摘要
目的：分析引起腰椎管狭窄症患者椎管狭窄的形态特点，指导临床手术治疗。方法：我院门诊及住院120例患者，男62例，女58例，年龄45~76岁，平均57.2岁，分为4个年龄段（40~49岁29例、50~59岁42例、60~69岁33例、70~79岁16例），所有患者常规行腰椎MRI检查。观察椎板、椎管、黄韧带、小关节的形态特点，测量L2/3、L3/4、L4/5、L5/S1轴位经椎间盘关节突平面黄韧带厚度、椎板厚度、椎管矢状径及椎管冠状径；分析各测量参数在不同年龄段、椎体节段的变化特点。结果：椎管狭窄类型：中央型椎管狭窄27例、侧隐窝型狭窄35例、混合型58例；小关节增生：单侧33例、双侧87例；椎管形态：“三角形”76例、“三叶草形”44例；黄韧带平均厚度在L2/3（2.4 mm）、L5/S1（3.1 mm）轻于L3/4（3.7 mm）、L4/5（4.5 mm）；随着年龄增加，黄韧带厚度增加，且L4/5增厚最明显；椎板厚度在L5节段最小4.5 mm，在L3节段最大，为5.8 mm，椎管冠状径在L4/5节段最小4.7 mm，在L2/3节段最大，为10.3 mm，二者随着年龄增加，在各个椎体节段变化不明显；黄韧带增厚，椎管冠状径变小。结论：①黄韧带增生肥厚引起椎管冠状径变小、双侧关节突关节尤其是上关节突增生内聚是椎管狭窄的主要因素；②手术时应扩大椎管的冠状径，切除黄韧带及部分关节突、扩大侧隐窝，保留棘突复合体。
Abstract
Objective: To analyze the cause and morphologic characteristics of lumbar spinal stenosis in the guidance of treatment planning. Materials and Methods: Altogether 120 patients including 62 males and 58 females, age ranged from 45~76 years old, with an average of 57.2 years old. The patients were divided into 4 groups, that is 29 cases in the 40~49 years old group, 42 cases in the 50~59 years old group, 33 cases in the 60~69 years old group, and 16 cases in the 70~79 years old group. All the patients had MRI examinations of the lumbar spine. The morphologic characteristics of spinal laminae, spinal canal, ligamentum flavum, and articular joints were observed. The lamina thickness, anterior-posterior diameter of the spinal canal on sagittal view and transverse diameter of spinal canal on coronal view were measured. The thickness of ligamentum flavum was measured on axial view at the level of L2/L3, L3/L4, L4/L5 articular joints. The changes of the measured parameters at different ages and different spinal segments were analyzed. Results: The type of spinal stenosis: central type 27 cases, lateral recess stenosis 35 cases, mixed type 58 cases, proliferation of articular joints: unilateral 33 cases, bilateral 87 cases; the shape of the spinal canal: “triangle” 76 cases, cloverleaf 44 cases. The average thickness of ligamentum flavum at L2/L3 was 2.4 mm, at L5/S1 was 3.1 mm, which was thinner than 3.7 mm at the level of L3/L4, at the level of L4/L5 was 4.5 mm. The thickness of ligamentum flavum increased with increasing age, the increase of thickness was most obvious at the level of L4/L5. The thickness of spinal lamina was 4.5 mm at L5, which was the minimum and 5.8 mm at L3 which was the maximum. The transverse diameter of the spinal canal on coronal view was 4.7 mm at the level of L4/L5 which was the minimum, and maximum of 10.3 mm at the level of L2/L3. The changes of these parameters was not obvious with increasing of age. As the thickness of ligamentum flavum increased, the transverse diameter of spinal canal on coronal view decreased. Conclusions: ①Increase thickness of ligamentum flavum caused the decrease of the transverse diameter of the spinal canal on coronal view, bilateral articular joint especially the superior articular joint hyperplasia with inner aggregation is the main factor causes spinal stenosis. ②During operation should increase the transverse diameter of the spinal canal on coronal view, excise the thickened ligamentum flavum and the hyperplastic part of the articular process, expand the lateral recess, and preserve the spinal process complex.
关键词
椎管狭窄 /
腰椎 /
磁共振成像
Key words
Spinal stenosis /
Lumbar vertebrae /
Magnetic resonance imaging
邢文华;郝利霞;霍洪军;杨学军;肖宇龙;李 峰;辛大奇.
腰椎管狭窄症椎管狭窄的MRI测量及其临床意义[J]. 中国临床医学影像杂志. 2014, 25(9): 645-648
XING Wen-hua;HAO Li-xia;HUO Hong-jun;YANG Xue-jun;XIAO Yu-long;LI Feng;XIN Da-qi.
Clinical significance of measuring lumbar spinal stenosis on MRI[J]. Journal of China Clinic Medical Imaging. 2014, 25(9): 645-648
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