腰椎退变性滑脱症的CT诊断及临床意义

目的：探讨腰椎退变性滑脱症的ＣＴ诊断依据和对硬膜囊、神经根的影响。材料和方法：回顾性分析了５８例腰椎退变性滑脱症（前滑脱４６例，后滑脱１２例）的ＣＴ表现、好发部位及其原因。结果：滑椎下缘相邻间盘均显示有相对性前、后膨出，椎小关节均有半脱位，硬膜囊均有受压，另外，在前滑脱中因１６例椎间盘向后上方突出，２３例椎小关节突明显增生肥大而压迫神经根。结论：ＣＴ不仅能诊断腰椎退变性滑脱症，而且还能显示硬膜囊和神经根的改变。     

腰椎小关节退行性变的CT诊断

目的：探讨CT对腰椎小关节退变的诊断价值。方法：采用SOMTOMNOVA型CT机进行腰3-骶1椎间盘扫描。结果：CT扫查腰椎间盘病变，同时显示腰椎小关节退变，其表现有：椎小关节增生肥大、硬化；椎小关节变窄；椎小关节面下方囊性变；关节囊钙化、真空；关节退变性滑脱。结论：CT扫描是检查和诊断腰椎小关节退行性改变的有效方法。     

腰椎滑脱的CT诊断及扫描基线的确立

目的;提高腰椎滑脱CT征象的认识及选择最佳显示的扫描基线。方法：31例分退变滑脱和真性滑脱对退变表现、崩裂滑脱表现和基线显示进行分析。结果：退变性滑脱、真性滑脱有椎间盘病变、硬膜囊受压、侧隐窝变窄、椎间孔变形等;真性滑脱有椎管及硬膜囊矢状径改变,椎间盘“假性滑脱”、“夹心征”、“叠椎征”;椎间孔扫描和峡部扫描需联合使用。结论：CT扫描不仅明确腰椎滑脱,而且可显示许多细小结构,鉴别退变滑脱和真性滑脱;CT扫描基线的灵活使用可获更多图像信息。     

腰椎退变滑脱的X线与CT表现分析

目的探讨X线平片和CT对腰椎退变性滑脱的诊断价值。方法收集腰椎退变性滑脱92例,对其X线平片和CT进行回顾性分析。结果腰椎退变性滑脱好发于第4腰椎,滑脱程度多在Ⅰ度以内,多合并不同程度的退行性变。X线平片能直观地显示腰椎退变性滑脱,是诊断本病最简单而有效的方法,而CT能清楚显示椎间盘、硬膜囊、关节突和椎管内外结构的变化。结论X线平片与CT结合对腰椎退变性滑脱的诊断和治疗有着重要作用。     

腰椎退变性(假性)滑脱的CT诊断与鉴别诊断

目的研究腰椎退变性滑脱的CT特征,使之与腰椎峡部裂引起的真性滑脱鉴别。方法对80例无腰椎外伤史和腰椎椎弓峡部裂史腰椎退变性滑脱的CT资料作回顾性分析。CT扫描范围从滑脱椎体椎弓开始至下位椎体上缘,所扫层面与椎间盘平行。结果 CT扫描有以下特征:①椎间盘退行性改变。②椎骨和椎小关节退行性改变,腰椎椎体边缘骨质增生及腰椎骨质疏松,椎小关节面增生硬化、关节面下囊变、碎裂、关节间隙变窄或不对称和关节囊钙化;滑脱腰椎椎弓完整,椎体及附件整体向前(后)移位,向前滑脱时,滑脱椎体下关节突向前移位,其前缘几乎与下位椎体上椎小关节突前缘相平或超出下位椎体上椎小关节突前缘,关节方向向矢状方向转化。③椎管、椎间孔和侧隐窝狭窄。④终板双重轮廓。结论腰椎退变性滑脱有其CT特征,能与腰椎峡部裂引起的真性滑脱鉴别。     

腰椎滑脱的CT诊断

腰椎滑脱大体上分为椎弓崩裂性腰椎滑脱和退变性腰椎滑脱。X线平片能较直观地显示腰椎峡部裂以及腰椎滑脱的程度，但对椎间盘、椎间孔、韧带、椎管径线、硬膜囊和神经根却较难显示。CT却能很好地显示以上几个方面。笔者选取腰椎滑脱的病例31例，分析其CT征象，报告如下。     

腰椎滑脱的平片及CT诊断

目的：提高对腰椎滑脱影像征象的认识。方法：常规X线正侧位片及CT扫描对腰椎滑脱的原因进行分析。结果：腰椎滑脱多为峡部裂及椎小关节病引起，14例峡部裂表现为环裂征及双面征。54例椎小关节病表现为椎小关节增生、肥大、关节局部变窄，关节间隙内“真空”现象，关节面囊性变，小关节半脱位等。滑脱主要表现为椎管矢状径增大，叠椎征，葫芦状改变，以及椎间盘假性膨出等。结论：X线正位片对诊断腰椎滑脱价值不大，侧位片能较为清楚地显示滑脱及程度，CT不仅能明确诊断而且可以提供更多信息，不失为目前腰椎滑脱的最佳诊断方法。     

腰椎退变的CT表现

目的 :探讨腰椎退变的CT表现及其诊断价值。材料和方法 :回顾性分析CT诊断为腰椎退变的 96 3例有关资料。结果 :96 3例中 ,椎间盘变性膨出 96例 ;椎间盘突出 713例 ;椎体后缘软骨结节 5 2例 ;椎小关节病 94例 ;退变性滑脱8例。结论 :CT扫描是检查和诊断腰椎退变的有效方法。     

腰椎相关结构的退变规律

目的 研究腰椎退变患者腰椎骨质、椎间盘、韧带、椎小关节退变及腰椎退变性失稳与年龄、性别的相关性,探讨腰椎退变规律.资料与方法 对1 180例腰椎退变患者的腰椎CT进行分析,观察不同年龄段、不同性别间椎体骨质、椎间盘、椎小关节、韧带退变以及退变性腰椎失稳的发生率.结果 腰椎退变患者腰椎间盘的退变率最高,其次是腰椎骨质、椎小关节、韧带、腰椎失稳.以36岁为年龄分界,36岁以下为腰椎低退变率年龄,以上是腰椎高退变率年龄,不同结构伴随年龄增长的退变率并不是同步递增的,腰椎骨质、椎小关节、韧带退变率及腰椎失稳发生率最高在65岁以上年龄段,而腰椎间盘退变率最高在36～45岁年龄段.男性腰椎间盘、骨质的退变率明显高于女性;椎小关节、韧带的退变率在男、女性间无显著差异;而女性腰椎失稳率明显高于男性.结论 总体上伴随年龄增长的腰椎退变,其不同结构的退变规律不一,在不同年龄段及性别间都存在明显差异,全面分析腰椎退变的影像表现有利于对腰椎退变性疾病的理解和治疗.     

腰椎椎管狭窄的CT诊断

本文对110例经CT证实的腰椎椎管狭窄的分析,认为特征性CT表现对提供正确的诊断,治疗极有帮助。其主要征象:①椎管内矢及横径缩短,造成椎管相对或绝对狭窄,压迫硬膜囊,脊髓或神经根;②椎体及小关节增生引起侧隐窝、椎间孔及椎管狭窄;③黄韧带肥厚引起椎管狭窄;④椎体滑脱及手术后残留的间盘组织,纤维瘢痕和移位的植骨片均可引起椎管狭窄。同时提出椎管狭窄绝大多数为退行性变引起的,它们往往同时存在椎骨的其它退变形式,很少有单纯存在的某一种退变形式。本文并对腰椎椎管狭窄诊断中的几个问题进行了简要的讨论。     

腰椎关节突关节直面小角度的CT特征与临床意义

目的: 探讨腰椎关节突关节直面小角度的CT特征及其临床意义.材料和方法: 收集86例腰腿痛的CT片,排除椎体、椎间盘等病变,以关节突关节角大小分为小关节角组和大关节角组,对照分析其关节突关节形态、退变程度、附属软组织病变、局部治疗效果.结果: 小关节角组(46例)比大关节角组(40例)退变程度轻、软组织病变不明显、局部保守治疗疗效良好.结论: 关节突关节角度的大小和形态是引起腰腿痛的重要解剖基础之一.     

CT诊断腰椎小关节综合征的价值

目的分析腰椎小关节综合征的CT表现,探讨CT对该病的诊断价值.材料和方法回顾性分析59例腰椎小关节综合征的CT表现.结果腰椎小关节综合征小关节异常主要包括小关节增生肥大、骨赘形成、关节间隙变窄、小关节真空现象,小关节半脱位、关节囊钙化及两侧小关节不对称以及侧隐窝狭窄,椎间盘真空征及轻度腰椎退行性滑脱.结论CT扫描可对腰椎小关节综合征诊断提供可靠影像学依据,对改进临床诊断和治疗腰腿痛有重要意义.     

腰椎小关节退变的CT诊断及临床意义

目的探讨CT的诊断价值及其临床意义。方法回顾153例腰椎小关节退变的临床症状与诊断,分析椎小关节退变的CT影像改变,进行重新认识、领会与提高。结果椎小关节退变CT影像表现为:小关节突的骨质增生、硬化、骨赘形成,关节软骨侵蚀,关节间隙狭窄、积气,关节面下小囊变及周围筋膜、韧带的钙化等。结论 CT扫描可准确显示腰椎小关节形态、结构等退行性改变,在目前临床医师未足够重视的情况下,运用CT的高分辨特性,对椎小关节退变的早期诊断提供可靠依据,充分提高他们对椎小关节退变的认识,为临床医师正确治疗反复腰腿痛的患者提供很好的帮助。     

Pathophysiology, neurology and diagnostic radiology of degenerative diseases of the lumbar spine

Degenerative diseases of the lumbar spine have a high medical and socioeconomic impact. The leading symptom is back pain, but there are many reasons for this. The aim of this paper is to describe the pathogenesis of degenerative diseases of the lumbar spine and their clinical symptoms in relation to the functional anatomy and biomechanics of the spine. Discs, vertebral facet joints, osseous and ligamentous structures as well as the erector trunci muscles are a functional unit. Progressive degenerative changes of the discs induce bone overgrowth and ligamentous thickening, affect the orientation of the vertebral facet joints and change the pressure, tension and shear forces of the spine. The different radiological diagnostic tools are presented and discussed according to the different degenerative diseases of the lumbar spine.     

螺旋CT多层面重建(MPR)在腰椎间盘病变诊断中的应用价值

目的　探讨螺旋CT多层面重建 (MPR)对腰椎间盘病变的诊断价值。方法　经常规扫描和螺旋扫描MPR重建腰椎间盘病变患者共 41例 ,对L3～ 4 、L4～ 5和L5～S1扫描所得结果进行对比观察。结果　 41例经常规扫描患者中有 35例表现为椎间盘膨出或/和突出 ,经螺旋CT扫描MPR重建示有 36例表现为神经根受压、硬膜囊受压或椎间孔骨性狭窄 ,其中常规扫描无异常发现的 6例患者 ,经MPR示椎间盘压迫神经根或椎间孔骨性狭窄致神经根受压。结论　MPR重建在诊断腰椎间盘病变、显示腰椎疾病的原因以及腰椎疾病的鉴别诊断等方面具有重要价值     

Migrating lumbar facet joint cysts

Objective The majority of lumbar facet joint cysts (LFJCs) are located in the spinal canal, on the medial aspect of the facet joint with characteristic diagnostic features. When they migrate away from the joint of origin, they cause diagnostic problems. Materials and methods In a 7-year period we examined by computed tomography (CT) and magnetic resonance (MR) imaging five unusual cases of facet joint cysts which migrated from the facet joint of origin. Results Three LFJCs were identified in the right S1 foramen, one in the right L5-S1 neural foramen and one in the left erector spinae and multifidus muscles between the levels of L2–L4 spinous process. Conclusions Awareness that spinal lesions identified at MRI and CT could be due to migrating facet joint cyst requires a high level of suspicion. The identification of the appositional contact of the cyst and the facet joint needs to be actively sought in the presence of degenerative facet joints.     

The effect of spondylosis on the outcome of chemonucleolysis

In an attempt to understand the relation between the outcome of chemonucleolysis treatment of lumbar discs and the presence of spondylosis (degenerative process) of the lumbar spine, 40 cases of disc herniation with subsequent intradiscal chymopapain injection (chemonucleolysis) were reviewed. Thirty-eight patients had plain radiographs, 25 had myelography, 28 had computed tomography (CT), and 15 had both myelography and CT. A review of these examinations revealed that 24 patients had minimal or mild spondylosis (group 1) and 13 patients had moderate spondylosis (group 2). Only one patient had a severe spondylosis (group 3). Chemonucleolysis failed in 8/24 (33%) patients from the first group and 2/13 (15%) cases from the second group. Therefore, the presence or absence of even moderate spondylosis did not affect the treatment success rate. A review of the 11 failed cases revealed spinal canal stenosis in three cases and a large disc herniation in two (one case with a myelographic block). Another case had a sequestered disc fragment. In two further cases, the disc herniation was far lateral with complete occlusion of the lateral foramen; another case exhibited severe degenerative changes of facet joints. In two other cases, treatment failure could not be explained by any radiographic finding. Of three patients with large disc herniation, only one responded successfully to intradiscal injection of chymopapain. Chemonucleolysis, however, failed in the only patient in the third group who had severe spondylosis of the facet joint.