螺旋CT多平面重建在骶骨骨折合并骶神经损伤治疗决策中的意义

目的 探讨螺旋CT多平面重建技术在骶骨骨折合并骶神经损伤中的诊断及手术指导意义.方法 2007年4月至2009年4月,对10例合并骶神经损伤的骶骨骨折患者采用显示骶神经根管全长的骶骨双斜位MPR技术,观察骶神经根管骨折情况以及骨块与神经根的位置关系.其中男7例,女3例;年龄30～55岁.受伤至入院时间1～30 d.致伤原因:车祸伤6例,重物砸伤3例,挤压伤1例.将所有患者进行双斜位(45°斜冠状位和30°斜矢状位)MPR检查后可清晰的显示骶神经根管的骨折情况,并进行临床验证.结果 根据临床表现、美国国立脊髓损伤学会和国际截瘫学会的脊髓损伤神经分类标准进行临床诊断:S1神经根损伤6例,S2神经根损伤2例,S1、S2神经根均损伤2例,经双斜位MPR检查后发现S1神经根管有骨折块进入3例,S2神经根管1例,S1、S2神经根管均有骨折块进入2例,此6例患者经手术证实(术中所见S1、S2神经被骨折块压迫),去除压迫后症状明显缓解,平均12周症状消失;而其余4例患者(S1神经损伤3例,S2神经损伤1例)经双斜位MPR检查后未发现骨折块进入骶神经根管(考虑单纯神经挫伤),予保守治疗平均13周症状消失.结论 骶骨双斜位MPR技术对于骶神经损伤性质的判定、定位诊断以及制定手术方案具有重要的临床意义,应作为骶骨骨折的常规检查.

Abstract：

Objective To study diagnostic and surgical significance of the multiplanar reconstrudion ( MPR)of spiral CT in sacral fracture with sacral neurological damage. Methods From April 2007 to April 2009, 10 cases of sacral fracture with sacral neurological damage in Shengjing Hospital of China Medical University were examined by double-oblique MPR of sacrum to show a total length of the sacral neural tube ,and observate course of sacral neural tube and the relationship between fracture and the neural tube. There were 7 males and 3 females, aged 30-55 years. The time from injury to hospitalization varied from 1 day to 1 months. The injury was caused by traffic accident in 6 cases, smash of heavy object in 3 cases and crush in 1 cases. All patients were examined with double-oblique MPR ( coronal oblique 45 degrees and 30 degrees oblique-shaped bit lost)to display the course of sacral neural tube and the condition of clearly, which was confirmed by operation and clinical validation. Results The clinical manifestations and international standards for Neurological Classifi cation of Spinal Cord Injury recommended by American Spinal Injury Association International Spinal Cord Society were the basis for clinical diagnose. Nerve injury diagnosed by clinical manifestation were S1 (6 cases), S2 (2 cases) ,S1 and S2(2 cases). After double-oblique MPR in patients ,we found 3 patients have fractures in sacral neural tube of S1, 1 patients in S2,and 2 patients both in S1 and S2,whom recovered average 12 month after operation( S1 and S2 nerve were pressed by fractures according to operating observation); And there were no fractures in sacral neural tube of other patients ( 3cases in S1, 1 cases in S2),these were contund, whom were recoverd average 13 month after expectant treatment. Conclusions Double-oblique MPR of sacrum has important clinical significance in diagnosis of nature and location with sacral nerve injury, as well as surgical planning. It can be used as routine examination of patients with sacral fracture.

Significance of double-oblique multiplanar reconstruction of the treatment decision-making in sacral fracture with sacral neurological damage

Objective To study diagnostic and surgical significance of the multiplanar reconstrudion ( MPR)of spiral CT in sacral fracture with sacral neurological damage. Methods From April 2007 to April 2009, 10 cases of sacral fracture with sacral neurological damage in Shengjing Hospital of China Medical University were examined by double-oblique MPR of sacrum to show a total length of the sacral neural tube ,and observate course of sacral neural tube and the relationship between fracture and the neural tube. There were 7 males and 3 females, aged 30-55 years. The time from injury to hospitalization varied from 1 day to 1 months. The injury was caused by traffic accident in 6 cases, smash of heavy object in 3 cases and crush in 1 cases. All patients were examined with double-oblique MPR ( coronal oblique 45 degrees and 30 degrees oblique-shaped bit lost)to display the course of sacral neural tube and the condition of clearly, which was confirmed by operation and clinical validation. Results The clinical manifestations and international standards for Neurological Classifi cation of Spinal Cord Injury recommended by American Spinal Injury Association International Spinal Cord Society were the basis for clinical diagnose. Nerve injury diagnosed by clinical manifestation were S1 (6 cases), S2 (2 cases) ,S1 and S2(2 cases). After double-oblique MPR in patients ,we found 3 patients have fractures in sacral neural tube of S1, 1 patients in S2,and 2 patients both in S1 and S2,whom recovered average 12 month after operation( S1 and S2 nerve were pressed by fractures according to operating observation); And there were no fractures in sacral neural tube of other patients ( 3cases in S1, 1 cases in S2),these were contund, whom were recoverd average 13 month after expectant treatment. Conclusions Double-oblique MPR of sacrum has important clinical significance in diagnosis of nature and location with sacral nerve injury, as well as surgical planning. It can be used as routine examination of patients with sacral fracture.