摘要
目的探讨骶骨骨折合并骶神经损伤的MRI诊断及其临床意义。方法1999年10月-2007年10月,对20例DenisⅡ型骶骨骨折合并骶神经损伤患者采用显示骶神经全长的骶骨斜冠状位MRI扫描,观察神经走行及毗邻关系。其中男17例,女3例;年龄30～55岁。受伤至入院时间1d～23个月。致伤原因:车祸伤10例,重物砸伤8例,挤压伤2例。合并耻骨骨折8例,尿道断裂4例。行常规骨盆X线片、CT、螺旋CT三维重建检查。X线片示骶骨外侧骨折块向后上方移位,骶孔线模糊、扭曲变形、左右不对称;CT示骶管于不同断面水平存在左右不对称及骨折侧结构紊乱、骶骨外侧骨折块向后上方移位,同时存在压缩且向骶骨中央突入。根据临床表现、美国国立脊髓损伤学会和国际截瘫学会1990年推荐的脊髓损伤神经分类标准、与MRI正常侧对比及Gierada等的研究结果进行临床及MRI诊断,并进行手术验证。结果临床诊断S1神经根损伤17例,S2神经根损伤14例,S3神经根损伤7例,S4神经根损伤6例;MRI诊断S1神经根损伤17例,S2神经根损伤14例,S3神经根损伤3例,S4神经根损伤2例;手术证实S1神经根损伤17例,S2神经根损伤14例,S3神经根损伤7例,S4神经根损伤1例。骶骨斜冠状位MRI扫描示骶神经全长及周围毗邻关系,骶神经损伤时发现有骨块压迫、神经根走行改变5例,损伤处神经根周围脂肪消失19例,骶管狭窄17例,骶神经出现异常增粗11例。结论骶骨斜冠状位MRI扫描对于骶神经损伤定位及定性诊断有重要价值。
Objective To study the MRI diagnosis of sacral fracture with sacral neurological damage and its clinical application. Methods From October 1999 to October 2007, 20 cases of sacral fracture （Denis classification, Type Ⅱ） with sacral neurological damage were examined by oblique coronal MRI of sacrum to show the whole length of sacral nerve. There were 17 males and 3 females, aged 30-55 years. The time from injury to hospitalization varied from 1 day to 23 months. The injury was caused by traffic accident in 10 cases, smash of heavy object in 8 cases and crush in 2 cases. Eight cases were accompanied by pubis fracture and 4 cases by urethral disruption. All patients accepted the examination of X-ray, CT and spiral CT 3D reconstruction. X-ray showed the displacement of fracture fragment was backwards and upwards, and sacral-hole line was vague, asymmetric and distorted. CT showed that sacral neural tube was left-right asymmetry, the displacement of fracture fragment was backwards and upwards, combining with the compression and intruding to sacrum center at different section levels. The clinical manifestations, international standards for Neurological Classification of Spinal Cord Injury recommended by American Spinal Injury Association International Spinal Cord Society, comparison between normal and abnormal MR1 and Gierada＇s results were the basis for clinical diagnose and MRI diagnose, which was confirmed by operation. Results Nerve injury diagnosed by clinical manifestation were S1 （17 cases）, S2 （14 cases）, S3 （7 cases）, and S4 （6 cases）. Nerve injury diagnosed by MRI were S1 （17 cases）, S2 （14 cases）, S3 （3 cases）, and S4 （2 cases）. Nerve injury confirmed by operation were S1 （17 cases）, S2 （14 cases）, S3 （7 cases）, and S （1 case）. Oblique coronal MRI of sacrum showed the whole length of sacral nerve and its adjacent relationship, detecting bone fragment compression and route alteration of never were evident in 5 cases, the fat disappearance around the site of nerve root injury in 19 cases, narrowness of sacral nerve canal in 17 cases and the abnormally enlarged sacral nerve in 11 cases. Conclusion Oblique coronal MRI of sacrum is of great value in the localization and the qualitative diagnosis of sacral neurological damage.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第9期1096-1099,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
骶骨骨折
骶神经损伤
MRJ诊断
Sacral fractures Sacral nerves injury MRI diagnosis
