儿童脊柱结核的MRI随访观察

目的：探讨MRI在儿童脊柱结核随访中的应用价值.方法：对2004年2月至2013年4月的21例经临床或手术诊断为脊柱结核的儿童患者MRI表现进行回顾性分析,其中男11例,女10例;年龄2～14岁,平均9.4岁.18例保守治疗,3倒手术治疗,病程2个月～3年,所有病例行2次或2次以上MRI检查.比较初次和复查结果,主要观察椎体及椎间隙信号变化、椎旁脓肿及后凸角的变化.结果：21例脊柱结核患者共累及85个椎体,其中颈椎、胸椎及腰骶椎发生率分别为10.6％（9/85）,49.4％ （42/85）及40％（34/85）.初诊及随访时相仿,15例出现椎体变扁或楔形变,10例可见椎间盘受累,而椎间隙可见不同程度变窄或融合.初诊13例后凸角＞0°,位于胸段7例,胸腰段2例,腰段3例,颈段1例.18例保守治疗患儿中,8例初诊及治疗过程中（2～9个月）后凸角均为0°;1例轻度后凸患儿（＜10°）,治疗12个月时后凸角稍增加;5例中度后凸患儿（10°～30°）,治疗过程中（3～12个月）多次随访均无明显改变;4例重度后凸患儿（＞30°）,保守治疗过程中及治疗后（3～28个月）多次随访后凸畸形均有不同程度加重,其中1例保守治疗失败后行手术治疗后凸角减小.结论：儿童脊柱结核运用MRI随访具有重要意义,能够清晰显示治疗后椎体及椎间隙信号变化、椎旁脓肿及后凸角的变化,为临床治疗及评估预后提供参考.

MRI-based follow-up study of spinal tuberculosis in children

Objective: To investigate the value of MRI follow-up in pediatric patients with spinal tuberculosis.Methods: From February 2004 to April 2013,MRI imaging data in 21 children with spinal tuberculosis by pathologically and clinically proven were retrospectively analysed. There were 11 males and 10 males,with an average age of 9.4 years old ranging from 2 to 14 years old. Eighteen patients were received conservative treatment,3 patients were treated by surgical operation. The course of disease ranged from 2 months to 3 years. All cases underwent two or more MRI examinations for follow-up. MRI findings of the first and second examination were comparatively analyzed,including signal changes of vertebral body and intervertebral,paraspinal abscess and the change of kyphosis angle.Results: In the 21 cases with tuberculosis,85 vertebral bodies were affected in total,including 10.6%(9/85),49.4%(42/85) and 40%(34/85) vertebral bodies separately in the cervical,thoracic,lumbosacral spine. Follow-up MRI showed vertebral body shape and signal had no obvious change during or after treatment,15 cases with vertebral bodies changed flat or cuneate,10 cases with disc involvement,and intervertebral space became narrowing at different level. Among 13 patients with kyphosis angle greater than 0°,7 were located on thoracic,2,3,1 were on thoracolumbar,lumbar and cervical spine,respectively. Among 18 cases with conservative treatment,kyphosis angle were 0° on the first and the follow up MRI of 8 patients. One case of mild(<10°) kyphosis,follow-up MRI during therapy showed the angle slightly increased;5 cases with moderate (10° to 30°),follow-up MRI during therapy showed no obvious change;4 cases with severe(>30°),follow-up MRI during and after therapy showed kyphosis increased in varying degrees.Conclusion: Follow-up MRI can make a big difference in the spinal tuberculosis of children;it can clearly show the change of the vertebral body and intervertebral space,paraspinal abscess and the kyphosis angle after the treatment,which can provide reference for clinical treatment and estimating prognosis.