磁共振扩散张量成像精准确定退行性脊柱侧凸责任节段的临床意义
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南京医科大学第一附属医院

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国家自然科学基金项目面上项目(编号:81772351)


Accurate localization of the symptomatic nerve roots of patients with adult degenerative scoliosis using diffusion tensor imaging
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1.the First Affliated Hospital with Nanjing Medical University;2.The First Affiliated Hospital of Nanjing Medical University

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    摘要:

    背景:在退变性脊柱侧弯诊治中,症状神经根的判断主要依据患者的症状及体征。由于脊柱旋转畸形,常规的MRI并不能准确选取椎间盘水平进行扫描,往往对诊断提供不了帮助。本实验主要通过MR扩散张量成像(DTI)来对脊柱侧弯病例中的症状神经根进行诊断,通过与症状体征诊断及神经根封闭术进行对照,评估其有效性。 目的:探讨MR扩散张量成像(DTI)相关参数与退变性脊柱侧凸(ADS)病人中神经根症状的关系,评价术前术后症状缓解情况,探讨DTI在脊柱侧凸神经根定位诊断的优势。方法:临床诊断为退变性脊柱侧凸的病人36例,行常规MRI及DTI检查,定量测量腰椎各神经根各向异性分数(FA)。应用T检验比较有症状及无神经症状神经根FA值的差异。对患者进行术前术后临床评价,并进行T检验评价手术的临床效果。结果:症状神经根与无症状神经根FA值有显著差异(P<0.01),DTI神经根定位与患者症状定位基本相符。术后患者JOA、VAS-BP、VAS-LP评分较术前明显改善;术后Cobb角明显矫正。结论:FA值能够作为判定症状神经根的依据,并与临床症状相一致。根据DTI结果进行精准神经根减压,术后症状缓解好。因此, DTI可以作为退变性脊柱侧凸患者神经根定位的有效辅助手段。

    Abstract:

    Background: In the diagnosis and treatment of adult degenerative scoliosis (ADS), the localization of symptomatic nerve roots is mainly based on the symptoms and signs of patients. Because of spinal rotation deformity, conventional MRI cannot accurately select the level of intervertebral disc for scanning. In the present study, MR diffusion tensor imaging (DTI) was used to diagnose symptomatic nerve roots in patients with ADS, and its effectiveness was evaluated by comparing with diagnosis based on symptoms and signs of nerve root block. Methods: Thirty-six patients who were clinically diagnosed to have ADS underwent routine MRI and DTI examinations, and fractional anisotropy (FA) of each nerve root in the lumbar spine was quantitatively measured. The t-test was used to compare the FA values of nerve roots with and without neurological symptoms. Preoperative and postoperative clinical evaluations were conducted on the patients, and the t-test was used to evaluate the clinical effects of surgery. Results: The FA values of symptomatic and asymptomatic nerve roots were significantly different (P<0.01). The DTI findings of symptomatic nerve roots were consistent with the diagnosis based on symptoms and nerve root block. The Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), Visual Analog Scale-Back Pain (VAS-BP), and Visual Analog Scale-Leg Pain (VAS-LP) scores of the postoperative patients were significantly improved as compared to those in the preoperation stage; the Cobb, Lumbar Lordosis (LL), Pelvic Tilt (PT), and Sacral Slope (SS) angles were corrected significantly post operation. Conclusion: The FA value can be used as a marker for predicting symptomatic nerve root and is consistent with clinical symptoms. According to the results of DTI, precise nerve root decompression can relieve the symptoms. Therefore, DTI can be used as an effective auxiliary method for symptomatic nerve root localization in patients with degenerative scoliosis.

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  • 收稿日期:2021-10-20
  • 最后修改日期:2021-11-10
  • 录用日期:2021-12-16
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