CT三维重组诊断寰枢关节不全脱位的实验及临床研究

目的 比较寰枢关节的影像检查方法及技术，评价CT三维重组（CT3D）诊断寰枢关节不全脱位的临床价值。方法 实验研究寰枢关节骨标本1套，模拟出寰枢关节正常及脱位的模型，进行X线、常规CT及CT3D检查。前瞻性分析影像学特点及诊断准确率。临床患者87例进行中立位CT3D检查，其中28例加行左、右旋转位。分析CT3D显示脱位征象的特点及诊断寰枢关节不全脱位的临床效果。结果 实验组CT3D能清楚、直观的显示寰枢关节不全脱位各种征象，诊断准确率达100％。表面阴影法（SSD）CT3D显示寰枢外侧关节面错位最清楚，寰椎下关节面错位程度测量值与标本测量值差异无统计学意义（P〉0．05）。87例患者中诊断为寰枢关节不全脱位72例，其中旋转型脱位52例，前脱位13例，后脱位7例。中立位显示寰枢外侧关节面错位72例，旋转位显示为旋转固定8例，旋转不对称15例。结论 CT3D能显示寰枢关节不全脱位的各种征象，特别是寰枢外侧关节面错位。其中SSD法3D较X线、常规CT的诊断准确率高，具有成为诊断寰枢关节不全脱位金标准的条件。     

下颈椎单关节脱位损伤的X线及CT诊断

目的 探讨下颈椎单关节脱位损伤的X线及CT诊断特点.方法 15例下颈椎单关节脱位损伤患者的X线及CT影像进行观察.结果 X线侧位片示:脱位椎体向前移位的距离＜25% 15例;脱位椎下位椎体关节侧块后缘到椎板线的距离突然改变13例;脱位椎体的双侧上关节突"领结"征12例.正位片示:脱位颈椎的棘突脱位侧偏移15例.斜位片示:小关节脱位或交锁5例.CT示:异常的"汉堡包"征7例;合并单侧关节突的骨折8例;脱位椎及上方的椎体旋转13例;脱位椎体和下位椎体的"双环征"12例.结论 结合受伤机制、临床表现和X线、CT的特征性征象,能对下颈椎单关节脱位损伤做出正确诊断.     

Uncovertebral and facet joint dislocations in cervical articular pillar fractures: CT evaluation

Computed tomographic (CT) scans and plain radiographs of 21 patients with surgically treated fractures or dislocations of the cervical spine were reviewed. CT effectively demonstrated the locked or perched facets and half of the 13 articular pillar fractures. The fracture lines through the articular pillar were difficult to detect in some cases or to distinguish from a facet joint in others. However, distraction of an adjacent uncovertebral or facet joint was demonstrated by CT in each case of articular pillar fracture or locked or perched facet. Therefore, CT demonstration of a distracted facet or uncovertebral joint is an indirect sign of an unstable fracture or of a dislocation that may be more readily recognized on plain radiographs or pluridirectional tomograms.     

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。     

MRI of cervical facet dislocation

The MRI examinations of eight patients with cervical vertebral dislocation demonstrated by conventional radiography were reviewed. All patients had axial and sagittal T 1- and T 2-weighted imaging on a 1.5-T unit. This revealed unilateral partial facet dislocation (in two patients), bilateral partial facet dislocation (in two), unilateral complete dislocation (in two) and bilateral complete facet dislocation (in two). In six patients there was cord contusion, three had focal disc protrusions and four unilateral absence of normal flow void in one of the cervical vertebral arteries. In all cases, the dislocated facets were shown well on the far-lateral sagittal images. Received: 19 September 1996 Accepted: 29 November 1996     

急性颈椎外伤的MRI诊断

目的 分析急性颈椎外伤的MRI征象,评价MRI在急性颈椎外伤诊断中的价值及限度。方法收集急性颈椎外伤150例,均有MRI检查和X线平片,15例有CT片,采用14个参数进行分析记录。结果150例中MRI检出骨折51个,小关节脱位30个,椎体脱位35个;外伤性椎间盘突出40个,硬膜外血肿2例;脊髓损伤69例;脊髓受压迫20例;前、后纵韧带损伤21例;棘间韧带和黄韧带损伤15例;椎前血肿或水肿30例;椎旁和背侧软组织损伤40例;X线平片发现椎体骨折55个,椎体脱位35个;小关节脱位35例,附件骨折25个,椎前软组织肿胀20例。15例CT均发现骨折,小关节脱位,椎管狭窄。结论MRI在显示脊髓、韧带、椎间盘和软组织损伤方面优于CT和X线平片。MRI能全面反映颈椎各种损伤的病理特征,为评估颈椎稳定性提供充分的依据;MRI和X线片的骨折检出率没有明显差异,CT应该用于复杂的颈椎骨折检查。     

Pure thoracolumbar facet dislocation: clinical features and CT appearance

The use of computed tomography (CT) in demonstrating pure dislocations of the thoracolumbar facets and in predicting the prognosis of this injury was evaluated and compared with radiography retrospectively. The records of 29 patients with pure thoracolumbar bilateral facet dislocation who were admitted to the trauma unit over a 4-year period were reviewed. Twenty-two patients (76%) had a complete neurologic loss that remained complete following immediate surgical stabilization; five (17%) had an incomplete neurologic loss, and two (7%) were normal neurologically. Plain radiographs of the spine, including anteroposterior and lateral views, documented the level and type of fracture but failed to depict the full extent of bony ad soft-tissue injuries. CT provided essential additional information, particularly regarding the status of the posterior elements of the vertebrae and the adequacy of the spinal canal. Pure thoracolumbar facet dislocations have a characteristic appearance on axial CT scans. Sagittal reformation through CT is essential in the evaluation of this type of spinal injury.     

椎小关节病的CT诊断：附402例分析

笔者对１０１７例肩背和／或腰腿痛患者的临床、Ｘ线及ＣＴ资料进行了回顾性分析。ＣＴ显示椎小关节异常４０２例，Ｘ线显示１８３例。ＣＴ对本病的显示率比Ｘ线高１２倍。ＣＴ能有效地显示关节突增生肥大、骨赘形成、关节间隙变窄、骨性关节面改变、关节脱位及半脱位、侧隐窝或椎间孔狭窄、关节囊钙化及关节“真空”征等。后二者Ｘ线检查难以显示。ＣＴ易于显示椎小关节病及其并存症，对肩背腰腿痛患者的合理施治有重要意义。     

Lumbar facet joint capsule: appearance at MR imaging and CT

The joint spaces and synovium of the lumbar facet joints extend beyond the articular surfaces of the joint in the majority of adults. The authors correlated magnetic resonance (MR) imaging, computed tomographic (CT), and axial cryomicrotome sections of 66 facet joints in nine cadavers. Extensions of the synovium and joint space along the superior and inferior articular processes, under the ligamentum flavum, and into the ligamentum flavum could be recognized with use of MR and, less successfully, CT. The injection of a paramagnetic contrast medium into the facet joint facilitated visualization of the capsule on MR images. On the ventral aspect of the lumbar facet joint, MR images showed regions of high signal intensity where the joint space extended into the ligamentum flavum or between the ligamentum flavum and lamina. On the dorsal aspect of the joint, MR demonstrated prominence of the fibrous joint capsule where the joint space extended under it along the inferior articular process or along the superior articular process. The variable appearance of the ventral and dorsal aspects of the lumbar facet joint on CT and MR images is due to extension of the synovium and joint space.     

Radicular pain avoidance during needle placement in lumbar diskography

OBJECTIVE: The objective of our study was to determine whether a method could be found to reduce iatrogenic radicular pain during needle placement in lumbar diskography. MATERIALS AND METHODS: After obtaining permission from the institutional review board at the University of Pittsburgh Medical Center, we conducted a study using medical records and existing data that were recorded for quality control during lumbar diskography. A coaxial technique was being used for lumbar diskography. We evaluated data for 71 intervertebral disks in 26 patients in which the needle placement was randomly high (superior) or low (inferior), and the associated pain response during needle placement was recorded. In an attempt to minimize iatrogenic pain during needle placement, we identified a potentially "safe window" for needle placement on MRI of the lumbar spine. On oblique fluoroscopy of the lumbar spine, the safe window is a triangle formed by the superior articular facet medially, the superior endplate of the lower vertebra inferiorly, and an imaginary line joining the tip of the superior articular facet and the superolateral tip of the vertebral body. This safe window was then used for needle placement in another 73 intervertebral disks in 27 patients. Pain response to needle placement was recorded for quality control, and the medical records were retrospectively compared with the initial 71 intervertebral disks in which needle placement was random. RESULTS: In the initial group with random needle placement, lower extremity radicular pain occurred in 13 (18.3%) of 71 intervertebral disks with superior needle placement and in 23 (32.4%) of 71 intervertebral disks with inferior needle placement (total, 50.7%). The pain responses of the superior and inferior groups were not significantly different (p = 0.27). On MRI, the average distances between the nerve ganglion-fascicle-rami and the superior articular facets at the superior disk level were 1.1, 1.4, and 2.5 mm at L3-L4, L4-L5, and L5-S1, respectively. The average distances between the nerve ganglion-fascicle-rami and the superior articular facets at the inferior disk level were 3.0, 3.6, and 6.6 mm at L3-L4, L4-L5, and L5-S1, respectively. When the safe window was used, only five (6.8%) of 73 patients reported radicular pain. The decrease in radicular pain between the two groups was significant (p < 0.001). CONCLUSION: Iatrogenic lower extremity radicular pain is common during random needle placement at lumbar diskography. High or low needle placement in the intervertebral disk could not predict whether radicular pain would be averted. We identified a safe window that can be used for needle placement during lumbar diskography to minimize iatrogenic lower extremity radicular pain and thereby improve the reliability of the test.     

Calcaneal fractures: CT aspects

Calcaneal fractures account for 33.3% of foot fractures and 1.5% of all fractures. They were divided by Warrick and Brenner into two main groups according to whether they modify the astragalocalcaneal joint or not. Given the anatomical complexity of the foot, conventional X-rays are not always able to correctly visualize the articular facets and therefore provide insufficient information as to the characteristics of the fracture line, the position of bone fragments, and the involvement of capsulo-ligamentous structures. The authors report their personal experience with CT in the study of 12 patients with monolateral calcaneal fractures previously diagnosed on conventional X-rays. High-resolution CT (HRCT) was employed with 3-mm contiguous sections on the axial and the coronal planes. CT was used to study the normal anatomy of the foot and to evaluate 3 patients with calcaneal fracture without impaction of the posterior facet; 9 patients with impaction into the calcaneal body were also examined with CT. In the first 3 cases, an oblique fracture line was observed crossing from craniolateral to mediocaudal and thus dividing the calcaneus into 2 large fragments: sustentaculum tali and posterior facet of the talar joint. In the extant 9 cases the impaction of the posterior facet was indicated by an interruption in lateral and/or medial calcaneal walls. In 2/9 cases bone fragments were seen in the tarsal sinus, in 4/9 the sustentacular fragment was displaced, in 2 the cuboid bone was impacted into the anterior process of the calcaneus and, finally, in 7/9 cases a lateral/medial dislocation of the calcaneal tuberosity was observed. On the basis of these results, CT proved to be of greater value than conventional X-rays in the imaging of calcaneal fractures and to have a fundamental role every time an accurate evaluation of the region is needed to plan treatment.     

外伤性胸腰椎骨折的X线和CT诊断

目的探讨X线和CT在外伤性胸腰椎骨折中的诊断价值。材料和方法57例胸腰椎骨折均行X线和CT检查。结果57例74个椎体骨折中单椎体骨折43例,多椎体骨折14例。爆裂型骨折45个椎体,压缩型骨折21个椎体,骨折脱位型9个椎体。骨折发生于前柱10个椎体,前中柱22个椎体,前中后柱39个椎体,中后柱2个椎体,前后柱1个椎体。结论X线平片对外伤性胸腰椎骨折有一定的价值,但CT在显示椎体三柱结构,骨折线,小关节脱位,椎管狭窄程度,脊柱稳定性,判断脊髓损伤等有明显优势。     

CT三维成像诊断寰枢关节不全脱位的临床价值

目的 评价CT三维成像对寰枢关节不全脱位的显示及诊断价值，探讨最佳三维成像方法。方法回顾性分析41例寰枢关节不全脱位的CT影像学表现，比较横断面图像、多层面重建(multiplanar reformatting，MPR)法、表面遮盖(surface shade display，SSD)法、最大强度投影(maximum intensity projection，MIP)法及容积重建(volume rendermg，VR)法三维图像显示的病变情况。结果寰枢关节不全脱位41例，其中旋转型脱位31例，前脱位5例，后脱位5例。影像学表现为上、下关节面错位41例，其中错位2～5mm 29例、5～9mm 12例；齿突侧距不对称15例；寰齿间隙增宽合并骨折8例。SSI)法三维影像直观显示移位的寰枢关节上、下关节面，齿突侧距不对称及寰齿间隙增宽；横断面图像和MPR、MIP及VR法三维图像显示移位的上、下关节面差、不直观。结论运用CT三维成像能准确显示及诊断寰枢关节不全脱位，并以SSD法三维成像最佳。     

The notched articular process of C7 (dorsalization of C7).

The frequency of variation from the standard in the articular processes of C7 is very high (43.9 percent). These variations are: (1) A notch on the back of the superior articular facet. (2) Elongation the the "articular pillary" so that the posterior edge of the inferior articular process of C7 lies backward in relation to the posterior edges of the other cervical articular process. (3) A combination of both. Item 1 should not be mistaken for a fracture and item 2 should not be mistaken for a dislocation. These variants represent a partial dorsalization of C7.     

Postoperative fractures of lumbar articular facets: occult cause of radiculopathy

Fracture of the inferior lumbar articular facets after laminectomy with facetectomy is a relatively common but unrecognized cause of radiculopathy. Although not all patients may be symptomatic from the fractures, some may have radiculopathy or back pain caused by displacement of the fracture fragment. In a series of 400 postoperative spinal computed tomographic (CT) scans, 25 patients were found who had fractures through the base of the inferior facets. Axial scans revealed no abnormality other than slight widening of the joint on the affected side. Sagittal views demonstrated a lucent defect similar to a pars interarticularis fracture, whereas coronal views showed the fracture at a different location in the base of the facet. Typically patients become symptomatic after a period of postsurgical well-being. A new pain pattern, local tenderness, pain on unusual movements, and relief with recumbency help suggest facet fracture versus recurrent disk herniation.     

胸腰椎外伤后脊髓损伤CT平扫的局限性

目的：探讨CT平扫诊断胸腰椎外伤后脊髓损伤的局限性。方法：收集近7a来48例胸腰椎外伤的CT平扫结果、X线片结果及临床资料，并进行对比分析。结果：48例胸腰椎外伤病人中椎体骨折73个，单发59个，多发14个，其中CT示碎骨入椎管内的有25处，血肿1处，附件骨折36处，X线片漏报附件骨折16处(44％)瘫痪病人11例，均经手术治疗，术中发现椎管内碎骨15处，血肿2处，脊髓挫伤或断裂10处。结论：CT平扫对椎体、附件骨折、椎管形态改变和碎骨片移位及明显的椎管内血肿的诊断，优于X线平片，但是对脊髓损伤的显示有局限性，建议胸腰椎外伤后瘫痪病人做脊髓造影(CTM)或磁共振成像(MRI)。     

胸腰椎爆裂性骨折的诊断分型和内固定治疗

报告我院１９８０年２月－１９９３年７月收治４６例胸腰椎爆裂骨折，涉及椎体４９个，笔者将骨折的诊断分为上终板损伤型，上下终板损伤型，上终板及侧方挤压型，爆裂旋转型及多椎体损伤型。提出治疗早期应行切开复位减压及内固定术；在不伴神经损伤或严重爆裂型骨折，早期可行保守观察。     

CT evaluation of the lumbosacral spine

The biologic cost-effectiveness of computed tomography (CT) versus myelography is so favorable to CT that it is now the method of choice for evaluating patients with less clear-cut clinical findings. CT is now used to detect lesions formerly difficult to diagnose, such as subluxation, arthrosis, facet osteophytes, and stenosis of the vertebral canal, as well as herniated disks and lateral disks. The findings in over 1,000 patients examined by CT for lumbosacral spinal pathology are documented. Associated or multiple abnormalities were present in about 60% of cases, with bulging or herniated disks occurring in 45% and 44%, respectively. Postsurgical arachnoiditis was seen in 43% of 64 patients studied for recurrence of symptoms after surgery.     

胸腰段脊椎爆裂骨折的CT诊断(附70例分析)

目的 研究胸腰段脊椎爆裂骨折的CT表现和椎体后缘的后移碎骨片引起椎管狭窄与神经损伤之间的关系。资料与方法 回顾性分析70例72个椎体爆裂骨折的CT表现，其中有2例为2个脊椎爆裂骨折。所有患者CT扫描层厚、层距均为5mm。结果 脊椎胸腰段爆裂骨折的CT表现如下：（1）椎体向心性爆裂；（2）碎骨片向后移位导致椎管狭窄；（3）椎基静脉孔垂直矢状向骨折；（4）单侧或双侧椎板骨折；（5）部分伴随横突、棘突、关节突和／或椎体骨折。椎管狭窄和程度与神经损伤有关。结论 CT扫描能很好地显示脊椎爆裂骨折和椎管狭窄的程度，是诊断胸腰椎爆裂骨折的重要方法，并对帮助制订治疗方案起着重要作用。     

Bilateral spondylolysis and associated dysplasia of C6.

Cervical spondylolysis is a rare condition, characterised by the presence of a corticated cleft between the superior and inferior articular facets of the articular mass (1). This defect involves the cervical equivalent of the pars interarticularis of the lumbar spine. Associated dysplastic changes are present, suggesting that the lesion is congenital (1 and 2). This case report describes bilateral spondylolysis and associated dysplasia of C6 in an 18 year old female. The importance of this lesion lies in its differentiation from the more serious articular mass fracture or dislocation (1).