破裂型腰椎间盘突出症的影像学诊断

对经手术治疗的９２例（１０７个）腰椎间盘突出症患者做ＭＲＩ、ＣＴ和椎管造影（Ｍｙｅ）检查，进行破裂型椎间盘突出症诊断的前瞻性研究。以手术所见髓核突出状态为标准诊断，确诊破裂型椎间盘突出３８例（４０个椎间盘），占３７％，其准确率依次为：ＭＲＩ＋ＣＴ＋Ｍｙｅ９６．７％（２９／３０），ＭＲＩ＋ＣＴ９１．２％（３１／３４），ＭＲＩ＋Ｍｙｅ８１．１％（３０／３７），ＣＴ＋Ｍｙｅ８０．Ｏ％（３２／４０），ＭＲＩ７６．９％（３０／３９），ＣＴ６５．２％（３０／４６），Ｍｙｅ６４．４％（２９／４５）。经统计学处理各组差异无显著意义。运用ＭＲＩ不同脉冲序列成像，可清楚地显示髓核、纤维环及后纵韧带和硬膜囊等结构。分别经椎间盘、椎间孔和椎弓根三个断层做ＣＴ扫描，并测量髓核突出率及动力位椎管造影有助于诊断破裂型椎间盘突出。文章讨论了椎间盘突出的分类及各种影像学检查的意义。

Imaging diagnosis of ruptured Iumbar disc herniation

The prospective study of imaging diagnosis of ruptured lumbar disc herniation by magnetic resonance image(MRI),computer tomography(CT) and myelography(Mye) on 92 cases (107 discs)under gone laminectomy and discectomy from March 1993 to January 1994 was presented. According to the operation findings, 38 cases(40 discs, 37% of the total subjects)were defined as ruptured lumbar disc herniation. Various imaging evaluations before operation were compared with the surgical outcome. The overall rates of accurancy were: MRI CT Mye 96.7%(29/30), MRI CT 91.2%(31/34), MRI Mye 81.1%(30/37), CT Mye 80. 0% (32/40) ,MRI 76. 9%(30/39) ,CT 65.2%(30/46),Mye 64. 4%(29/45). There were no statistical difference between them. Nucleus pulposus, annulus fibrosis, posterior longitudinal ligament line and dural sac were clearly showed using different pulse sequence in MRI.CT images through intervertebral disc, intervertebral foramen and pedicle stratum, measurement of the nucleus pulposus protrusion percentage as well as dynamic myelography were helpful in the diagnosis of ruptured lumbar disc herniation. Classification of lumbar disc herniation and significance of imaging examination were also disscussed.Author's address (Department of Orthopaedic Surgery and Department of Radiology, Changzheng Hospital, The Second Military Medical University,Shanghai, 200003)