本文選題：腰椎間盤突出 + 腰椎損傷��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:分析損傷后腰椎間盤突出癥的MRI征象,量化分析損傷后腰椎間盤突出癥的MRI數(shù)據(jù),鑒別新鮮與陳舊性椎間盤突出。同時(shí)與CT、X線等影像學(xué)傳統(tǒng)檢查方法相對比,探討MR在法醫(yī)鑒定中的應(yīng)用價(jià)值,為損傷后腰椎間盤突出癥的法醫(yī)學(xué)鑒定中提供客觀指標(biāo)和新方法。材料與方法:收集2012-02~2017-02因腰椎外傷在本院行磁共振檢查的患者共120例,回顧性分析其常規(guī)MRI檢查的影像學(xué)表現(xiàn),并比較其與CT、X線檢查的優(yōu)勢。常規(guī)MR掃描包括軸位及矢狀位TIWI、T2WI和T2脂肪抑制序列,觀察損傷后腰椎間盤突出癥的MRI征象,包括椎間盤突出的部位、椎間盤突出的方向、MRI各序列信號強(qiáng)度特征、脊髓是否出現(xiàn)壓迫癥狀等,測量腰椎MR椎間盤超過正中矢狀線的距離及椎管狹窄程度,根據(jù)椎間盤突出的表現(xiàn)對所得數(shù)據(jù)進(jìn)行分型、統(tǒng)計(jì)。結(jié)果:(1)本組120例損傷后腰椎間盤突出癥最多發(fā)生于腰4/腰5層面及腰5/骶1層面;以中央型數(shù)量最多,其次為旁中央型。(2)本組120例損傷后腰椎間盤突出癥在MRI上以混雜T1WI、混雜T2WI及混雜T2壓脂像信號為主,其次為T1WI、T2WI及T2壓脂像等信號。(3)本組120例損傷后腰椎間盤突出癥有93例脊髓均存在不同程度的受壓改變,61例合并信號改變;120例均存在腰部皮下T1WI低、T2WI高及T2壓脂像高信號影。(4)120例損傷后腰椎間盤突出癥中,腰椎MR上顯示椎間盤超過正中矢狀線的距離范圍為1.03mm-13.39mm,平均為7.32mm;椎管中央矢狀徑范圍為1.11mm-13.97mm,平均為7.68mm;椎管橫徑范圍為7.68mm-29.90mm,平均為19.83mm。(5)新鮮損傷后的突出椎間盤以混雜信號為主,陳舊性損傷后的突出椎間盤在MRI上信號減弱。結(jié)論:(1)損傷后腰椎間盤突出癥的發(fā)生部位及突出類型類似于一般性腰椎間盤突出,以腰4/腰5層面及腰5/骶1層面為主,以中央型及旁中央型為主,因此,當(dāng)患者出現(xiàn)一般性腰椎間盤突出癥狀時(shí),應(yīng)高度警惕合并外傷、復(fù)合傷的可能,此時(shí)應(yīng)進(jìn)行MR檢查或隨訪復(fù)查。(2)損傷后腰椎間盤突出癥在MR上多表現(xiàn)為椎間盤的混雜信號或等信號,其中新鮮損傷后的突出椎間盤以混雜信號為主,陳舊性損傷后的突出椎間盤在MRI上信號減弱,若CT、X線上合并有椎間盤內(nèi)鈣化灶,則更提示為陳舊性損傷。(3)當(dāng)MRI上顯示脊髓受壓改變的同時(shí),信號改變是合并外傷的有力佐證,腰部皮下脂肪間隙的異常信號�？商崾驹\斷。(4)腰椎MR椎間盤超過正中矢狀線的距離的增大、椎管中央矢狀徑的減小以及椎管橫徑的減小可協(xié)助本病的診斷。
[Abstract]:Objective: to analyze the MRI signs of lumbar disc herniation after injury, and to quantitatively analyze the MRI data of lumbar disc herniation after injury, and to distinguish fresh from old disc herniation. At the same time, compared with traditional imaging methods, such as CTX ray, the application value of Mr in forensic identification was discussed, which provided objective index and new method for forensic identification of lumbar disc herniation after injury. Materials and methods: a total of 120 patients with lumbar spine trauma underwent MRI examination in our hospital from 2012-02 to 2017-02. The imaging findings of conventional MRI were analyzed retrospectively, and the advantages of conventional MRI were compared. Conventional Mr scans included axial and sagittal T2WI and T2 fat suppression sequences. The MRI signs of lumbar disc herniation after injury were observed, including the location of disc herniation, the direction of disc herniation and the signal intensity characteristics of each sequence. Whether the spinal cord appeared compression symptoms or not, the distance of lumbar intervertebral disc exceeding the median sagittal line and the degree of spinal canal stenosis were measured, and the data were classified according to the manifestation of disc herniation. Results (1) 120 cases of lumbar intervertebral disc herniation occurred mostly in lumbar 4 / lumbar 5 and lumbar 5 / sac1, and the number of central type was the most. The second was paracentral type.) in this group, 120 cases of lumbar disc herniation after injury were characterized by mixed T 1WI, mixed T2WI and mixed T 2 compression lipography signal on MRI. In this group of 120 cases of lumbar intervertebral disc herniation after injury, 93 cases have different degree of compression changes of spinal cord, 61 cases with signal changes, 120 cases have lumbar subcutaneous T1WI low T 2WI high and T 2 compression imaging. In 120 cases of lumbar disc herniation after injury, The distance between median sagittal line and median sagittal line of lumbar disc was 1.03mm-13.39mm (mean 7.32mm), central sagittal diameter was 1.11mm-13.97mm (mean 7.68mm), transverse diameter of vertebral canal was 7.68mm-29.90mm (mean 19.83mm.5) The signal intensity of the herniated intervertebral disc decreased on MRI after the old injury. Conclusion 1) the location and type of lumbar disc herniation after injury are similar to those of general lumbar disc herniation. The main types of lumbar disc herniation are lumbar 4 / lumbar 5 and lumbar 5 / sac1, and central and paracentric lumbar disc herniation. When patients have general lumbar disc herniation symptoms, they should be highly alert to the possibility of combined trauma and compound injury. At this time, Mr examination or follow-up examination should be performed. 2) after injury, lumbar disc herniation was mostly presented as mixed signal or isointensity of intervertebral disc on Mr, in which the intervertebral disc after fresh injury was mainly characterized by mixed signal. The signal intensity of the herniated intervertebral disc after the old injury was weakened on MRI. If there is calcification in the intervertebral disc on CTX ray, it is more likely to be the old injury. (3) when the changes of spinal cord compression are shown on the MRI, the signal change is a strong evidence of the complicated injury. Abnormal signals in the lumbar subcutaneous fat space often suggest that the increase of the distance between the median sagittal line of the lumbar intervertebral disc, the reduction of the central sagittal diameter of the spinal canal and the reduction of the transverse diameter of the spinal canal may assist in the diagnosis of the disease.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：D919.4

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本文編號：1940411