椎管内硬膜外血管脂肪瘤一例_胡富碧

典型小病例回顾-骶管脂肪瘤
椎管内脂肪瘤是一种少见的先天性肿瘤，常合并其他先天性畸形，如脊柱裂、脊膜膨出等。

该病发病机理尚不清楚，1、神经管闭合时包含一些移位的中胚层成分所致，2、软脊膜早期的毛细血管网残留，引起周围间胚细胞分化成脂肪细胞，形成脂肪瘤，3、外伤引起硬脊膜外脂肪组织移植所致。

椎管脂肪瘤可位于硬脊膜内外或髓内。

硬膜外多见于颈胸段，髓外硬膜下发生于髓外、软脊膜下，肿瘤可向髓内和硬脊膜外发展，髓内肿瘤表面覆盖正常的神经组织。

椎管内脂肪瘤生长较缓慢，由于较多位于脊髓背侧，以肢体麻木常见，当肿瘤过大，出现脊髓压迫症状。

CT检查肿瘤呈均匀的低密度改变，CT值为-70~-120Hu，边缘清楚，增强后无强化。

MRI检查表现为T1WI、T2WI上高信号，压脂序列瘤体信号极低甚至无信号。

Advances in Clinical Medicine 临床医学进展, 2023, 13(9), 13784-13788 Published Online September 2023 in Hans. https:///journal/acm https:///10.12677/acm.2023.1391926硬膜外血管脂肪瘤的MRI 表现：1例病例汇报 张百慧1，黄明刚2*1西安医学院研究生院，陕西 西安 2陕西省人民医院CT 室，陕西 西安收稿日期：2023年7月29日；录用日期：2023年8月21日；发布日期：2023年8月29日摘要 患者，女，61岁，主诉腰酸困双下肢坠胀半年，加重2月，专科查体发现椎旁双侧椎旁叩击痛阳性，双下肢屈肌及伸肌感觉减退；胸腰椎MRI 平扫示：胸12-腰1椎体节段左侧椎间孔走行区见团片状稍短T1稍长T2信号影，界欠清，形态欠规整，大小约：1.1 cm × 1.0 cm × 2.5 cm ，临近脊髓受压向右移位，压脂序列上见病变内小斑点状的信号减低，周围椎旁软组织内见斑片状压脂高信号影，增强扫描病变整体呈明显强化，其内见小斑点状无强化区域；MRI 诊断：海绵状血管瘤，神经源性肿瘤不除外；术后病理诊断：胸12-腰1神经根管血管脂肪瘤。

关键词血管脂肪瘤，椎管内硬膜外，核磁共振MRI Presentation of Epidural Angiolipoma: A Case ReportBaihui Zhang 1, Minggang Huang 2*1Graduate School, Xi’an Medical University, Xi’an Shaanxi 2CT Room of Shaanxi Provincial People’s Hospital, Xi’an ShaanxiReceived: Jul. 29th , 2023; accepted: Aug. 21st , 2023; published: Aug. 29th , 2023AbstractA 61-year-old female patient complained of lumbar soreness and swelling of both lower limbs for *通讯作者。

椎管内硬膜外血管脂肪瘤磁共振表现（6例报道及文献复习）MRI of spinal epidural angiolipomas(six cases report and review of the literature)戚荣丰，张宗军，卢光明，张龙江，朱宗明（南京大学医学院临床学院南京军区总医院影像科，江苏南京210002）QI Rong-feng,ZHANG Zong-jun,LU Guang-ming,ZHANG Long-jiang,ZHU Zong-ming (Clinical College of Medical School,Nanjing University;Department of Medical Imaging,Nanjing General Hospital of Nanjing Military Command,PLA,Nanjing 210002,China)[关键词]血管脂瘤；磁共振成像[中图分类号]R 730.262；R 445.2[文献标识码]B [文章编号]1008－1062（2009）10－0791－03[收稿日期]2009－03－09；[修回日期]2009－04－08[作者简介]戚荣丰（1984－），男，江苏兴化人，在读硕士研究生。

[通讯作者]张宗军，南京军区总医院影像科，210002。

血管脂肪瘤是由血管及脂肪组织构成的常见的良性肿瘤[1]，常发生于躯干及肢体皮下组织，发生于椎管内的比较罕见，国外报道占所有椎管内肿瘤的0.04%～1.2%，占所有椎管内硬膜外肿瘤的2%～3%[2-5]。

本病由Berenbruch 于1890年首次报道，截至目前，国外报道约100例[6-7]，国内报道不足40例，文献报道以个案为主[8]。

该病分为两种亚型：非浸润型和浸润型，前者占绝大多数，常局限于硬膜外，后者常浸润周围组织，尤其是椎体骨组织[9-10]。

本文收集在我院接受手术治疗并经病理证实的6例患者，对该肿瘤MRI 表现进行分析，并回顾国内外文献，以期提高正确诊断能力。

-1262-Chinese Journal of New Clinical Medicine,December2020,Volume13,Number12临床论著腰5/骶1节段不同程度硬膜外脂肪增多的影像学特征黄策，张丰艺，夏振元，廖丽岚，潘云学，彭起奎作者单位：533300广西，田林县人民医院放射科(黄策,张丰艺，廖丽岚,潘云学，彭起奎)；530007南宁，广西医科大学第二附属医院放射科(夏振元)作者简介：黄策(1976-),男，大学本科，医学学士，主治医师,研究方向：医学影像诊断。

************************［摘要］目的探讨腰5/紙1节段不同程度硬膜外脂肪增多的影像学特征。

方法收集75例腰5/紙1节段不同程度硬膜外脂肪增多患者的磁共振成像(MRI)影像资料，分析脂肪增多部位、形态特征以及硬膜囊盲端位置和受压特点。

结果所有患者硬膜外脂肪均呈绫带状，位于硬膜囊腹侧72例，背侧3例。

轻度21例，仅2例(9.5%)硬膜囊受压，矩形1例,不规则1例,盲端随机位于S】椎体节段平面。

中度31例,14例(45.2%)硬膜囊受压,不规则8例,“Y”形4例,三角形2例,24例(77.4%)盲管位于S】中部至L5下缘平面。

重度23例，硬膜囊均明显受压(100.0%)，表现为“Y”形9例，不规则形7例，星形3例,点线形3例,三角形1例,19例(82.6%)盲端约平于L5下缘平面。

结论腰5/紙1节段不同程度硬膜外脂肪增多MRI表现具有一定特征性，且分级越高,硬膜囊受压比例越高,认识这些征象，有助于提示临床注意。

［关键词］硬膜外脂肪增多症；腰椎；磁共振成像［中图分类号］R445.2［文献标识码］A［文章编号］1674-3806(2020)12-1262-03dA：10.3969/j.Pti1674-3806.2020.12.19Imaging feateres of differeni degrees of epid—al lipomatosis in L5/S1segmeei HUANG Ce,ZHANG Fengqi,XIA Zheo-quan,et aO Department of Radiology,he People0Hospital of Tianlio County,Guangxi533300,China [Abstract]Objective To explore the imaging features of ddferent degrees of epidural lipomatosis in L5/S1segment.Meeeode Themagneticeesonanceimaging(MRI)dataoo75patientswith di o e eentdegeeesooepidueaiii-pomatosisin L5jS1segmentweeeco i ected,and theiocation and moephoiogicaichaeacteeisticsooiipomatosisaswe i asthe location and compression characteristies of the blind end of dural sac were analyzed.Resets The imaging featuresoodi o e eentdegeeesooepidueaiiipomatosisin L5jS1segmentin a i thecasesweeein damask eibbons,amongwhom,theoocusoo72caseswasiocated in theeenteaisideoodueaisacand theoocusoo3casesin thedoesaiside.Theeeweee21mild cases,including only2cases(9.5%)of dural sac compression,1case of recOngle and1case of imeguTrity,and thebiind end waseandomiyiocated on S1piane.Theeeweee31modeeatecases,inciuding14cases(45.2%)oodural sac compression,8cases of imeguTrity,4cases of“Y”shape,2cases of Wiangle,and the blind tubes of24cases(77.4%)were located in the middle of S]to the Twei edge of L5.There were23severe cases,whose duralsacs were obviously compressed(100.0%),showing+Y”shape in9cases,imeguTr shape in7cases,star shape in3cases,dot-line shape in3cases,Wiangle in1case,and the blind end of19cases(82.6%)was approximately Oatto the Twei edge of L5.Conclrsion DiPerent degrees of epidural lipomatosis in L5/S1segment show certain charao-teeiticHin MRIoindingH,and thehigheethegeade,thehigheethepeopoetion oodueaiHaccompee H ion.Undeetandingthese signs is helpful to prompting clinical attention.[Key words]Spinal epidural lipomatosis(SEL)；Lumbai spine；Mayne t ie resonance imaging(MRI)硬膜外脂肪组织增多是一种临床少见的硬膜外脂肪组织病理性增多的现象，以腰5/骶1节段多见。

•经验交流•症状性腰椎管硬膜外脂肪增多症的诊断与手术治疗顾仕荣，张明，陈斌辉，桑裴铭，方海名(宁波市医疗中心李惠利医院骨科，浙江宁波315000)【摘要】目的:探讨症状性腰椎管硬膜外脂肪增多症的诊断与手术治疗的临床疗效。

方法：回顾性分析2012年2月至2018年11月进行压迫节段的半椎板切除椎间融合内固定术治疗的19例症状性腰椎管内硬膜外脂肪增多症患者的临床资料，其中男7例，女12例；年龄48~72(57.6±1.2冤岁；病程6~60(18.6±5.1)个月曰减压平面:L q^-L s S］平面4例，L2,3-L4,s平面5例丄3,4-L4,5平面2例丄3,4-^1平面6例丄4,5」$平面2例遥分别于术前、术后6个月采用视觉模拟疼痛评分(visual analogue scale,VAS)评价腿疼和腰疼的缓解程度，采用Oswestry功能障碍指数评分(Oswestry Dis-abilityIndex,ODI)评价功能恢复情况，并采用Fischgrund标准判定总体疗效遥结果：所有患者获随访，随访时间12~37(16.3±3.8)个月遥19例患者均顺利完成手术，椎管內压迫节段脂肪组织全部摘除遥手术时间125〜260(186±15)min,出血量150~500(280±46)ml遥2例患者出现部分切口脂肪液化渗液不愈，经切口撑开去除积液后积极换药抗炎处理后愈合遥所有患者无马尾神经损伤、脑脊液漏、钉棒断裂等并发症。

术前腰痛、腿疼VAS评分分别为(5.3±0.7)、(6.8±0.8)分，术后6个月分别为(2.1±0.4)、(2.3±0.5冤分，术后6个月与术前比较差异有统计学意义(><0.05)遥术后6个月ODI评分(12.1±2.3)分较术前(45.5±2.8)分明显改善(><0.05)遥根据Fischgrund标准，本组优13例，良4例，可2例遥结论：症状性腰椎管硬膜外脂肪增多症患者进行压迫节段的半椎板切除椎间融合內固定手术，可解除硬脊膜及马尾神经的压迫，术后能取得较好的临床疗效遥【关键词】椎管；硬膜；骨折固定术，內中图分类号:R744.2DOI：10.12200/j.issn.l003-0034.2021.05.012开放科学(资源服务)标识码(OSID)：匚.Diagnosis and surgical treatment of symptomatic lumbar spinal epidural liposis GU Shi・rong,ZHANG Ming,CHEN月in-hui,S粤晕G>^i・ming,and云粤晕G Hamming.Department o枣Orthopaedics,晕ingbo Medico/Treatment Centre Li Hui/i Hos-pita/,晕ingbo315000,Zhe/iang,ChinaABSTRACT Objective：To explore diagnosis and surgical treatment of symptomatic lumbar spinal epidural lipoplasia. Methods:A retrospective analysis of19patients with symptomatic lumbar spinal epidural hyperplasia treated with hemil­aminectomy and interbody fusion and internal fixation from February2012to November2018were performed袁including7males and12females袁aged from48to72years old with an average of(57.6±1.2)years old；the course of disease ranged from6to60months with an average of(18.6±5.1)months；plane requiring decompression:L2,3-L5S i on4cases,L2,3-L4,5on5cas-es,L3,4-L4,5on2cases,L3,4-L5S i on6cases,L4,5-L5S i on2cases.Visual analogue scale(VAS)before operation and6monthsafter opertaion were used to evaluate relief of leg pain and back pain,Oswestry Disability Index(ODI)was used to evaluate re­covery of functiona,and Fischgrund was used to assess overall efficacy.Results:All patients were followed up from12to37 months with an average of(16.3±3.8)months.Ninteen patients were successfully completed operation袁and all adipose tissuesin the compressed segment of the spinal canal were removed.Operation time was from125to260min with an average of(186±15)min,and blood bleeding was from150to500ml with an average of(280±46)ml.Two patients occurred partial incision fat liquefaction and exudate did not heal袁the incision was opened to remove effusion,the dressing was changed and anti-inflam­matory treatments were performed.No complications such as cauda equina injury,cerebrospinal fluid leakage,and broken nails occurred.Preopertaive VAS of back pain and leg pain were5.3±0.7and6.8±0.8,respectively袁while2.1±0.4and2.3±0.5re­spectively at6months after opertaion,there were statistical significant difference between6months after operation and before operation(>0.05).Postoperative ODI score at6months was12.1±2.3袁and significantly improved than that of before opera­tion45.5±2.8(>0.05).According to Fischgrund criteria,13patients got excellent result,4good,and2fair.Conclusion:Pa­tients with symptomatic lumbar spinal epidural lipoplasia undergo hemilaminectomy and internal fixation of compression seg-通讯作者:张明E-mail:*************Corresponding author：ZHANG Ming E-mail:zmwxh@ment could relieve compression of dura mater and cauda equina,and fchieve good clinicfl results. KEYWORDS Spinal canal；Dura mater；Fracture fixjtion,internfl椎管内脂肪充填硬膜外间隙中，是椎管内的重要成分，它给了硬膜囊足够的缓冲空间，但是当椎管内的脂肪过度沉积时，它也会压迫硬膜囊和脊髓从而引起脊髓的压迫症状。