屈伸位颈椎MR扫描对颈椎管狭窄程度的研究

目的：研究颈椎管狭窄者在颈椎屈伸位下椎管狭窄程度的变化。方法：30例颈椎管狭窄,男13例,女17例;年龄28～66岁,平均39岁。颈椎椎管矢状径10mm以下即绝对狭窄者12例,颈椎椎管矢状径10～12mm即相对狭窄者18例．均行中立、前屈、后伸位MR扫描,获取MR图像后评价颈椎管的狭窄程度和颈髓受压情况的变化,结果：颈椎管狭窄者在后伸位上出现颈椎管狭窄加重19例,较前屈位8例明显多（P〈0．05）。结论：对于颈椎管狭窄的影像学诊断,屈伸位颈椎MR扫描可较好地补充常规中立位MR检查,而且后伸位MR较中立位和前屈位更具敏感性     

颈椎动力位MRI在颈椎病临床诊治中的作用

目的通过颈椎动力位MRI检查测定颈椎病发生发展中的静力性和动力性因素,探讨动力位MRI埘颈椎病早期诊断并早期干预、手术治疗的指导意义。方法对15位被检者行日本骨科学会（Japanese Orthopaedic Association,JOA）评分、颈椎X线及MRI检查．测量Pavlov比值、腹背侧蛛下腔矢状径、脊髓及蛛下腔正中矢状径、脊髓及蛛下腔面积,蛛下腔狭窄度分级,计算脊髓／蛛下腔矢状径比、面积比．进行过屈、中立、过伸3种体位间比较。将JOA评分与部分测量指标进行相关性研究。结果Pavlov比值示8例骨性椎管狭窄。腹背侧蛛下腔狭窄程度在过屈位有一定缓解,过伸位有一定加重;过屈位与过伸位问差异有统计学意义（P〈0．05）。JOA评分与Pavlov比值、面积比有相关性。结论颈椎动力位MRI能反映颈椎在屈伸位变化时内部结构的变化,对临床诊断、干预及手术均有一定的意义。     

颈椎过伸伤患者MRI椎前高信号、椎管矢状径与神经功能的相关性分析

目的:探讨成人无骨折脱位型颈椎过伸伤患者MRI椎前高信号、椎管矢状径与神经功能的相关性。方法:回顾性分析2010年9月至2013年12月收治的无骨折脱位型颈椎过伸伤患者病例资料100例,根据MRI T2序列有无椎前高信号分为椎前高信号组和无椎前高信号组,其中椎前高信号组39例,男31例,女8例,年龄21～83岁,平均(58.10±14.78)岁;无椎前高信号组61例,男49例,女12例,年龄32～77岁,平均(55.05±10.36)岁。通过MRI正中矢状面测量下颈椎各椎间盘层面椎管矢状径,并记录年龄、性别、受伤原因及椎管狭窄节段数;采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经功能分级及运动评分对神经功能进行评价。 结果:ASIA运动评分椎前高信号组为52.56±31.97,无椎前高信号组为67.70±22.83,两组差异有统计学意义(P=0.013);椎前高信号组患者的髓内高信号发生率明显高于无椎前高信号组(P=0.006);两组患者ASIA运动评分与损伤节段椎间盘层面椎管矢状径存在正相关(P=0.003),且椎管狭窄节段越多,ASIA分级越差。结论:成人无骨折脱位颈椎过伸伤MRI椎前高信号、椎管矢状径均与伤后神经功能相关,而存在多节段椎管狭窄的患者更易遭受严重的颈髓损伤。     

腰椎神经根冠状位、矢状位和轴位MR扫描定位诊断腰椎椎间孔狭窄症

 目的 探讨腰椎神经根冠状位、矢状位和轴位 MR 扫描定位诊断腰椎椎间孔狭窄症的可行性和有效性。方法回顾性分析 2006 年 6 月至 2011 年 6 月共 21 例腰椎椎间孔狭窄患者的相关资料,男 10 例,女 11 例;年龄 36~65 岁, 平均 45.6 岁。病史 6~36 个月,平均 9.4 个月。5 例表现为腰痛伴单侧下肢痛,16 例为单侧下肢痛。根据腰椎侧位 X 线片测量椎间隙和椎间孔高度并行腰椎神经根冠状位、矢状位和轴位 MR 扫描检查,了解神经根周围组织结构的改变,定位诊断神经根受压部位;并通过手术证实影像学诊断的准确性。结果 21 例患者中 9 例为椎间盘突出导致椎间孔狭窄,12 例为椎间盘弥漫性膨出合并关节突关节增生、肥大导致椎间孔狭窄;21 例均为下腰椎椎间孔横向狭窄,20 例为 L4,5 椎间孔狭窄,造成 L4 神经根受压;1 例为 L5S1 椎间孔狭窄,造成 L5 神经根受压。经手术探查证实与术前定位诊断完全符合,符合率为 100%（21/21）。术后 20 例患者下肢疼痛症状完全缓解,1 例下肢疼痛症状缓解不满意。结论 腰椎神经根冠状位、矢状位和轴位 MRI 扫描方法能准确定位诊断椎间孔狭窄,为确定手术方案提供了准确的影像学依据。     

脊髓型颈椎病患者颈椎动态MRI检查价值与安全性分析

目的 探究脊髓型颈椎病（CSM）患者颈椎动态MRI（DMRI）检查的价值与安全性。方法 2019年1月—2021年9月，87例CSM患者于苏州大学附属第二医院行颈椎DMRI检查。在矢状面前屈、后伸和中立位MRI T2加权像上观察是否存在脊髓隐匿性压迫。记录患者在DMRI检查前后的症状及体征、疼痛视觉模拟量表（VAS）评分。以DMRI检查后原有症状或体征加重或出现新的症状与体征考虑为短期内脊髓损伤加重。结果 87例患者中17例（19.5%）存在脊髓隐匿性压迫，其中2例在前屈位MRI检查中发现，15例在后伸位MRI检查中发现。DMRI检查后73例患者无明显不适，出现颈肩部不适5例，轻度头晕4例，呼吸不畅、轻度胸闷3例，恶心2例，DMRI检查后VAS评分无下降。85例患者无脊髓神经损伤加重，2例脊髓钳夹伴MRI T2加权像高信号改变患者检查后症状、体征加重。结论 颈椎DMRI是一种相对安全的补充检查，19.5%（17/87）的CSM患者在屈、伸位MRI检查中可发现脊髓隐匿压迫，脊髓钳夹损伤伴MRI T2加权像高信号改变的CSM患者应慎行DMRI检查。     

CT辅助腰椎终板形态学研究

目的：通过计算机断层扫描技术对健康成人腰椎终板结构进行解剖测量与研究,为腰椎假体的优化设计与临床应用提供有益指导。方法：有偿征集60名健康成人（男女均等）,签署知情同意书后于西安交通大学第二附属医院影像科行全腰段CT扫描。将扫描数据导入计算机辅助软件Mimics 16.0进行三维重建及测量。采集指标包括正中矢状径、最大冠状径,凹陷深度、正中矢状面凹陷角,冠状面凹陷角等共9项,最后利用统计学软件对采集数据进行统计学分析。结果：上下终板的正中矢状径与最大冠状径不但具有性别差异（P<0.05）,而且随着腰椎序列的增加呈增大趋势。上下终板凹陷深度无性别差异（P>0.05）,自L₁至L₅变化较小,分别在1.5~2.0 mm与2.2~3.9 mm波动;同一序列男性下终板凹陷深度大于上终板且差异有统计学意义（P<0.05）,而女性上下终板凹陷深度比较差异无统计学意义（P>0.05）。上下终板矢状面凹陷角与冠状面凹陷角随着椎体序数的增加整体变化较小而且绝大部分椎体序列上矢状面与冠状面凹陷角均无性别差异（P>0.05）。统计学显示靠近尾侧腰椎终板最大凹陷处位于终板平面偏背侧。结论：人体腰椎终板解剖结构比较复杂,熟悉掌握终板解剖参数以及术前充分利用CT辅助测量对于腰椎假体的研制及临床应用具有重要意义。     

颈椎动力位MRI在脊髓型颈椎病诊治中的作用

目的探讨颈椎动力位MRI在脊髓型颈椎病诊治中的作用。方法分别测量42例患者共59节病变节段在颈椎过屈、中立、过伸位时的硬膜囊中矢径与脊髓中矢径,对比两者在不同体位下的变化。结果 59节病变节段,在过屈、中立、过伸位时,测出平均硬膜囊中矢径分别是:(7.63±0.90)mm,(6.48±0.82)mm,(5.85±0.89)mm;平均脊髓中矢径分别是:(6.44±0.80)mm,(5.81±0.82)mm,(5.56±0.82)mm。在过伸位时,硬膜囊中矢径与脊髓中矢径之间差值最小(0.29±0.60)mm(P0.01),脊髓代偿空间最小。结论在脊髓型患者中,颈椎病动力位MRI可以显示脊髓在不同体位下动态受压变化,对其治疗方式的选择有极大帮助。     

术中颈椎持续牵引的有限元分析

目的分析在颈椎术中持续牵引的安全性。方法采集志愿者颈椎薄层CT扫描数据,以DICOM格式保存,使用医学三维重建软件进行全颈椎三维有限元模型建立,应用模型优化软件对模型进行优化,以STL格式文件导入到有限元分析软件进行有限元分析,对模型施加10Nm纯扭矩模拟颈椎中立位、前屈位及过伸位,再施加50~300N的牵引力,测量不同三维运动状态下颈椎管长度、椎管横径及矢状径的变化。结果在颈椎中立、前屈及后伸三种不同运动状态下,随着牵引重量的增加,颈椎后伸位椎管长度的增量最大,中立位增量最小;所有体位各节段颈椎椎管横径、矢状径均减小,中立位下颈椎椎管横径、矢状径下降幅度最小,后伸位下降幅度最大。在中立位50N牵引力作用下,与前屈、后伸位无牵引状态相比,其椎管长度增加1.76%;各节段椎管横径小于前屈位,基本大于后伸位;椎管矢状径略小于上述两种体位,但是横矢状径增(减)量均小于1 mm。结论小重量牵引对于颈椎手术而言并无因颈脊髓牵拉及椎管狭窄加重而出现颈脊髓损伤的风险,是安全可行的。     

颈椎间盘突出的动态MRI测量及意义

目的：通过对颈椎间盘突出的动态ＭＲＩ测量,了解突出椎间盘及椎管内软组织在颈椎过伸、中立、过屈三位置下的变化,并探讨其临床意义。方法：对３１例中立位ＭＲＩ扫描发现颈椎间盘突出者,行过屈、过伸位扫描。测量三位置下硬膜囊前间隙、脊髓中矢径、硬膜囊中矢径、突出椎间盘大小及椎管／椎体矢径,分析其动态变化。结果：１４例椎管、椎体比值小于０．７５,占４５．２％。３１例颈椎间盘突出的硬膜囊、脊髓中矢径及突出的椎间盘大小在三位置变化中有显著性差异（Ｐ＜０．０５或Ｐ＜０．０１）,而硬膜囊前间隙大小变化无显著性差异（Ｐ＞０．０５）。结论：发育性颈椎管狭窄者易患颈椎间盘突出,且好发于Ｃ４～Ｃ７节段,动态ＭＲＩ可为治疗颈椎多节段椎间盘突出前路非广泛减压植骨术提供帮助。     

腰椎Modic改变的MRI定量与下腰痛相关性研究

目的：通过测定MRI T2正中矢状位像上腰椎终板Modic面积改变率分析Modic面积改变率大小与下腰痛程度的相关性。方法：2011年12月至2012年6月,对因下腰痛手术的70例患者进行疼痛和功能评分（JOA、VAS）和MRI检查,男39例,女31例;年龄29～72岁,平均（51.00±11.89）岁。70例中54例有腰椎终板Modic改变,将54例患者按Modic分型标准分为4型：Modic I型15例,ModicⅡ型21例,Modic Ⅲ型11例,Modic混和型7例（由于Modic混合型例数太少未纳入研究排除）.在MRI T2正中矢状位上测量各分型Modic改变面积及对应椎体的面积,两者面积比较得出Modic改变率,对于多节段Modic改变的求比率之和,观察JOA、VAS评分与Modic改变率之间的相关性。结果：ModicⅠ型改变率和JOA评分的相关系数r=-0.308,P=0.048<0.05,两者具有负相关性;与VAS评分的相关系数r=0.428,P=0.021<0.05,两者具有正相关性。ModicⅡ型改变率和JOA评分的相关系数r=-0.375,P=0.043<0.05,两者有负相关性;与VAS评分的相关系数r=0.352,P=0.041<0.05,两者具有正相关性。Modic Ⅲ型面积改变率与下腰痛程度无明显相关性（P>0.05）.结论：下腰痛患者中ModicⅠ、Ⅱ型面积改变率分别与下腰痛的疼痛程度有密切关系,ModicⅢ型面积改变率与下腰痛程度无明显相关性。     

马尾冗余症在腰椎管狭窄症患者中的临床意义及相关危险因素分析

目的:探究马尾冗余症(redundant nerve roots,RNRs)在腰椎管狭窄患者中的诊疗意义,并筛选与RNRs相关的危险因素。方法:回顾性分析2015年4月1日至2020年11月30日196例于皖南医学院弋矶山医院脊柱外科就诊的腰椎管狭窄症患者临床资料。根据是否出现RNRs将所有患者分为RNRs阳性组和RNRs阴性组。比较两组患者一般临床资料、影像学参数、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)等指标差异性,利用二元Logistic回归分析筛选与RNRs高度相关的危险因素。结果:RNRs阳性组59例,RNRs阴性组137例。196例腰椎管狭窄症患者RNRs发生率为30.10%(59/196)。两组患者VAS、ODI组间差异有统计学意义(P<0.05),RNRs阳性组患者临床症状较RNRs阴性组重。年龄、狭窄节段数、腰椎硬膜囊面积平均值、最狭窄节段及最狭窄节段硬膜囊面积差异有统计学意义(P<0.05)。二元Logistic回归分析显示狭窄节段数、椎...     

The diagnostic value of a treadmill test in predicting lumbar spinal stenosis

Lumbar spinal stenosis is a frequent indication for spinal surgery. The predictive quality of treadmill testing and MRI for diagnostic verification is not yet clearly defined. Aim of the current study was to assess correlations between treadmill testing and MRI findings in the lumbar spine. Twenty-five patients with lumbar spinal stenosis were prospectively examined. Treadmill tests were performed and the area of the dural sac and neuroforamina was examined with MRI for the narrowest spinal segment. VAS and ODI were used for clinical assessment. The median age of the patients was 67 years. In the narrowest spinal segment the median area of the dural sac was 91 mm². The median ODI was 66 per cent. The median walking distance in the treadmill test was 70 m. The distance reached in the treadmill test correlated with the area of the dural sac (Spearman’s ρ = 0.53) and ODI (ρ = −0.51), but not with the area of the neuroforamina and VAS. The distance reached in the treadmill test predicts the grade of stenosis in MRI but has a limited diagnostic importance for the level of clinical symptoms in lumbar spinal stenosis.     

Verification of measurements of lumbar spinal dimensions in T1- and T2-weighted magnetic resonance imaging sequences

Background contextMagnetic resonance imaging (MRI) is commonly used to assess patients with lumbar spinal stenosis. No single MRI sequence has been shown to be superior in spinal canal measurements. There are also cost concerns for the increased clinical and research use of MRI. Using only a single sequence may lower the financial burden; however, this requires spinal canal measurements in both T1 and T2 MRI to be reliable. Evidence for this is currently lacking.PurposeThe aim of this study was to determine the intra- and inter-reader reliability of MRI measurements of the lumbar spine and the reliability of measurements using T1- and T2-weighted MRI films.Study design/settingRetrospective study.Patient sampleForty-two randomly selected patients who underwent spinal stenosis surgery.Outcome measuresLumbar spinal canal measurements and reliability analysis between T1- and T2-weighted MRI.MethodsQualitative ratings of MRI features were performed according to previously published criteria by 2 independent readers (JP-YC, HS). Measurements in axial scan included midline anteroposterior (AP) vertebral body diameter, midvertebral body width, midline AP spinal canal diameter, midline AP dural sac diameter, spinal canal width/interpedicular distance, pedicle width (right and left), and lamina angle. Measurements in the sagittal scan included midline AP body diameter, midvertebral body height, and AP spinal canal diameter. Cronbach alpha was used to characterize intra- and inter-reader reliability for qualitative rating data. Similarly, T1 and T2 comparison also was performed in the same manner.ResultsGood to excellent intra- and interobserver reliability was obtained for all measurements. Reliability analysis of all T1 and T2 measurements was excellent.ConclusionsEither T1 or T2 images can be used for measurements of spinal canal dimensions. These findings are of importance, as not every patient undergoing preoperative MRI assessment will necessarily have both sequences performed and only a single sequence is required for research studies. Our findings are also of relevance in measurement of lumbar canal diameters.     

The effect of flexion-extension motion of the lumbar spine on the capacity of the spinal canal. An experimental study

The symptoms of lumbar spinal stenosis are often posture-dependent, and it is generally accepted that the capacity of the spinal canal is affected by flexion-extension motions of the lumbar spine. A study of spinal capacity in flexion-extension of ten cadaver specimens on the lumbar spine was done and measurements were obtained from the flexion-extension lateral myelograms. There proved to be a larger capacity of dural sac of 3.5 to 6.0 ml (4.85 +/- 0.75 ml) in flexion than in extension, and the differences were highly significant (P less than 0.001). In addition, the sagittal diameter of the dural sac and the length of the spinal canal increased from extension to flexion. Because of the effect of flexion-extension motion of the lumbar spine on the spinal capacity, we suggest that maintaining the lumbar spine in flexion is more suitable since spinal canal capacity is enlarged and symptoms may be mitigated.     

The increase in dural sac area is maintained at 2 years after X-stop implantation for the treatment of spinal stenosis with no significant alteration in lumbar spine range of movement

Background contextThe X-stop interspinous process decompression (IPD) device has been used effectively in the management of symptomatic spinal stenosis. This study examines the radiological outcomes at 2 years postoperatively after X-stop implantation.PurposeTo measure the effect of X-stop IPD device on the dural sac and foraminal areas at 24 months postoperatively at instrumented level in symptomatic lumbar canal stenosis. We also aimed to assess its effect on change in lumbar spine movement.Study designProspective observational study.Patient sampleForty-eight patients treated with X-stop had preoperative positional magnetic resonance imaging (MRI) scans, 40 of whom had 2 years postoperative positional MRI scans. Complete scans were available for 39 of these patients.Outcome measuresPositional MRI scans were performed pre- and postoperatively. Measurements were done on these scans and are presented as the outcome measures.MethodsAll patients had a multipositional MRI scan preoperatively and at 6 and 24 months postoperatively. Foraminal area was measured in flexion and extension. Dural cross-sectional area was measured in standing erect and in sitting neutral, flexion, and extension (sitting) positions. The total range of movement (ROM) of the lumbar spine and individual segments was also measured.ResultsComplete scan data for 39 patients' scans were available. An increase in mean dural sac area was found in all positions. At 24 months after surgery, the mean dural sac area increased significantly in all four postures mentioned above. A small increase in mean foraminal area was noted, but this was not statistically significant. Mean anterior disc height reduced from 5.9 to 4.1 mm (p=.006) at 24 months at the instrumented level in single-level cases, from 7.7 to 6.1 mm (p=.032) in double-level cases caudally, and from 8.54 to 7.91 (p=.106) mm cranially. We hypothesize that the reduction in anterior disc heights could be a result of the natural progression of spinal stenosis with aging. There was no significant change in posterior disc heights at instrumented level or adjacent levels. The mean lumbar spine motion was 21.7° preoperatively and 23° at 24 months (p=.584) in single-level cases. This was 32.1° to 31.1° (p=.637) in double-level cases. There was no significant change in the individual segmental range of motion at instrumented and adjacent levels.ConclusionX-stop interspinous device remains effective in decompressing the stenosed spinal segment by increasing the anatomic dural cross-sectional area and foraminal area of spinal canal. It does not significantly alter the ROM of lumbar spine at instrumented and adjacent levels at 24 months postoperatively.     

老年腰椎椎管狭窄症患者术中硬膜囊撕裂位置及术中术后处理对策

目的探讨老年腰椎椎管狭窄症患者手术发生硬膜囊撕裂的解剖学机制,比较撕裂位置及术中、术后处理对策。方法回顾性分析2012年01月~2014年01月本院行腰椎后路手术的216例〉70岁老年患者,记录患者一般资料、病程时间、术前诊断、手术方式和节段、术中硬膜囊撕裂的位置、术后脑脊液漏情况和处理方法以及并发症等。结果共计151例患者入选,其中男89例,女62例,年龄70~93岁,平均78.12岁。术中发生硬膜囊撕裂共计34例,术后出现脑脊液漏23例,硬膜囊撕裂位置发生率硬膜囊后外侧〉根袖〉硬膜囊外侧〉硬膜囊腹侧。术中采取硬膜囊缝合修补、明胶海绵压迫、生物蛋白胶粘合等处理,术后常规给予预防感染、神经根脱水、补液等治疗,均于术后3~10 d拔管,3~4周切口愈合,全部患者未出现严重并发症。结论 〉70岁老年腰椎椎管狭窄症患者术中硬膜囊撕裂及术后脑脊液漏的发生率高于整体人群,且多位于硬膜囊后外侧及根袖,术中及时发现并仔细缝合或修补破损的硬膜、术后间断夹闭引流管、延长拔管时间能获得良好的效果。     

Coflex棘突间动力内固定装置治疗退行性腰椎管狭窄

目的：评价采用Coflex棘突间动力内固定装置治疗退行性腰椎管狭窄的疗效及其影像学变化。方法：2007年10月至2009年2月对诊断为退行性腰椎管狭窄的30例行Coflex棘突间动力内固定治疗。其中男17例,女13例;年龄39～65岁,平均45岁。手术在L4,5节段20例,L5S1节段9例,1例同时行L4,5、L5S1双节段治疗。所有患者手术前后均行Oswestry功能障碍指数评分（ODI）和日本骨科学会评分（JOA）。影像学观察指标包括X线中立位椎间隙腹、背侧高度,动力位手术节段上下两椎体的边缘与其相邻椎体的边缘连线的夹角变化;CT测量指标包括椎管面积、硬膜囊面积、椎管矢状径、硬膜囊横矢状径。手术采用椎板开窗或部分切除,椎管减压后棘突间植入Coflex装置。结果：随访5～19个月,ODI分值由术前的平均（62.41±10.38）分下降到平均（10.49±5.93）分（P〈0.01）,JOA分值由术前的平均（8.96±2.76）分提高到平均（25.36±1.55）分（P〈0.01）。3例术后疼痛改善不明显而需药物或封闭治疗,3例麻痹及感觉减退症状无改善,其余患者症状均获明显改善,未再出现间歇性跛行及神经根压迫症状。未发现与Colfex装置本身相关的并发症。X线检查椎间隙背侧高度明显增大,手术节段相邻椎体间运动幅度无明显增大。CT检查术后椎管内空间,硬膜囊面积均有所增加。结论：采用Coflex棘突间动力内固定治疗退行性腰椎管狭窄,短期相关并发症少,同时对增加椎管及硬膜囊面积,增加椎间隙后缘高度,防止相邻节段运动幅度增加以及预防邻椎病发生具有积极的作用。     

MRI中椎管及硬膜囊大小与单节段腰椎间盘突出症治疗的相关性研究

目的:探讨MRI中椎管及硬膜囊大小对椎间盘突出症治疗方法选择的参考价值。方法:对2010年1月至2012年12月非手术和手术治疗的144例腰椎间盘突出症患者的临床资料进行回顾性分析。其中非手术组91例,男55例,女36例,年龄20～ 68岁,平均(43.37±12.48)岁;手术组53例,男28例,女25例,年龄20～ 64岁,平均(42.98±12.95)岁。采用JOA评分(29 分)对两组患者治疗前后的临床表现(包括症状、体征、日常活动受限度和膀胱功能)及效果进行量化评价。同时在腰椎MRI T2轴位测量椎管和硬膜囊大小的相关参数(包括椎管正中矢径和有效矢径、侧隐窝宽度、椎管和硬膜囊面积),并计算有效矢径/正中矢径、隐窝宽度/正中矢径和膜囊面积/椎管面积的比值。将两组患者的各参数值进行统计学比较,并分析其与治疗前JOA评分的相关性。结果:(1)144例患者随访1～3年,平均2.1年。治疗前非手术组和手术组的JOA评分分别为16.27±2.96和12.64±3.30,差异有统计学意义(t=6.319,p<0.01).末次随访非手术组与手术组比较,JOA评分(25.41±2.22 vs 25.76±2.29;t=-0.853,p=0.396>0.05),改善率[(72.95±12.54)% vs (76.80±9.45)%;t=-1.855,p=0.065>0.05]和优良率(84.91% vs 78.02%;χ₂=3.704,p=0.295>0.05)的差异均无统计学意义;但非手术组的复发率(14.29%)较手术组(5.67%)高。(2)手术组椎管正中矢径和有效矢径、侧隐窝宽度、椎管和硬膜囊面积、有效矢径/正中矢径、隐窝宽度/正中矢径均小于非手术组,硬膜囊面积/椎管面积则大于非手术组,两组比较差异均有统计学意义(p<0.01).(3)治疗前JOA评分与椎管正中矢径和有效矢径、侧隐窝宽度、椎管及硬膜囊面积有正相关性(p<0.01);与有效矢径/正中矢径、侧隐窝宽度/正中矢径也有正相关性(p<0.05);而与硬膜囊面积/椎管面积有负相关性(p<0.01).结论:非手术和手术治疗腰椎间盘突出症均能获得良好的效果,但非手术治疗复发率较高。术前测量椎管及硬膜囊的MRI参数对椎间盘突出症治疗方法的选择有一定的临床参考价值,但需要进一步完善和临床验证。     

自控腰椎纵轴加压器诊断隐匿性腰椎退行性变

目的探讨自控腰椎纵轴加压器对隐匿性腰椎退行性变的诊断价值。方法采用自制"自控腰椎纵轴加压器"对120例腰腿痛(98例坐骨神经痛、22例腰痛)患者行腰椎纵轴加压CT/MR检查,所加压力不超过患者体质量的50%,并与常规腰椎CT/MR检查进行比较,硬膜囊面积减小(>15mm2)并降至75mm2以下、侧隐窝狭窄、椎间盘突出或程度增加等异常征像为腰椎纵轴加压检查的附加有效信息(AVI)。结果 120例中43例存在AVI,包括硬膜囊面积减小33例,椎间盘突出11例和突出程度增加15例,侧隐窝或椎间孔狭窄12例。98例坐骨神经痛患者中40例(40/98,40.82%)出现AVI,22例腰痛患者中仅3例(3/22,13.64%)出现AVI(P<0.05)。结论腰椎纵轴加压CT/MR检查对显示腰椎及椎管的隐匿性退行性变具有重要临床价值。