儿童颈部椎间盘钙化病的CT及X线平片表现

目的 探讨儿童颈部椎间盘钙化病(CDC)的影像学表现.方法 搜集11例CDC,其中7例经X线平片、4例经CT诊断,对比观察椎间盘钙化形态和分布、椎体和椎间隙变化、椎管有无狭窄、有无椎旁软组织受累等.结果 椎间盘钙化形态多样,多数分布于椎间盘中央偏前,钙化髓核可向周围脱出.椎骨呈现生长障碍性改变和骨质增生.CT显示病变细节优于平片,X线平片可更好地显示纵向上的变化.结论 X线平片具有辐射小、性价比高等优点,更适合用于儿童颈部CDC的诊断和随访;CT可作为复杂情况下的备选方案.     

颈椎病的影像诊断并附460例分析

目的:通过分析临床诊断的460例颈椎病患者的影像表现,总结其各分型的影像学特点,提高其诊断水平。材料与方法:对460例诊断为颈椎病患者的平片和CT检查颈椎骨质、椎间隙、椎间孔及椎间盘改变的影像表现,进行分类统计。结果:颈椎病患者中,X线表现中以椎间隙变窄多见,好发部位以颈5/6为主,CT表现中以颈椎间盘突出常见,以颈5/6椎间盘好发,神经根型颈椎病较多。结论:X线平片和CT检查的影像表现结合临床表现即可诊断颈椎病并分型。     

介入治疗腰椎间盘突出症的 19例体会

本院采用介入治疗腰椎间盘突出症患者 19例,取得较好疗效,现报告如下。 1 对象与方法 1999～ 2001年共收治 19例腰椎间盘突出症患者中,男 14例,女 5例,年龄 20～ 50岁,平均年龄 32岁。所有病例根据临床症状和体征及 X线片和 CT片确诊。 X线平片表现 ：（ 1）早期腰椎失去正常曲度,变直或略侧弯。（ 2）髓核脱出 4～ 6周可出现椎间隙变窄,可一致性变窄,也可前后或左右不对称变窄,骨关节面硬化。（ 3）椎体边缘骨赘形成,椎间孔变窄。 CT片表现：（ 1）椎间盘后缘及椎管内限局性突出软组织影,其密度与相应椎间盘密度一致（介于…     

骨梗死影像学诊断价值

目的:探讨骨梗死的影像学诊断价值.方法:回顾性分析35例累及75处骨骼骨梗死患者的X线平片、CT及MRI影像学资料.结果:病变主要累及股骨下段和胫骨上段,多双侧发病.骨梗死急性期、亚急性期X线平片、CT表现无明显异常或表现为局部的骨质疏松及斑点状钙化,MRI表现为病变中心T1W1呈等或稍高信号.T2W1呈等或稍高信号,病灶边缘呈典型的地图样改变;慢性期X线平片及CT袁现为不规则状、蜿蜒状骨质硬化,MRI表现为病变中心T1W1及T2W1均呈低信号.结论:MRI检查可诊断早期骨梗死,明确侵及范围,反映不同时期病理学变化,X线平片有助于亚急性期及慢性期骨梗死诊断,CT检查较X线平片敏感.     

椎体血管瘤的影像表现(附8例报告)

目的:讨论椎体血管瘤的X线平片、CT、MRI及DSA的影像学特征及其应用价值。材料与方法:经手术和病理证实的椎体血管瘤8例。全部病例均经X线平片、CT、MRI检查,其中2例进行了DSA诊断及介入治疗。结果:X线平片显示6个病灶,CT和MRI显示全部8个病灶,DSA检查2例,皆显示其特征性改变。结论:X线平片的椎体栅栏、网格状改变可帮助诊断椎体血管瘤。CT及MRI上均有特征性表现,对椎体血管瘤的检出率高于X线平片。DSA可显示椎体血管瘤的供血动脉,具有特征性表现,并且对介入治疗及外科手术有极大帮助。     

骨梗死影像学诊断价值

目的：探讨骨梗死的影像学诊断价值。方法：回顾性分析35例累及75处骨骼骨梗死患者的X线平片、CT及MRI影像学资料。结果：病变主要累及股骨下段和胫骨上段,多双侧发病。骨梗死急性期、亚急性期X线平片、CT表现无明显异常或表现为局部的骨质疏松及斑点状钙化,MRI表现为病变中心T1WI呈等或稍高信号,T2WI呈等或稍高信号,病灶边缘呈典型的地图样改变;慢性期X线平片及CT表现为不规则状、蜿蜒状骨质硬化,MRI表现为病变中心T1WI及T2WI均呈低信号。结论：MRI检查可诊断早期骨梗死,明确侵及范围,反映不同时期病理学变化,X线平片有助于亚急性期及慢性期骨梗死诊断,CT检查较X线平片敏感。     

影像学在诊断颈椎病中的应用

目的通过对85例颈椎病影像学资料进行分析,探讨颈椎病的影像学特征及其X线片、CT、MRI及MRA检查方法的选择原则,以便临床上对不同类型以及不同程度的颈椎病选择合适的诊断技术。方法 2005年6月2009年7月,85例均行颈椎标准X线片、CT、MRI及MRA检查,对其影像学资料进行分析。结果颈椎病以椎体及小关节增生、生理曲度改变、椎间隙变窄和局部失稳为常见X线表现,X线片、CT、MRI及MRA对颈椎病的诊断有不同的优点及限度。结论 X线片为首选检查方法 ,绝大部分可明确诊断,特殊情况加做CT、MRI或MRA检查。     

椎体血管瘤的比较影像学研究

目的：探讨X线平片、CT、MRI三种影像学检查方法对诊断椎体血管瘤的应用价值。方法：搜集13个椎体血管瘤病灶的X线平片、CT及MRI表现,对其影像特征进行对比研究。结果：X线检查显示10个病灶,骨小梁呈“栅栏状”改变;CT扫描显示12个病灶,横断面表现为蜂窝状或风状结构;MRI扫描显示全部13个病灶,10例显示为短T1、长T2的信号影,3例显示为长T1、长T2的信号影,并且清晰显示了脊髓情况。结论：椎体血管瘤在X线平片、CT及MRI上均有特征性影像学表现,CT、MRI对椎体血管瘤的检出率高于X线平片。MRI对椎体血管瘤的诊断、分型及指导治疗均具有十分重要的意义。     

CT诊断腰椎间盘突出症的对照研究

目的探讨腰椎间盘突出症的CT与X线平片所见征象的差异。方法回顾性分析56例同时经CT扫描和X线平片照摄并结合临床表现诊断为腰椎间盘突出症患者的影像学资料，作对照研究。结果椎间盘突出的X线平片主要表现有：腰脊椎侧弯和生理曲度变直及侧凸改变、椎间隙改变、椎体后缘唇样增生、相邻椎体后角局限性骨增生呈“磨角”样改变、相邻椎体后缘局限性骨吸收和相邻椎体面弧形压迹等；CT扫描的主要征象有：脱入椎管的髓核块影，硬膜囊受压、神经根水肿及移位，脱出髓核的部位部分钙化或骨化和髓核碎裂并在椎管内上下滑移等。CT的阳性发现率显著高于X线平片，分别为100％和61．29％。结论CT和X线平片诊断腰椎间盘突出症各有千秋，在临床工作中可根据具体情况选择应用，但CT诊断价值优于X线平片。     

骨梗死影像学诊断价值

目的:探讨骨梗死的影像学诊断价值。方法:回顾性分析35例累及75处骨骼骨梗死患者的X线平片、CT及MRI影像学资料。结果:病变主要累及股骨下段和胫骨上段,多双侧发病。骨梗死急性期、亚急性期X线平片、CT表现无明显异常或表现为局部的骨质疏松及斑点状钙化,MRI表现为病变中心T1WI呈等或稍高信号,T2WI呈等或稍高信号,病灶边缘呈典型的地图样改变;慢性期X线平片及CT表现为不规则状、蜿蜒状骨质硬化,MRI表现为病变中心T1WI及T2WI均呈低信号。结论:MRI检查可诊断早期骨梗死,明确侵及范围,反映不同时期病理学变化,X线平片有助于亚急性期及慢性期骨梗死诊断,CT检查较X线平片敏感。     

Artificial disc replacement--evolutionary treatment for degenerative disc disease

Back pain is a common problem that affects the majority of people at some point in their lives. Most back pain is not serious, but back pain caused by injury and aging can result in chronic pain that can last months, years, or indefinitely. Arthrodesis (ie, spinal, fusion) has been the treatment of choice for symptomatic degenerative disc disease that has not responded to conservative treatment modalities. Artificial disc replacement is a more recent option that preserves spinal motion but also recreates the natural function of the disc. The history of artificial disc replacement surgery, preoperative preparation, the surgical procedure, and postoperative recovery are discussed.     

人工髓核假体置入治疗腰椎间盘突出症的疗效分析

目的：观察已在临床初步开展起来的人工髓核置换术治疗腰椎间盘突出症的中、远期临床疗效及并发症,分析其对策。 方法：纳入2002-02/2004-08南方医科大学附属南方医院脊柱骨病外科采用单枚人工髓核假体置换术治疗单节段腰椎间盘突出症患者98例,获得24～48个月随访患者75例,按平均随访时间达24,36,48个月,分为24个月组（n=30）,36个月组（n=23）,48个月组（n=22）。选同期采用单纯椎间盘髓核摘除术患者30例作为对照组,评估各组术后临床疗效,主观症状采用Oswestry功能障碍指数问卷表（0%表示正常,越接近100%则功能障碍越严重）和Prolo功能评分表（小于或等于5分为差,6～7分为中等,8～10为优）评价,分析术后影像学检查并测量手术节段活动度和椎间隙高度变化情况,同时观察假体位置情况,腰椎MRI观察假体位置和软骨终板的信号变化情况。腰椎活动度=（腰椎中立角度-前屈角度）＋（后伸角度-腰椎中立角度）=后伸角度-前屈角度;为消除X射线放大率的影响,椎间隙高度变化情况采用病变椎间隙后缘高度与上位椎体中部矢状径的比值表示。 结果：75例获得24～48个月随访者,全部进入结果分析。①48个月组2例、36个月组1例发生假体脱出,二次手术取出。其余患者术后临床症状均明显缓解,疼痛消失。②24,36,48个月组及对照组术后末次Oswestry功能障碍指数均较术前降低,差异有显著性意义（14.2%,52.1%;15.5%,55.2%;15.1%,53.6%;15.5%,51.5%;P〈0.05）。③24,36,48个月组及对照组术后末次Prolo能评分均较术前升高,差异有显著性意义（8.5,4.6分;8.6,4.5分;8.7,4.3分;8.4,4.2分;P〈0.05）。④24,36,48个月组同期手术节段腰椎活动度均高于对照组,差异有显著意义（P〈0.05）。⑤24个月组手术节段椎间高度较术前降低约4%、36个月组降低约12%、48个月组降低约18%、对照组较术前降低约25%,各组术前和术后椎间隙高度比值比较,差异具有显著性意义（P〈0.05）。⑥主要并发症：早期出现术后一过性腰痛24例,假体脱出3例。中、远期发现假体下沉32例,软骨终板损伤39例。 结论：单枚人工髓核假体置换治疗腰椎间盘突出症中、远期随访临床疗效肯定,但存在较严重并发症,应慎重开展此项手术。     

MRI of the intervertebral disc in lumbar disc disease

Background. MRI of the intervertebral disc in discopathy of the lumbar spine have been presented.
Material and methods. a group of 51 patients clinically diagnosed as discopathy of the lumbar spine were subjected to three MR imaging procedures. Imaging was performed before surgery, 6 weeks after surgery, and 12 weeks after surgery.
Results. The MRI was consistent with the surgery findings in 88.2% of cases. Instead, images taken 6 weeks after surgery were non-characteristic and difficult to differentiate. In the spinal canal tissue was visible with the image similar to nucleus pulposus herniation, granulation from a growing haematoma, or after surgery scar. Twelve weeks after surgery, the MR image is characteristic and correlated with the patient's clinical state.
Conclusions.
1. MRI image allows an evaluation of intervertebral disc healing after discectomy.
2.MRI 12 weeks post-surgery correlates with patient's clinical symptoms.
3.MRI with Gd-DTPA contrast enhanced allows a precise analysis of the causes of unsatisfactory results of operative treatment.
     

Anatomy of intervertebral disc and pathophysiology of herniated disc disease

This discussion reviews developments in normal and abnormal disc biology over the past decade. The anatomic and biochemical structure of the disc is reviewed. Emphasis is placed on recent neurochemical changes identified in disc degeneration and disc herniation. Biomechanical considerations for the normal disc are presented. Influence of mechanical factors on disc nutrition, disc degeneration and disc herniation is reviewed. Biologic events underlying the diagnostic methods used in evaluating disorders of the intervertebral disc are presented. The biologic consequences of iatrogenic disc injury in discectomy are also discussed.     

Result of laser-assisted disc ablation after unsuccessful percutaneous disc decompression

OBJECTIVE: The author assessed results of laser-assisted disc decompression (LADA) in patients who already had earlier unsuccessful percutaneous discectomy (PD) at the same level. SUMMARY BACKGROUND DATA: The efficacy of LADA after failed PD for the same disc level is not well established. However the literature does not suggest any contraindication to performing LADA in previously failed PD. METHODS: Prospective study of LADA after failed PD at the same disc level in 15 patients was done. Results were assessed clinically using the Japanese Orthopaedic Association (JOA) scale for an average follow up of 13 months. RESULTS: No patient had excellent recovery, 7 patients had poor recovery, 5 patients had fair recovery, and only 3 patients had good recovery. None of the patients had worsening of symptoms after the LADA. CONCLUSIONS: Repetition of another form of minimally invasive surgery by laser (Neo:Yag) for the same level of disc herniation after unsuccessful PD has low rate of success.     

腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系

目的：研究腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系。方法：通过151例腰腿痛患者CT片观察椎间盘突出状况和测定关节突关节角度,其中73例患者还做了MRI检查,了解关节突关节不对称与椎间盘退变的关系。结果：关节突关节不对称与椎间盘退变和突出有关,而椎间盘突出方向与关节面的偏向无关。结论：关节突关节不对称增加了椎间盘退变和突出的危险性。     

Medium-term outcomes of artificial disc replacement for severe cervical disc narrowing

ObjectiveTo determine if the Bryan cervical disc prosthesis could relieve objective neurological symptoms, signs, and restore mobility in patients with severe cervical disc narrowing.MethodsClinical data of thirty-two patients underwent Bryan cervical disc replacement has been collected from April 2006 to February 2010. Severe cervical disc narrowing with grade V disc degeneration were included in this study. Bryan cervical disc prostheses have been implanted through anterior approach. Japanese Orthopedics Association (JOA) score, visual analog scale, Odom's scale, and flexion-extension radiological follow-ups were applied for evaluations.ResultsA total of 41 Bryan disc prostheses from 32 patients with an average follow-up duration of 33.5 months (range 23 to 44 months) were evaluated. Clinical functions of patients were significantly improved. Preoperative averaged visual analog scale score of 6.3±2.2 was decreased to 1.3±1.2 (at 36 months, P<0.001), while preoperative averaged JOA score of 14.4±1.2 was increased to 16.3±0.9 (at 36 months, P<0.001). Thirty of 32 patients received excellent to good outcomes in Odom's scale. Averaged mobility was restored to (9.9±3.2)° at the last follow-up evaluation of 36 months. No subsidence or migration of implant was identified.ConclusionsAcceptable clinical outcome for treatment of severe cervical disc narrowing with cervical disc replacement technique has been performed in current study. Most patients maintained good postoperative mobility and no significant adjacent level degeneration were found. Cervical disc replacement may be applicable in treatment of severe cervical disc narrowing; however, longer follow-ups are required for ensuring the long-term efficacy of cervical disc replacement.