骨关节结核影像学检查临床对比分析

目的探讨不同影像学方法诊断骨关节结核的临床效果。方法对36例骨关节结核患者分别采用X线、CT及MRI等三种方法进行检查,比较三种检查方法的对骨关节结核各征象的显示情况及诊断敏感性。结果 MRI在椎体骨质破坏、关节腔积液、椎间盘破坏、椎管狭窄等征象显示方面明显优于CT和X线平片,且差异具有统计学意义。X线平片、CT、MRI等三种影像学检查方法对骨关节结核患椎的诊断敏感性比较存在明显差异;进行两两比较发现,MRI诊断敏感性明显优于X线平片和CT;而CT的诊断敏感性又明显优于X线平片,且差异具有统计学意义。结论 MRI在骨关节结核早期诊断敏感性方面明显优于X线平片和CT。     

腰椎滑脱症合并腰椎间盘突出的诊断和治疗分析

目的 探讨腰椎滑脱症合并腰椎间盘突出的诊断和治疗。方法 对14例腰椎滑脱症合并腰椎间盘突出患者临床症状、体征、X线片、CT和MRI进行回顾分析。结果 腰椎滑脱合并腰椎间盘突出以同一间隙多见,好发于L_4 ～_5,L_5 ～S_1,主要症状为腰痛伴坐骨神经痛。结论 纠正腰椎滑脱、充分减压的同时处理突出的椎间盘,才可以取得满意疗效。     

腰椎小关节的不对称与椎间盘脱出的关系

过去一直认为后背痛病人中椎小关节的不对称是一很有意义的征象,提示腰椎的扭转性损伤,而且将导致腰间盘脱出。作者分析了136例由CT诊断为L_4～L(?)或L_5～S_1层面椎间盘脱出,并只接受了保守治疗的患者。根据髓核脱出主要在中心部还是偏于一侧而分为中心型和偏一侧型二组,偏一侧型突出的边缘不超过中线。中心型脱出50例,偏一侧型86例。发生在L_4～L_5、L_5～S_1层面者68例。脱出在L_4～L_5层面的,相邻正常的L_5～S_1层面的椎小关节测量结果同L_5～S_1层面脱出者之测量结果做对比,同样,L_5～S_1层面脱出的其相邻正常的L_4～L_5层面小关节角度同L_4～L_5脱出者做对比。其中2例正常的L_5～S_1层面椎小关节严重增生影响测量而排除。所以共计有136个脱出的椎间盘同134个正常的椎间盘进行对照。     

早期股骨头缺血性坏死的综合影像诊断

目的：探讨股骨头缺血性坏死的早期X线平片、CT、MRI诊断价值。方法：对20例Ficat分期标准0～Ⅱa期股骨头缺血性坏死患者行X线平片、CT、MRI检查。结果：20例早期股骨头缺血性坏死中X线平片仅发现Ⅱa期病变3个,阳性率15％。CT发现0～Ⅱa期病变13个．阳性率65％。MRI发现0～Ⅱa期病变20例，阳性率100％。结论：MRI诊断早期股骨头缺血性坏死的敏感性最高，CT次之，X线平片最差。     

年轻士兵腰椎间盘突出症影像学诊断对比分析

目的总结年轻士兵腰椎间盘突出症（LDH）的X线平片、CT及MRI特点,进一步探讨影像学对诊断LDH的价值。方法收集我院32例经临床及影像学确诊的年轻士兵LDH的临床资料,分析其腰椎X线平片、CT及MRI影像特点。结果 32例中,X线平片表现为椎间盘病变8例,CT表现为椎间盘突出29例,MRI均表现为椎间盘突出。结论年轻士兵LDH较轻,X线平片阳性表现少,结合症状、体征可起筛查作用,而CT、MRI检查具有确诊价值,可为临床确诊提供重要的参考依据。     

腰椎间隙感染的影像学诊断价值

笔者报告应用CT、ECT、X线平片和MR诊断椎间隙感染13例。根据本组X线平片所示,将其分为3期:骨质吸收疏松期,骨质破坏期和增生修复期。作者认为尽管x线平片和断层在椎间隙感染的早期敏感性和特异性较低,但仍是一种简单易行的诊断方法。CT能清楚显示病灶的部位。骨扫描对椎间隙感染具有高度的敏感性。MR比X线平片、CT、ECT更准确、更敏感、更有助于早期诊断。     

髓核化学溶解术后椎间隙的MRI表现:对术后椎间盘变性的推测

作者对26例腰椎间盘脱出髓核化学溶解术后的椎间隙进行了研究。男22例,女4例,年龄17～58岁。发生于L_(4～5)椎间盘21例,L_5～S_1椎间盘5例。使用0.5T超导型MR机和体线圈,获取层厚1.0cm的矢状面T1(SE TR500ms/TE40ms)和T_2(SE TR1500ms/TE80ms)加权象,并摄同期腰椎侧位和过伸过屈侧位X线片。利用Brandner′s方法计算椎间盘前份和后份的高度指数,用Wiltse′s法测量脊柱前凸角。髓核溶解术后3个月,脱出椎间盘后份的平均高度指数在MRI和腰椎侧位片上分别降至治疗前的57%和63%,2年后未见增加;其前份平均高度指数分别降至治疗前的41%和59%,2年后又分别升至67%和71%。治疗后3个月,治疗部位的平均脊柱前凸角在MRI和腰椎     

椎间隙前后等宽在诊断椎间盘病变中的作用

椎间隙异常是诊断脊柱病变一个重要而不可忽视的X线征象。近年来，随着脊柱疾病的不断增加，特别是腰椎间盘病变日趋年轻化，X线平片在脊柱病变的首选检查中发挥了不可替代的作用，但一个重要的X线征象长期以来被忽视。我们在实际工作中发现25例腰椎间隙前后等宽的患者，经过CT及MRI检查后对照，均有不同程度的椎间盘突出表现，现报告如下。     

类风湿性关节炎腕关节病变的影像学分析:X线、CT和MR影像对比观察

目的　比较观察X线平片、CT和MRI在检查类风湿性关节炎 (RA)患者早期腕关节病变中的作用。方法　选取 2 5例RA患者 ,其中女 2 0例 ,男 5例 ,年龄为 2 8～ 70岁 ,平均 4 5 .36岁。临床诊断符合 1987年美国纽约类风湿协会修订的RA诊断标准。为比较观察X线平片、CT和MRI在RA早期诊断中的作用 ,左、右腕分别行CT和MR冠状面扫描。MR成像仪的场强为 0 .3T。扫描时先行平扫 ,扫描序列分别为SET1WI和梯度回波重T2 WI(T2 WI)。然后行增强T1WI作进一步检查。结果　 2 5例临床诊断为RA患者的 5 0个腕关节中 ,X线显示骨侵蚀病变者有 14个腕关节 ,MRI检出骨侵蚀病变者有 5 0个腕关节 ;2 5例中行CT检查者有 16例 32个腕关节 ,其中 2 2个腕关节有骨侵蚀病变。MRI共检出 16 4处腕骨的骨侵蚀病灶 ,而X线平片仅检出 2 1处腕骨骨侵蚀病灶 ,CT检出 6 8处骨侵蚀病灶。月骨是最易受累的部位 ,其X线、CT和MR的检出率分别为 6 .0 %、2 8.1%和5 4 .0 %。在类风湿关节炎骨质侵蚀病变的检出上 ,3种检查方法之间经两两比较分析 ,差异均有非常显著性意义 (P值均 <0 .0 1)。MRI不仅可显示RA早期CT和X线所不能显示的腕部骨质侵蚀改变 ,还可显示滑膜炎性及水肿改变 ,增强MRI可鉴别血管翳与关节积液。结论　在检查RA患者早期腕关节病变方     

骨肉瘤的X线平片、CT、MRI诊断

目的:评估X线平片、CT、MRI诊断骨肉瘤的价值.材料和方法:回顾性分析20例经手术病理证实为骨肉瘤的X线平片、CT、MRI表现.结果:20例X线平片均能清楚显示骨肉瘤的基本表现,术前正确诊断17例,误诊3例;CT显示骨肉瘤的骨质破坏及瘤骨优于X线平片11例;MRI显示骨肉瘤的早期骨破坏及周围软组织、病变范围及骨骺(骺板)侵袭、瘤周水肿优于X线平片及CT14例.结论:X线平片是诊断骨肉瘤的首选及基本方法,CT或MRI对提高骨肉瘤的诊断、分期及临床治疗提供全面、准确的影像学资料,尤其MRI对于指导保留骨骺的保肢术的选择具有重要意义.     

腰椎曲度及下腰椎椎间盘高度MSCT负荷前后的比较

目的：对比分析负荷前后MSCT测量的腰椎曲度及下腰椎椎间盘高度变化并与立位X线片对照,检验自制腰椎应力器加压效果。方法：采用自制腰椎应力器对30例腰腿痛患者负荷前后各作一次MSCT扫描,并摄立位X线腰椎侧位平片。在负荷前后Topogram像、负荷前正中矢状面重组图及X线平片上分别测量Th12～S1相邻椎体间夹角、L1与S1夹角、腰椎椎体长度及下腰椎椎间盘高度。在正中矢状面重组图上沿椎间隙夹角平分线重组横轴面图像,测量L3～S1三个椎间隙平面硬膜囊面积并观察椎管内结构变化。结果：负荷前Topogram像与正中矢状面重建像及负荷后Topogram像与X线侧位片上Th12～S1相邻椎体间夹角、L1与S1夹角及腰椎长度、L3～S1椎间盘高度测量结果近乎相等,组间对应测量值比较差异无显著性意义。负荷后L3与L4椎体角显著增大（t=5.36,P〈0.01）,L4与L5、L5与S1椎体角无显著增大（t=2.59,P〉0.05）,其中L4与L5椎体角变化最小。负荷后仅L4-5椎间盘高度显著缩小（t=4.21,P〈0.05）,L3～S1各平面硬膜囊面积均显著缩小,腰椎长度缩短（t=2.37,P〉0.05）,椎间盘膨隆或突出更明显,黄韧带增厚,椎管内结构毗邻关系更密切。结论：自制应力器加压检查能有效模拟人体腰部直立位生理状态情形,对腰椎退变性病变早期诊断及病情的准确评价具有重要意义。     

单节段腰椎间盘突出症保守治疗与单纯髓核摘除术的远期效果观察

目的 分析比较保守治疗与单纯髓核摘除术对单节段腰椎间盘突出症的远期疗效及其影像学变化,为临床治疗腰椎间盘突出症提供参考.方法 回顾性分析1983年1月-2008年6月收治且随访10年以上的182例单节段腰椎间盘突出症患者的病例资料.其中保守治疗组73例,男49例,女24例,L4-L5突出44例,L5-S1突出29例,随访时间17.61±3.87年;手术治疗组109例,均采用单纯髓核摘除术治疗,男71例,女38例,L4-L5突出68例,L5-S1突出41例,随访时间17.17±3.47年.通过对两组患者临床表现、影像学变化、神经功能评定、病变间隙及其头侧邻近节段椎间隙高度变化、病变间隙头侧邻近节段退变发生率的比较研究,观察保守治疗与单纯髓核摘除术治疗单节段腰椎间盘突出症的远期疗效.结果 保守治疗组73例中8例因出现间歇性跛行而行椎管减压手术,手术治疗组109例中13例因原间隙椎间盘突出复发行二次手术.随访终点手术治疗组病变间隙高度(0.62±0.15cm)显著低于保守治疗组(0.69±0.13cm,P＜0.05),而Oswestry评分(23.9％±6.3％)、病变间隙头侧邻近节段椎间隙高度(0.83±0.11cm)与保守治疗组(分别为23.3％±6 5％、0.82±0.11cm)比较差异无统计学意义.保守治疗组5例、手术治疗组9例出现影像学退行性不稳定表现,但均无明显临床症状.依据UCLA标准,保守治疗组8例(12％)、手术治疗组23例(22％)出现病变间隙头侧邻近节段退变,两组邻近节段退变发生率比较差异具有统计学意义(P＜0.05).结论 保守治疗与单纯髓核摘除术治疗单节段腰椎间盘突出症均可获得较好的远期效果.单纯髓核摘除术后远期病变椎间隙高度明显变窄,邻近节段退变较少引发临床症状.     

青壮年腰椎间盘突出与椎体后缘骨质反应的CT研究

目的分析16层螺旋CT多平面重建对青壮年腰椎间盘突出程度与椎体后缘骨质反应的关系,为临床治疗提供依据。方法38例有腰腿疼痛症状及体征并进行16层螺旋CT检查诊断腰椎间盘突出的患者的影像资料进行回顾性分析。结果38例患者中CT显示共61节腰椎间盘突m,中央型突出21节（34％）,旁中央型28节（46％）,椎间孔型12节（20％）,以腰5／骶1节段突出最常见,约占51％。相成61节椎体表现为,骨质硬化32节（52％）、增生9节（15％）、骨质缺损并骨块20节（33％）,均伴椎管狭窄或椎间孔狭窄;合并后纵韧带骨化7例（18％）,椎间盘突出轻度25节（41％）、重度36节（59％）。旁中央型突出和重度突出易导致椎体后缘骨质缺损及椎间孔狭窄（P〈0．05）。结论青壮年腰椎间盘突出程度较重,均伴有骨质变化,软骨结节、后纵韧带钙化、椎间孔狭窄常见。     

腰椎椎间盘MRI T2加权信号强度变化的探讨

目的：探讨腰椎间盘Ｔ２加权ＭＲＩ信号变化与年龄、椎间隙位置和椎间盘突出的关系。材料和方法：本文收集了１６５例患者（８２５只腰椎间盘），其中正常６１９只，突出２０６只，２０１只手术证实。患者分为正常和突出两组，每组分６个年龄段；信号强度分为三型：强、不规则和低三型。检查方法均采用ＳＥ程序（ＴＲ２０００ｍｓ，ＴＥ４０，８０ｍｓ）。全部资料经统计学处理。结果：在正常椎间盘，年龄影响主要在２０岁组与３０岁至７０岁以上组，３０岁组与５０至７０岁以上组之间；椎间隙位置影响主要在腰（４－５）与腰（１－２，２－３，３－４），腰５骶１与腰１－２，２－３，３－４之间。在伴有突出的椎间盘，年龄影响主要在２０岁组与３０，６０及７０岁以上组之间：椎间隙位置影响主要在腰（４－５）与腰５骶１之间。结论：两组椎间盘信号变化均与年龄和椎间隙位置有关，各型信号的椎间盘均可发生突出。     

Comparison of myelography and computed tomography in establishing lumbar disc herniation

The results of lumbar myelography and computed tomography (CT) were compared in 51 consecutive patients with clinically suggested lumbar disc herniation. A total of 100 intervertebral levels were examined. At 62 levels, either L4/L5 or L5/S1, myelography was normal. CT showed no pathologic changes at 55 levels. The results concurred between myelography and CT in 89 per cent of the patients with normal findings. Four cases of disc herniation and one bulging disc, which had been missed at myelography because of a large epidural space at L5/S1, were picked up by CT. Two of these were verified by surgery and two were treated conservatively. There was one possible false negative case with CT as well. Abnormalities were shown at 38 intervertebral levels, 22 in the bulging and 16 in the herniated disc group. The pathologic changes concurred in 84 per cent between the two investigations. For intervertebral disc herniation the true negative rate was, for myelography 88 per cent and for CT 97 per cent. The treatment strategy could have been based on CT alone at 37 out of 38 levels (97%), and on myelography alone at 34 out of 38 levels (89%). Furthermore, at CT the imaging of soft tissues and intervertebral joints was superior to that at myelography. It is concluded that CT should be the primary examination method of imaging for lumbar disc herniation. Myelography is, however, to be preferred where the level of the lesion is clinically unclear or when the entire lumbar region and thoraco-lumbar junction are to be examined.     

腰椎间盘突出术后椎体滑脱与复发的影像诊断(附24例报告)

目的：为了提高对腰椎间盘突出术后并发椎体滑脱和椎间盘突出复发影像表现的认识。方法：笔者复习了１００例椎间盘术后因症状未能缓解或有所加重患者的腰椎平片、ＣＴ和ＭＲＩ片。结果：发现１８例因１个或多个椎体半椎板及全椎板切除者发生椎体滑脱。６例椎间盘突出复发（其中２例伴有椎体滑脱）,手术区域疤痕组织增生明显,部分患者有硬脊膜腔受压或受牵拉移位。结论：术后椎体滑脱和椎间盘突出复发的发生,患者症状是否好转,与手术方式和椎板切除多少有关     

Does a herniated nucleus pulposus contribute significantly to a decrease in height of the intervertebral disc?

A lumbar intervertebral disc with a herniated nucleus pulposus (HNP) often exhibits a decrease in the height of the intervertebral space. Our purpose was to ascertain whether the loss of volume of an HNP is sufficient to cause a perceptible decrease in the height of the intervertebral space. MRI of 44 patients with 51 HNPs were reviewed. The volumes of the herniated material and of the intervertebral discs were calculated for every level from L 1–2 to L 5–S 1. The average volume of the HNP was 503 ± 301 mm³. The average volumes of all 220 intervertebral discs and of the 127 normal-appearing discs were 14 442 ± 4200 mm³ and 17 476 ± 2885 mm³ respectively. The average volume of the HNP represented 3.5 % of the parent disc. An average HNP caused a decrease in intervertebral space height of 0.35 mm (0.56 pixels). Therefore, the loss of the volume of the HNP does not cause a significant decrease in the intervertebral space height. The average calculated decrease in the disc height is less than that reported in normal diurnal variation. Received: 1 February 1999/Accepted: 24 October 1999     

腰椎假性滑脱的平片和CT影像对比研究

目的：评价平片和ＣＴ对腰椎假性滑脱的诊断价值。方法：作者总结分析了我院１９９２－０７～１９９６－１０因腰腿痛进行Ｘ线检查的病例共５３１６例。并分为３组：Ａ组、单纯平片检查３４７２例,Ｂ组、ＣＴ检查１７８２例,Ｃ组、平片加ＣＴ检查６２例。结果：结果表明平片是诊断腰椎假性滑脱最简单而有效的方法。结论：腰椎平片能直观的显示腰椎假性滑脱,尤其对假性滑脱发生的部位及形态类型的显示明显优于ＣＴ。而ＣＴ的优势在于能清楚地表现椎间盘、硬膜囊、关节突和椎管内外结构的变化。     

Assessment of lumbar vertebrae morphology by magnetic resonance imaging in osteoporosis

Objective

To investigate the lumbar spinal morphology in patients with and without osteoporosis by comparing the endplate changes, intervertebral disc changes, and vertebral heights.

Design

This is a retrospective study. Medical records of the 3,530 patients admitted to the Physical Medicine and Rehabilitation outpatient clinics with low back pain between August 2010 and August 2011 were retrospectively reviewed. A total of 64 patients of whom 57 were females (89.1?%) and seven were males (10.9?%) were included in the study. Participants were divided into an osteoporosis group, an osteopenia group, and a nonosteoporotic control group, according to bone mineral densities.

Results

In this study, mid heights of L3, L4, and L5 vertebrae were found to be higher in the normal group than in both the osteopenic and osteoporotic groups. Mid part heights of L1-2, L2-3, and L5-S1 intervertebral discs were significantly lower in the normal group when compared to the osteopenic and osteoporotic groups. End-plate marrow abnormality was detected in L1 lower end plate in 75?% of normal subjects, 40.6?% of osteopenics, and 25?% of osteoporotics. Statistically significant difference in the presence of Schmorl nodes in L5 vertebra lower end plates was present between groups; 58.3?% of normals, 34.4?% of osteopenics and 15?% of osteoporotics had Schmorl nodes in L5 vertebra lower end plates. There was a significant difference regarding disc degeneration and intradiscal gas presence in L5-S1 intervertebral discs between groups; 66.7?% of normals, 28.1?% of osteopenics, and 25?% of osteoporotics had severe disc degeneration and intradiscal gas was present in L5-S1 intervertebral discs.

Conclusions

Significant changes in morphology of the lumbar spine and intervertebral discs were found. It was revealed that the effects of osteoporosis are not limited to the bone but also present in the intervertebral discs. Mid heights of intervertebral discs were higher in the osteoporotic and osteopenic groups when compared to normal subjects along with the lowered mid heights of lumbar vertebrae. It was also observed that stronger vertebral bones were associated with more disc and vertebral degeneration.     

腰椎曲度变直与中青年腰椎间盘突出症的相关性研究

目的：探讨腰椎曲度变直与腰椎间盘突出症的相关性。方法收集曲度变直和曲度正常的中青年腰椎间盘突出症患者各80例进行回顾性分析,记录患者的年龄、性别、病程、职业分类和腰椎 MRI表现。治疗6个月后随访复查,记录复发情况并测量弓顶距离。结果2组患者的年龄、性别比及病程大致相似;曲度变直组患者以久坐久站人员为主,高达70%,而曲度正常组以传统体力工作人员稍多(P<0.05);曲度变直组患者弓顶距离较治疗前增大(P<0.05);曲度变直组患者以 L4/L5椎间盘突出占多数,而曲度正常组患者以 L5/S1椎间盘突出占多数(P<0.001);曲度变直组患者复发率高于曲度正常组,2组患者中复发患者的平均弓顶距离均较未复发患者的小(P<0.05)。结论腰椎曲度变直组患者 L4/L5节段椎间盘突出和复发的发生率均较高。腰椎生物力学结构平衡的恢复和重建方面的有利于患者的疗效和功能恢复。