【作者】 张强；

【导师】 范顺武；

【作者基本信息】 浙江大学 ， 骨外科（专业学位）， 2016， 硕士

【摘要】 目的分析腰椎管狭窄症患者马尾神经冗余征(RNRs)的MR的特点,来推断RNRs的形成机制和危险因素。方法回顾性研究2014年1月至2016年3月被诊断为腰椎管狭窄症的住院病人222例,将其分为冗余组和非冗余组,病例选择标准是MR上腰椎硬膜囊水平面最狭窄的面积至少小于100平方毫米或椎管前后径小于10mm。通过测量分析最狭窄处硬膜囊横断位面积、冗余神经根的相对长度、狭窄处椎间盘突出是否锐利和是否多节段狭窄等指标来统计分析。结果冗余组的58例,非冗余组164例,冗余组年龄67.3±9.8岁,非冗余组年龄57.1±12.4岁,差异有统计学意义(p<0.05)。腰椎管最狭窄位置在L2-L4位置时,更容易发生冗余,差异有统计学意义(p<0.05)。冗余组最狭窄的硬膜囊面积是45.2±16.3平方毫米,非冗余组最狭窄的的硬膜囊面积是60.3±21.5平方毫米,差异有统计学意义(P<0.05)。冗余组的狭窄处突起锐利的有31例,非锐利的有27例,非冗余组锐利的有26例,非锐利的有138例,差异有统计学意义(p<0.05)。冗余组多节段狭窄的有24例,单节段狭窄的有34例,非冗余组多节段狭窄的有45例,单节段狭窄的有119例,差异有统计学意义(P<0.05)。在冗余组里面,多节段狭窄时冗余神经根相对长度是2.89±1.00,单节段的相对长度为2.19±0.68,差异有统计学意义(P<0.05)。结论马尾神经冗余征在是一种影像学表现,在腰椎管狭窄症的患者中较常见,年龄、腰椎管狭窄程度、狭窄位置、狭窄处锐利突起和多节段狭窄都是RNRs的相关危险因素。更多还原

【Abstract】 ObjectiveThe purpose of this study was to evaluate magnetic resonance (MR)-detected redundant nerve roots (RNRs) of the cauda equina in patients with lumbar spinal canal stenosis.MethodsA retrospective study was conducted of 222 lumbar spinal canal stenosis patients between January 2014 and March 2016. Patients were divided into two groups with and without RNRs. The dural sac cross-sectional area (CSA) and anteroposterior diameter were measured on T2w axial MRI. The inclusion criterion for the lumbar spinal canal stenosis was a dural sac CSA 100 mm2 or anteroposterior diameter 10mm in at least one measured level. The cross-sectional area (CSA) of the dural sac, the intra canal protuberances in the site of stenosis and the length of the RNRs relative to the height of the upper vertebral body of the level of the stenosis were measured.ResultsRNRs were detected in 26.1% of the patients. The mean age of the patients with RNRs was 67.3±9.8 years, and the patients without RNRs was 57.1±12.4 years(p<0.05). The patients with RNRs, the spinal canal stenosis was significantly more frequent at L2-4(p<0.05). The maximum stenosis of the patients with RNRs was 45.2±16.3 mm2, and without RNRs was 60.3±21.5(p<0.05). The presence of an intracanal protuberance with sharp margin in the site of the stenosis(OR=6.1) and the presence of the multilevel lumbar spinal stenosis (OR=1.9) were independent risk factors for the development of RNRs. The mean relative length of the RNRs was significantly higher in patients with multilevel lumbar spinal stenosis than those with single level lumbar spinal stenosis(p<0.05).ConclusionsWith an occurrence rate of 26.1%, RNRs of the cauda equina are not uncommon in cases with lumbar spinal canal stenosis. Advanced age, the degree of the maximum lumbar spinal canal stenosis, a canal stenosis at L2-4, the presence of a sharp intracanal protuberance in the site of the stenosis, and the presence of the multilevel lumbar spinal stenosis are the related risk factors.更多还原