本文選題：黃韌帶骨化癥　切入點：胸椎管狹窄癥　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的通過回顧性分析黃韌帶骨化所致胸椎狹窄癥(thoracic ossification of the ligamentum flavum,TOLF)CT聯(lián)合MRI的影像學表現(xiàn),概括TOLF合并硬脊膜骨化粘連的影像學表現(xiàn),探討TOLF致胸椎管狹窄癥中CT聯(lián)合MRI硬脊膜骨化粘連征象的診斷價值,以期指導臨床制定最佳手術(shù)方案,并探討硬脊膜粘連對胸椎管狹窄癥的影響。方法選取自2010年6月到2016年9月期間于青島大學附屬醫(yī)院經(jīng)同一骨科醫(yī)師實施后路一期手術(shù)治療胸椎黃韌帶骨化癥患者63名進行隨訪,采集患者病程、手術(shù)時間、術(shù)中出血量、術(shù)后住院天數(shù)、術(shù)后并發(fā)癥情況,運用胸椎管狹窄癥改良JOA評分標準對術(shù)前及術(shù)后末次隨訪進行評分。對所有患者行X線、CT和MRI檢查,觀察患者影像學征象,所有患者根據(jù)術(shù)前一周內(nèi)行CT聯(lián)合MRI檢查的結(jié)果分為2組:研究組和對照組,研究組20例:CT上出現(xiàn)“車軌征”、“逗號征”、“橋洞征”三者之一且MRI存在“鋸齒線樣征”;對照組43例:不出現(xiàn)或CT和MRI不同時出現(xiàn)影像征象。所有患者所行影像學檢查均由我院放射科采集并報告,對于影像學特征性征象已由放射科副主任醫(yī)師及以上復核無誤。以手術(shù)中所見硬脊膜與黃韌帶粘連作為診斷硬脊膜粘連的“金標準”。術(shù)前CT聯(lián)合MRI檢查所見影像征象與之比較,計算特異性和敏感性,并得出陽性似然比(陽性似然比5,表明具有參考價值;陽性似然比10,表明有診斷價值)。所有患者以術(shù)中所見為標準分為分粘連組和未粘連組,對比兩組手術(shù)時間、術(shù)中出血量、術(shù)后住院天數(shù)、術(shù)后恢復率及術(shù)后腦脊液漏發(fā)生情況。結(jié)果1.研究組中CT以及MRI均出現(xiàn)特征性征象者20例;對照組中單獨出現(xiàn)CT特征性征象者19例,其中“車軌征”11例,“逗號征”5例,“橋洞征”3例,單獨出現(xiàn)MRI“鋸齒線樣征”3例;兩者均無21例。2.術(shù)中發(fā)現(xiàn)共19例患者存在硬脊膜粘連,其中研究組中15例,對照組中4例。3.CT出現(xiàn)“車軌征”或“橋洞征”或“逗號征”且MRI上呈“鋸齒線樣征”的陽性似然比最高為6.93;單獨CT出現(xiàn)“車軌征”的陽性似然比為4.81;單獨CT出現(xiàn)“逗號征”的陽性似然比為1.54;單獨CT出現(xiàn)“骨橋征”的陽性似然比為1.73;單獨MRI出現(xiàn)“鋸齒狀線征”的陽性似然比為3.22。4.粘連組手術(shù)時間為90.9±30.9分鐘/每節(jié)段,未粘連組手術(shù)時間為64.5±23.3分鐘/每節(jié)段,差別有統(tǒng)計學意義;粘連組術(shù)后住院天數(shù)為10.44±2.15天,未粘連組術(shù)后住院天數(shù)為8.84±2.08天,差別有統(tǒng)計學意義。粘連組術(shù)后腦脊液漏發(fā)生率為57.9%,未粘連組術(shù)后腦脊液漏發(fā)生率為18.2%。結(jié)論1.術(shù)前CT聯(lián)合MRI對黃韌帶增厚致胸椎管狹窄患者硬脊膜粘連的診斷具有參考價值。2.硬脊膜發(fā)生粘連會延長手術(shù)時間,增加大手術(shù)及麻醉風險,術(shù)后腦脊液漏發(fā)生率高,延長術(shù)后恢復周期,術(shù)前明確診斷對于評估術(shù)后及術(shù)前交待病情有指導意義。
[Abstract]:Objective to summarize the imaging findings of thoracic spinal stenosis caused by ossification of ligamentum flavum by thoracic ossification of the ligamentum TOLFN combined with MRI, and to summarize the imaging findings of TOLF complicated with ossification of dura dura. To investigate the diagnostic value of CT and MRI epidural ossification in thoracic spinal canal stenosis caused by TOLF in order to guide clinical work out the best operation plan. To explore the effect of dural adhesion on thoracic spinal canal stenosis methods from June 2010 to September 2016, the patients with ossification of ligamentum flavum of thoracic vertebra were treated by one stage operation by the same orthopedic surgeon in the affiliated hospital of Qingdao university. 63 of them were followed up. The course of disease, the time of operation, the amount of intraoperative bleeding, the days of hospitalization after operation, and the postoperative complications were collected. The preoperative and postoperative follow-up were evaluated with modified JOA score of thoracic spinal stenosis. All patients were examined by X-ray CT and MRI. All the patients were divided into two groups according to the results of CT and MRI examination within one week before operation: the study group and the control group. In the study group, 20 cases had "car-track sign", "comma sign", "bridge hole sign" and MRI had "serrated linear sign" in 20 cases of CT, and 43 cases in control group: no sign or CT and MRI were not present at the same time. All the patients underwent imaging examination. All the examinations were collected and reported by the radiology department of our hospital. The imaging characteristic signs have been checked by the deputy chief physician of radiology department and above. The adhesion of dura mater and ligamentum flavum seen during operation was taken as the "golden standard" for the diagnosis of dura mater adhesions. The imaging signs of CT and MRI before operation were compared with them. The specificity and sensitivity were calculated, and the positive likelihood ratio (5 positive likelihood ratio, 5 positive likelihood ratio, 10 positive likelihood ratio) was calculated, indicating diagnostic value. All patients were divided into adhesive group and non-adhesion group according to intraoperative criteria. The operative time, intraoperative bleeding volume, postoperative hospital stay, postoperative recovery rate and cerebrospinal fluid leakage were compared between the two groups. Results 1. In the study group, 20 cases had characteristic signs of CT and MRI. In the control group, there were 19 cases with characteristic CT signs, including 11 cases of "vehicle-track sign", 5 cases of "comma sign", 3 cases of "bridge hole sign" and 3 cases of MRI "sawtooth line sign", none of them had 21 cases of dural adhesion during operation. There were 15 cases in the study group. In the control group, 4 cases. 3. Ct showed "vehicle-track sign" or "bridge hole sign" or "comma sign" and the highest positive likelihood ratio of "serrated linear sign" on MRI was 6.93; the positive likelihood ratio of single CT sign of "vehicle-track sign" was 4.81; and that of CT alone was 4.81. The positive likelihood ratio of "comma sign" was 1.54, the positive likelihood ratio of "bone bridge sign" on CT was 1.73, the positive likelihood ratio of "serrated line sign" on MRI was 3.22.4.The operative time of adhesive group was 90.9 鹵30.9 minutes / segment. The postoperative hospitalization time was 10.44 鹵2.15 days in the adhesion group and 8.84 鹵2.08 days in the non-adhesion group. The incidence of cerebrospinal fluid leakage was 57.9 in adhesion group and 18.2 in non-adhesion group. Conclusion 1. Ct combined with MRI before operation is a diagnostic tool for dural adhesion in patients with thoracic spinal canal stenosis caused by thickening of ligamentum flavum. Have reference value. 2.The dura mater adhesions can prolong the operation time, Increasing the risk of major surgery and anesthesia, high incidence of cerebrospinal fluid leakage, prolonging the postoperative recovery period, preoperative diagnosis for the evaluation of postoperative and preoperative state of the disease has a guiding significance.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R681.5;R445.2;R816.8

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