放疗临床分析

目的：研究转移性肿瘤致脊髓压迫征急诊放疗的临床疗效。方法方便选取自2013年3月—2015年12月在该院接受治疗的50例转移性肿瘤致脊髓压迫征患者,对患者进行急诊放疗,观察治疗后患者的疼痛程度、运动功能障碍、括约肌功能改善情况。结果50例转移性肿瘤致脊髓压迫征患者在进行急诊放疗后,患者的疼痛程度、运动功能障碍、括约肌功能明显改善,疼痛改善有效率为90%,运动功能障碍改善有效率为92%,括约肌功能改善有效率为96%,治疗总有效率为92%。结论转移性肿瘤致脊髓压迫征急诊放疗效果较好,患者脊髓的压迫症状明显减轻,供血改善,神经症状、体征可有效缓解,提升患者的生活质量。     

平山病外科治疗的中期临床效果及影像学结果

目的：回顾性分析应用颈前路融合内固定术治疗平山病的中期临床及影像学结果,探讨外科治疗的意义和价值。方法：36例平山病患者采用颈椎前路融合钛板内固定术治疗,观察术后3个月、1年、2年时肌肉萎缩和肌力变化,测量术后C2-7颈椎活动度的改变及C4-7节段中立位颈椎MRI横断面脊髓面积的改变。结果：（1）临床结果：除1例患者外,所有患者术后肌肉萎缩和肌无力无继续进展。随着时间推移,自觉肌无力改善的患者比例逐年增高：术后3个月为26.5%,术后1年为36.0%,术后2年时有85.7%的患者感觉肌力增加;同时肌萎缩改善的患者比例也逐年增高：术后3个月为8.8%,术后1年为24.0%,术后2年时有35.8%的患者感觉肌萎缩好转。截至术后2年随访时段时,14例患者中有12例受累肌力改善,5例肌肉萎缩得到不同程度改善。（2）影像学结果：C2-7颈椎活动度术后较术前显著减小,由术前平均62.25°±2.10°减少为术后2年时平均13.67°±7.51°（P<0.01）。屈曲位MRI脊髓不再受到压迫。颈椎各个节段MR横断面积：术后3个月时仅C6一个节段的面积较术前增大（P<0.05）;术后1年时C4-5-6三个节段面积均较术前增大（均为P<0.01）;术后2年时C4-5-6-7四个节段面积均较术前增大,其中C4脊髓面积增大15.60%、C5增大19.08%、C6增大21.60%、C7增大23.91%,与术前相比差异均具有统计学意义（P<0.05）。结论：前路内固定植骨融合术是治疗平山病的有效方法,可以获得较好的中期临床转归和影像学结果,对于控制平山病的发展和转归有着积极的意义和价值。     

Hepatic actinomycosis

Primary hepatic actinomycosis is seldom seen, and almost all cases have been diagnosed by laparotomy. Treatment with high-dose parental penicillin for prolonged periods is recommended. In the past concomitant surgical drainage also has been recommended, but the nonoperative success reported here and by others suggests that surgical drainage is not essential to the treatment.     

一期后前路联合手术治疗椎管狭窄合并巨大间盘突出脊髓型颈椎病

目的:探讨一期后、前路联合手术治疗椎管狭窄合并巨大间盘突出脊髓型颈椎病的临床疗效和应用价值.方法:回顾分析2007年1月至2010年6月接受该术式的25例患者的临床资料,男17例,女8例,年龄56-74岁,平均60,4岁.结果:本组25例患者经3、6、24月的随访,JOA评分平均改善率分别为63.5%,74.4%,76.5%,术后行X线,MRI复查,内固定无松动,颈髓压迫解除,恢复了圆柱形状.结论:一期后、前路联合手术治疗椎管狭窄合并巨大间盘突出脊髓型颈椎病是一种有效可行的手术方法,能充分解除脊髓压迫,重建颈椎稳定性.优点:缩短治疗周期,消除了二次手术的痛苦,节省了医疗费用.     

Syringomyelia after operation： diagnosis and its formational mechanism

Objective： To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods： Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years （range 2-10 months） by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results： All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid （CSF）. The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion： The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.     

上消化道出血合并截瘫一例

1 病例资料 患者女性,65岁.主因"黑便1 d、呕血 2 h"于2006年12月20日入北京大学第三医院.患者1 d前无明显诱因排黑便1次,量约400 mL,2 h来呕鲜血2次,总量约500 mL,伴头晕、心悸、中上腹不适,无腹痛、晕厥、胸痛等不适.既往史:高血压、冠心病、糖尿病及肾功能不全,近期服用阿司匹林.否认肝病史.入院查体:血压153/93 mm Hg(1 mm Hg=0.133 kPa),脉搏80次/min,外周淋巴结未触及,贫血貌,巩膜无黄染,结膜苍白,双肺呼吸音清,心率80次/min,律齐,未闻及杂音.腹软,剑下压痛,无反跳痛、肌紧张,肝脾未触及,肠鸣音2～3次/min.     

Pathoanatomic investigation of cervical spondylotic myelopathy

Multiple dural sac and spinal cord indentations are often observed on MRI in cervical spondylotic myelopathy. However, it is rare that all of the indented levels contribute to clinical symptoms. Pathological changes in cervical compression myelopathy have previously been reported. Still the critical degree of spinal cord compression needed to induce pathologic changes is unknown. To clearfy this matter the relationships between the spinal cord as well as the dural sac indentations, and pathological changes of the cervical spinal cord were investigated in cadavers. Sixty-eight cadavers were used for this study. The dural sac and the spinal cord were observed especially regarding presence of indentations. The spinal cord was removed from the specimens in order to perform histopathological examination. The indentations of the dural sac and the spinal cord were observed at C4/ 5, C5/6, C6/7 and C3/4 intervertebral levels in order of incidence. However, all of the dural sac indentations were not correlated with spinal cord indentations. Pathological changes in the spinal cord were observed in two specimens with less than 30% of the AP compression ratio. One specimen with 20.9% in the AP compression ratio had remarkable histopathological changes. In the other specimen with 29.6% in the AP compression ratio, diffuse demyelination was distributed in the lateral white matter. The results indicate that the critical degree of the AP compression ratio is 30% to induce histopathological changes in the spinal cord. If a spinal cord indentation in the patient with cervical spondylotic myelopathy on imaging, i.e. MRI, show less than 30% in the AP compression ratio, the clinical symptoms, i.e. numbness, tickling and paresthetic pain, may not be improved after the surgery because of some histopathological changes in the spinal cord.     

Thoracic actinomycosis presented with tracheoesophageal fistula and fatal pulmonary infection

We report a case of a 60-year-old Saudi woman who developed tracheoesophageal fistula and fatal pulmonary infection secondary to thoracic actinomycosis. The cause, clinical presentation, radiological features and treatment of thoracic actinomycosis are discussed.     

Clinics in diagnostic imaging (161). Cervical OPLL with cord compression

A 53-year-old man presented with acute cervical myelopathy following a fall. Cervical radiography and computed tomography showed ossification of the posterior longitudinal ligament (OPLL) from C2 to C6 level, with severe cervical canal stenosis and cord compression. Magnetic resonance imaging further showed increased T2-weighted signal in the spinal cord at the level of greatest central spinal canal stenosis. OPLL is a significant cause of myelopathy in Asian populations and is found in up to 25% of patients presenting with cervical compression myelopathy. The clinical presentation, radiological evaluation and management of OPLL are discussed.