CAJ | 학술논문

目的探讨经MRI判断翼状韧带损伤程度，并以此作为制定治疗方案依据的可行性。方法（1）患者入组标准：有明确的颅颈交界区外伤史，并且受伤时间在1周以内。无颅底及颈部手术史，无MRI检查禁忌证。共计109例患者入组。（2）影像检查：采用3.0 T超导MR，在翼状韧带ROI内行高分辨率质子密度加权成像（proton density weighted image, PDWI）。根据MR影像特点将韧带损伤分3度。Ⅰ度损伤MR主要表现为韧带出现局限性条状或斑片状高信号，异常信号未及韧带边缘，Ⅱ度损伤MR表现为韧带内出现斜行或横行高信号，异常信号达韧带边缘，Ⅲ度损伤表现为韧带撕裂大于韧带横径的1/2或完全断裂。（3）治疗：Ⅰ度损伤采用保守治疗，Ⅱ、Ⅲ度损伤采取手术治疗。（4）随访：分别于治疗后3、6个月对患者的临床症状改善情况进行随访，同时行影像复查。其间患者如有不适随时就诊。保守治疗者，随访期内临床症状渐进性缓解，6个月时MR成像病灶不同程度缩小或消失，认为恢复良好，随访期内临床症状渐进性加重，认为病情进展；手术治疗效果主要通过患者临床症状、颈部运动功能恢复情况及DR寰枢关节情况判定。临床症状渐进性缓解，6个月时DR成像寰枢椎关节对位良好，认为恢复良好。结果（1）高分辨MR PDWI成像显示78患者韧带无损伤，31例翼状韧带不同程度损伤，其中Ⅰ度损伤18例、Ⅱ度损伤9例、Ⅲ度损伤4例。（2）Ⅰ度损伤患者采取保守治疗，随访均恢复良好。6例Ⅱ度损伤者进行手术治疗，随访均恢复良好；3例保守治疗者，2例临床症状渐进性加重，于保守治疗3个月时行手术治疗，术后恢复良好。4例Ⅲ度损伤患者均采用手术治疗，1例术中出现呼吸衰竭，抢救无效死亡；余3例手术顺利，术后恢复良好。结论高分辨PDWI是一种评价翼状韧带损伤程度的有效方法，Ⅰ度损伤建议采用保守治疗，Ⅱ度以上损伤建议早期手术治疗。目的探討經MRI判斷翼狀韌帶損傷程度，併以此作為製定治療方案依據的可行性。方法（1）患者入組標準：有明確的顱頸交界區外傷史，併且受傷時間在1週以內。無顱底及頸部手術史，無MRI檢查禁忌證。共計109例患者入組。（2）影像檢查：採用3.0 T超導MR，在翼狀韌帶ROI內行高分辨率質子密度加權成像（proton density weighted image, PDWI）。根據MR影像特點將韌帶損傷分3度。Ⅰ度損傷MR主要錶現為韌帶齣現跼限性條狀或斑片狀高信號，異常信號未及韌帶邊緣，Ⅱ度損傷MR錶現為韌帶內齣現斜行或橫行高信號，異常信號達韌帶邊緣，Ⅲ度損傷錶現為韌帶撕裂大于韌帶橫徑的1/2或完全斷裂。（3）治療：Ⅰ度損傷採用保守治療，Ⅱ、Ⅲ度損傷採取手術治療。（4）隨訪：分彆于治療後3、6箇月對患者的臨床癥狀改善情況進行隨訪，同時行影像複查。其間患者如有不適隨時就診。保守治療者，隨訪期內臨床癥狀漸進性緩解，6箇月時MR成像病竈不同程度縮小或消失，認為恢複良好，隨訪期內臨床癥狀漸進性加重，認為病情進展；手術治療效果主要通過患者臨床癥狀、頸部運動功能恢複情況及DR寰樞關節情況判定。臨床癥狀漸進性緩解，6箇月時DR成像寰樞椎關節對位良好，認為恢複良好。結果（1）高分辨MR PDWI成像顯示78患者韌帶無損傷，31例翼狀韌帶不同程度損傷，其中Ⅰ度損傷18例、Ⅱ度損傷9例、Ⅲ度損傷4例。（2）Ⅰ度損傷患者採取保守治療，隨訪均恢複良好。6例Ⅱ度損傷者進行手術治療，隨訪均恢複良好；3例保守治療者，2例臨床癥狀漸進性加重，于保守治療3箇月時行手術治療，術後恢複良好。4例Ⅲ度損傷患者均採用手術治療，1例術中齣現呼吸衰竭，搶救無效死亡；餘3例手術順利，術後恢複良好。結論高分辨PDWI是一種評價翼狀韌帶損傷程度的有效方法，Ⅰ度損傷建議採用保守治療，Ⅱ度以上損傷建議早期手術治療。
목적탐토경MRI판단익상인대손상정도，병이차작위제정치료방안의거적가행성。방법（1）환자입조표준：유명학적로경교계구외상사，병차수상시간재1주이내。무로저급경부수술사，무MRI검사금기증。공계109례환자입조。（2）영상검사：채용3.0 T초도MR，재익상인대ROI내행고분변솔질자밀도가권성상（proton density weighted image, PDWI）。근거MR영상특점장인대손상분3도。Ⅰ도손상MR주요표현위인대출현국한성조상혹반편상고신호，이상신호미급인대변연，Ⅱ도손상MR표현위인대내출현사행혹횡행고신호，이상신호체인대변연，Ⅲ도손상표현위인대시렬대우인대횡경적1/2혹완전단렬。（3）치료：Ⅰ도손상채용보수치료，Ⅱ、Ⅲ도손상채취수술치료。（4）수방：분별우치료후3、6개월대환자적림상증상개선정황진행수방，동시행영상복사。기간환자여유불괄수시취진。보수치료자，수방기내림상증상점진성완해，6개월시MR성상병조불동정도축소혹소실，인위회복량호，수방기내림상증상점진성가중，인위병정진전；수술치료효과주요통과환자림상증상、경부운동공능회복정황급DR환추관절정황판정。림상증상점진성완해，6개월시DR성상환추추관절대위량호，인위회복량호。결과（1）고분변MR PDWI성상현시78환자인대무손상，31례익상인대불동정도손상，기중Ⅰ도손상18례、Ⅱ도손상9례、Ⅲ도손상4례。（2）Ⅰ도손상환자채취보수치료，수방균회복량호。6례Ⅱ도손상자진행수술치료，수방균회복량호；3례보수치료자，2례림상증상점진성가중，우보수치료3개월시행수술치료，술후회복량호。4례Ⅲ도손상환자균채용수술치료，1례술중출현호흡쇠갈，창구무효사망；여3례수술순리，술후회복량호。결론고분변PDWI시일충평개익상인대손상정도적유효방법，Ⅰ도손상건의채용보수치료，Ⅱ도이상손상건의조기수술치료。
Objective To investigate the imaging features of alar ligament and its extent, and provide the basis forclinical treatment.Methods 3.0 T superconducting MRI was used to scan the alar ligament with high resolution PDWI sequence (Proton density weighted imaging, PDWI)in 109 patients of emergency admissions due to head and neck trauma. Based on imaging features, ligamentous injury was classified into three degrees(Ⅰ to Ⅲ degrees).Patients with Ⅰ degree ligamentous injury were treated conservatively, andⅡtoⅢdegree injury patients were treated with surgery, then follow-up was performed with MRI for the recovery of ligaments and clinical evaluation for symptoms (6 months follow-up period). Results High-resolution PDWI showed 78 patients with no ligament injury.On follow-up, patients recovered well (atlantoaxial joint motor function and clinical symptoms). Thirty one patients had alar ligament injury in varying degrees, of which 18 patients had grade Ⅰ injury, nine patients had degree Ⅱinjury, and four patients had degreeⅢinjury .All gradeⅠinjury patients received conservative treatment. Follow-up of patients showed good recovery, MR revealed the lesions shrank in varying degrees or disappear. <br> Six gradeⅡinjury patients had surgical treatment, and three received conservative treatment. On follow-up, seven patients had a good recovery, two patients underwent surgical treatment within 3 months after injury and recovered well.Three gradeⅢpatients treated by surgery, and all with good recovery postoperative, and a patient died of respiratory failure. Conclusions High resolution PDWI is an effective tool to evaluate the extent of the alar ligament injury. Grade Ⅰ ligamentous injury patients treated conservatively can achieve good results, GradeⅡandⅢligamentous injury patients should receive surgical treatment early.