摘要
目的探讨术中颈椎间盘造影在诊断颈椎损伤和颈椎病方面的价值，并检验MRI在诊断颈椎损伤和颈椎病方面的价值。方法2006年1月-2007年2月，对30例颈椎损伤患者行前路切开复位、椎间盘摘除（含椎体次全切除）、取髂骨植骨钛钢板内固定术，术中对拟切除间盘及邻近间盘进行造影，共造影105个椎间盘，切除45个椎间盘，术中观察前纵韧带的损伤情况，造影观察颈椎间盘和后纵韧带的损伤情况。13例颈椎病患者，术中对41个椎间盘进行造影，切除15个椎间盘。所有患者术前均由同一名放射科有经验的主任医师阅读MRI片，对颈椎损伤情况做出诊断。造影由术者执行。结果MRI诊断前纵韧带损伤：灵敏度为85．00％，特异度为90．00％；诊断后纵韧带损伤：灵敏度为64．28％，特异度为93．75％；诊断椎间盘损伤：灵敏度为73．17％，特异度为75％。术中颈椎间盘造影诊断间盘损伤41个，灵敏度为100％，特异度为100％。13例颈椎病患者，术前MRI诊断病变间盘13个，术造影椎间盘41个，诊断病变间盘15个，手术切除15个。结果发现漏诊2例，误诊0例。因颈椎病患者病例数较少，本研究未计算灵敏度和特异度，仅对其造影图像进行了分析总结。对所有造影图像分析发现，后纵韧带断裂和椎间盘损伤均有特征性改变。结论术中颈椎间盘造影，在明确手术的必要性及手术节段的选择方面具有独到的优势；术中椎间盘造影是X线、CT和MRI检查必要的有益的补充。
Objective To evaluate the cervical intraoperative discography and magnetic resonance imaging （MRI） in diagnosis of cervical injuries. Methods From January 2006 to February 2007, 30 patients with cervical injuries were treated surgically in our department. Cervical intraoperative discography was performed by the operator for all the discs to be excised and their nearby discs （105 discs altogether） to observe the injury to posterior longitudinal ligaments and discs. The injury to the anterior longitudinal liga- ments was explored during operation. Images of discography were recorded by fluoroscopy. The same senior radiologist examined the MRI films of all the patients to make a diagnosis of their cervical injury. The diagnoses were compared with the findings of the exploration. The sensitivity and specificity of intraoperative discography and MRI were calculated. Results The sensitivity and specificity of MRI for anterior longitudinal ligament injury were 85.00% and 90. 00%, for posterior longitudinal ligament injury were 64. 28% and 93.75%, and for disc injury were 73. 17% and 75.00%. The sensitivity and specificity of intraoperative discography for disc injury were 100%. Conclusions The intraoperative cervical discography has a particular advantage in definitely determining whether the operation is necessary and which segment should be fused. The intraoperative discography is a necessary supplement to X-ray, CT and MRI.
出处
《中华创伤骨科杂志》
CAS
CSCD
2007年第11期1042-1045,共4页
Chinese Journal of Orthopaedic Trauma
关键词
磁共振成像
颈椎
椎间盘
造影
Magnetic resonance imaging
Cervical vertebrae
Intervertebral disk
Intraoper-ative discography
