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目的探讨转移瘤硬膜外脊髓压迫症(MESCC)瘫痪状态与影像学特征的相关性。方法 2006年7月-2008年12月,对连续收治的56例MESCC患者按Frankel分级进行瘫痪状态评估,并对86个主要病变脊椎进行MRI及CT扫描。主要病变脊椎影像学评估因素包括:病变脊椎节段、侵犯硬膜囊、累及椎板、椎体后壁向后突出、病变脊椎连续、累及椎弓根、椎体前柱骨折、椎体后壁骨折、病变脊椎位于上胸椎和(或)颈胸交界。结果多重回归方程表明MESCC瘫痪状态与侵犯硬膜囊、椎体后壁向后突出、椎体前柱骨折、病变脊椎位于上胸椎和(或)颈胸交界等主要病变脊椎影像学特征存在线性回归关系。回归方程决定系数R~2=0.856,校正决定系数R_c ~2=0.841。标准化回归系数显示,侵犯椎管内硬膜外间隙对MESCC瘫痪状态影响最大。结论采用侵犯椎管内硬膜外间隙的影像学特征预测MESCC患者瘫痪状态的发生具有明显滞后性。椎体后壁向后突出可预示MESCC患者的神经学不稳定。位于上胸椎和(或)颈胸交界的主要病变脊椎常连续发生且易发生运动功能损害。累及椎板的转移瘤易于向椎管内硬膜外间隙侵犯。椎体前柱骨折不能用以预测MESCC患者的运动功能损害。
Objective To investigate the correlation between paralytic status and imaging features of metastatic epidural spinal cord compression (MESCC). Methods From July 2006 to December 2008, 56 consecutive patients with MESCC underwent Frankel classification for paralysis assessment. MRI and CT scans were performed on 86 major lesions of the spine. The major lesion spine imaging assessment factors include: lesions of the spinal segment, the invasion of the dural sac, involving the lamina, the posterior wall of the vertebral body protruding back and forth, lesions of the spine continuous, involving the pedicle, anterior vertebral fractures, posterior vertebral wall Fracture, lesions in the upper thoracic vertebra and (or) neck and chest junction. Results The multiple regression equation showed that there was a linear regression of the imaging features of the main lesions such as paralysis of MESCC, infiltration of the dural sac, posterior vertebral wall posterior projection, anterior vertebral column fracture, lesion vertebra located in the upper thoracic vertebra and / or cervical-thorax junction relationship. The regression equation determines the coefficient R ~ 2 = 0.856 and the correction coefficient R_c ~ 2 = 0.841. The standardized regression coefficients showed that the invasion of spinal epidural space had the greatest impact on the paralysis of MESCC. Conclusion The imaging features of the epidural space of the spinal canal are used to predict the paralysis of MESCC patients with obvious hysteresis. Backward posterior wall of the vertebral body predicts neurological instability in MESCC patients. Located in the upper thoracic vertebrae and (or) cervical spine at the junction of the main lesion often occur continuously and prone to motor impairment. Metastatic tumors involving the lamina are prone to invasion of the epidural space in the spinal canal. Anterior vertebral column fractures can not be used to predict motor function impairment in MESCC patients.