MRI在产瘫节前损伤中的诊断价值

目的探讨MRI在产瘫节前损伤中的诊断价值。方法2006年11月-2008年2月,收治产瘫患儿10例。男8例,女2例;年龄2个月～3岁,平均11.4个月。左侧7例,右侧3例。临床分型按Tassin分型:Ⅱ型2例,Ⅲ型6例,Ⅳ型2例。术前均行臂丛神经MRI检查,并与术中探查情况进行比较。结果术前MRI检查1例未见异常,9例创伤性脊膜囊肿。其中脊髓偏移6例,向健侧偏移4例,向患侧偏移2例;脊髓变形6例;撕脱神经根增粗2例。MRI检查神经根为阳性19根中,术中探查真阳性16根,假阳性3根;MRI检查阴性6根中,假阴性2根,真阴性4根。MRI对产瘫节前损伤诊断的敏感性为84.2%、特异性为80.0%和准确性为83.3%,结果具有统计学意义(P<0.05),即MRI检查结果与术中探查结果一致。结论MRI能显示产瘫节前损伤情况,对产瘫的早期诊断及手术时机的选择有参考作用,可作为术前的常规检查。

VALUE OF MRI IN DIAGNOSIS OF OBSTETRICAL BRACHIAL PLEXUS PALSY PRE-GANGLIONIC INJURY

Objective To evaluate the value of MRI in diagnosis of obstetrical brachial plexus palsy pre-ganglionic injury.Methods From November 2006 to February 2008,10 patients with obstetrical brachial plexus palsy were treated,8 males and 2 females,aged from 2 months to 3 years(11.4 months on average).There were 7 cases of left side and 3 of right side.According to Tassin classification,2 cases were type II,6 type III and 2 type IV.All patients were performed MRI examinations before the operation,whose results were compared with those of exploration during the operation.Results MRI examinations showed 1 patient was normal and 9 patients had post-traumatic spinalmeningolcele.The 6 patients had displacement of spinal cord(4 towards the healthy side and 2 towards the sick side),6 had deformity of spinal cord,and 2 had avulsed nerve root thickening.MRI detected 19 nerve roots were positive,16 were true positive and 3 false positive in surgical exploration.MRI detected 6 nerve roots were negative,4 were true negative and 2 false negative in surgical exploration.The sensitivity,specificity and accuracy of MRI in diagnosis of obstetrical brachial plexus palsy pre-ganglionic injury were 84.2%,80.0%and 83.3%,respectively.There were significant differences in the results by preoperative MRI examinations and by exploration during the operation(P<0.05).Conclusion MRI can show pre-ganglionic injury of brachial plexus of the patients with obstetrical brachial plexus palsy and can supply references for early diagnosis and operation time.MRI can be routinely conducted as a preoperative examination.