MR在梨狀肌綜合征的诊断中的应用.ppt

病例 患者女，70岁， 主诉：腰痛伴左下肢放射痛1个月。 专科检查：脊柱无压痛，无放射痛，左臀部压痛，梨状肌紧张试验阴性，左4字征阳性；直腿抬高试验：左50度阳性，加强阴性；右80°阴性。;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;上述临床及影像表现，是否能提示梨状肌综合征可能？;梨状肌综合征的MR表现;梨状肌综合征：亦称梨状肌损伤、梨状孔狭窄综合征或坐骨神经出口综合征。系指因梨状肌发生损伤、痉挛、变性等因素致坐骨神经的梨状孔出口狭窄，从而使通过该孔的坐骨神经和其他骶丛神经及臀部血管遭受牵拉、压迫并产生相关的临床症状。本病是引起干性坐骨神经痛常见的原因之一。;梨状肌的解剖;坐骨神经是人体最粗大的神经，起始于腰骶部的脊髓，途径骨盆，并从坐骨大孔穿出，抵达臀部，然后沿大腿后面下行到足。;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;病理基础 梨状肌与坐骨神经的解剖关系密切，当其发生变异时，将导致坐骨神经受压迫或刺激而产生梨状肌综合征，此种异常也是梨状肌综合征导致坐骨神经痛的主要原因。臀部外伤出血、粘连、疤痕形成、注射药物使梨状肌变性、纤维痉挛，均可损伤梨状肌。;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;梨状肌综合征的临床症状;梨状肌综合征的专科检查;梨状肌综合征的正常MR表现;由脊柱全长矢状位获得骶２～３椎体水平垂直骶骨纵轴横断影像,后以梨状肌长轴为标志得到坐骨神经斜矢状位影像。;PROSET序列斜冠状位显示坐骨神经解剖;斜冠状位 SPACE 序列扫描;梨状肌综合征的MR诊断;腰椎未见明显畸形，腰椎活动度正常，腰部棘突及双侧棘旁无明显叩压痛，无放射痛；左侧梨状肌压痛，无放射痛；直腿抬高试验双80度阴性，双侧股神经牵拉试验阴性，梨状肌紧张试验阳性，左髋4字征阳性；双下肢感觉肌力正常；双侧腱反射正常，病理征未引