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。     

腰椎小关节退变的CT诊断

目的确定cT扫描对诊断腰椎小关节退变的可行性。方法208例临床疑诊腰椎小关节退变患者于临床症状出现后1个月～1a内均接受了螺旋cT扫描。结果cT扫描证实，208例中有313个腰椎小关节发生改变。腰椎小关节退变的cT表现主要是关节突增生肥大合并骨赘形成，椎小关节间隙变窄或消失，关节腔内“真空征”，关节面毛糙硬化，小关节半脱位，以及伴发椎间盘突出、膨出，黄韧带肥厚和钙化等。结论螺旋cT扫描可准确显示腰椎小关节的形态、结构及其异常改变，能为腰椎小关节退变的早期诊断提供可靠依据。     

寰齿关节和寰枢外侧关节退变性骨关节病的CT表现

目的：探讨寰齿（AO）关节与寰枢（AA）外侧关节退变的关系。方法：对164例接受头颅CT检查病人的AAU关节行CT扫描。结果：寰枢关节退变性骨关节病（AAOA）的影像学表现主要为关节间隙变窄和骨赘。二关节退变有相关性。结论：AO关节和AA外侧关节退变分别见于40岁和50岁以后,二者有一这一的关联。     

胸椎管狭窄的影像学诊断

本文报告１７例胸椎管狭窄，对其在胸椎平片，脊髓造影，ＣＴ和ＣＴＭ上的表现进行了观察和分析。引起本病的主要原因是椎板小关节的增生肥大、间盘疝，黄韧带和后纵韧带的肥厚和骨化，同颈和腰椎管狭窄相化，胸椎管狭窄具有如下特点：（１）发病率低；（２）临床症状出现晚，进展缓慢，呈进行性加重；（３）狭窄部位主要位于间盘－椎间关节平面，（４）韧带骨化更明显，范围更广泛，对不同影像学检查方法的价值和早期诊断的重要性进     

颈椎退变性滑脱与外伤性滑脱的X线鉴别

退行性非椎弓崩解性滑脱有前和后滑脱两种,椎弓部均完整。作者复习了椎体滑动2mm以上的颈椎退行性关节炎42例、外伤22例。退行性者以前脱多见,表现为椎间隙狭窄和骨赘形成,相邻椎体前移并有小关节面呈“圆钝”状变形,关节突变薄,小关节间隙则正常。随颈椎发生僵硬,应力的作用使椎间盘和小关节囊韧带过度伸拉松弛造成脱位,久后小关节间隙也可变窄。作者的部份病人仅小关节有严重的退变,椎间隙无改变,提示一些滑脱的主要原因是小关节病变所致。后脱则是由于颈     

腰椎间盘与椎小关节退行性改变的CT影像探讨

目的探讨腰椎间盘退行性改变及椎小关节进行性改变的CT影像特点。方法对52例腰椎退行性改变的患进行CT扫描，分析其椎间盘、椎小关节、韧带的CT表现。结果腰椎问盘的退行性改变的CT影像可表现为椎间盘的膨出、突出、髓核脱出及真空现象。椎小关节的退行性改变的CT影像可表现为关节突的增生肥大、骨形成、关节间隙变窄及关节面下囊样变。本52位患中，表现为椎间盘退行性改变占11.5％，表现为椎小关节的退行性改变占28.8％，腰椎间盘与椎小关节均受累占48.1％。结论椎小关节的退行性改变是腰椎间盘的退行性改变的早期征象。     

膝关节骨关节炎的临床与放射学评价

双膝关节骨关节炎（Ｏｓｔｅｏａｒｔｈｒｉｔｉｓ，ＯＡ）病变程度的判断，长期以来一直根据Ｘ线片中关节间隙的狭窄与骨赘增生的程度进行分期与分级。但大量的临床病例证明膝关节ＯＡ患者的Ｘ线改变与其临床表现之间常缺乏对应关系，使其对临床治疗方案的选择缺乏指导意义。为此，我们将膝关节ＯＡ患者的临床表现与Ｘ片改变进行对照分析，参照Ｌａｒｓｏｎ膝关节评分系统〔１〕对膝关节ＯＡ患者进行临床评价，并通过关节镜与开放手术中对关节病变的观察，研究膝关节ＯＡ的临床症状、体征、Ｘ线片改变与关节内结构病变之间的关系。我们将临…     

CT对腰椎退行性变的诊断价值

目的探讨ＣＴ在诊断腰椎退行性变中的价值。方法回顾分析３００例腰椎退行性变的ＣＴ检查资料,找出其影像变化的特征。结果在３００例ＣＴ诊断为腰椎退行性变的病例中,表现为：（１）椎体骨质增生１９４例,占６４７％;（２）椎间盘膨出１１０例,占３６７％;（３）椎间盘突出９７例,占３２３％;（４）椎小关节病９７例,占３２３％;（５）椎间盘膨出和突出６１例,占２０３％;（６）退变性骨性椎管狭窄中央型２３例,占７７％;侧隐窝狭窄１９例,占６３％;（７）黄韧带肥厚１８例,占６０％;（８）退变性脊椎滑脱６例,占２０％;（９）真空现象５例,占１７％。结论ＣＴ检查不仅能明确腰椎退行性变的诊断,而且能为临床表现的解释和治疗提供更多的信息和依据。     

寰齿关节退行性骨关节病CT表现及临床相关性分析

目的 探讨寰齿关节退行性骨关节病的CT表现及其临床相关因素.资料与方法 回顾性分析114例颈椎CT表现.结果 寰齿关节退行性骨关节病67例,40例有慢性颈枕部疼痛症状,63例合并中下颈椎退行性骨关节病.骨质增生、齿状突周围钙化及关节间隙狭窄或消失发生率分别为95.52%、32.84%和17.91%.结论 寰齿关节退行性骨关节病与下颈椎退变密切相关,影像学特征包括关节边缘骨赘、关节间隙狭窄及齿状突周围钙化.     

腰椎退变的CT表现（附300例分析）

笔者对３００例腰椎退变病人作了ＣＴ检查，就其ＣＴ表现进行分析，探讨退变的病理变化，引起临床症状的原因，为腰椎退变提供可靠的影像学根据。     

Association of transverse ligament calcification with anterior atlanto-odontoid osteoarthritis: CT findings

The craniocervical junction was assessed in 700 consecutive unselected patients undergoing CT of the brain or paranasal sinuses, to investigate whether transverse ligament calcification was associated with advanced degenerative changes at the anterior atlanto-odontoid (AO) joint. Calcific deposits within the transverse ligament were seen in 40 patients (5.7%). The prevalence of this condition increased with age. Advanced degenerative changes (marked osteophytes and obliteration of the joint space) at the anterior AO joint were significantly more frequent in patients with transverse ligament calcification than in age-matched controls. We conclude that transverse ligament calcification is seen frequently in the elderly and very frequently with advanced degenerative changes at the anterior AO joint.     

Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation

OBJECTIVE: The purpose of our study was to describe the MR appearance and coexistence of anterior cruciate ligament ganglia with mucoid degeneration and to address the clinical significance of these entities. MATERIALS AND METHODS: A database search of 4221 knee MRI examinations over 2 years revealed 90 examinations with reported anterior cruciate ligament ganglion or mucoid degeneration. Imaging criteria for ligament ganglion included fluid signal in the ligament disproportionate to joint fluid showing mass effect on intact ligament bundles. The size, location, complexity, and degree of lobulation of ganglia were recorded. Criteria for mucoid degeneration included ligament bundles poorly seen on T1-weighted and proton density-weighted images but with both bundles seen as intact on T2-weighted images. Intraosseous cysts at the ligament attachments and presence of joint effusion were noted. Clinical assessment of ligament instability was recorded when available. RESULTS: Of 74 examinations that met imaging criteria, 56 (76%) had discrete intraligamentous ganglia, 18 (24%) had mucoid degeneration, and 26 (35%) had features of both. Ganglia were located in the proximal ligament in 16 examinations (22%) and the distal ligament in 10 (14%) and involved the entire ligament in 30 (40%). Ganglia ranged in maximum diameter from 20 to 73 mm (mean, 31 mm). Complexity of ganglia was mild (41%), moderate (39.2%), or marked (19.8%). Intraosseous cysts were noted proximally in 48 examinations (65%) and distally in 20 (27%). Of 52 patients with accessible records, 48 had no clinical evidence of instability. Twelve patients who underwent arthroscopy had an intact anterior cruciate ligament at that time. CONCLUSION: Anterior cruciate ligament ganglia and mucoid degeneration commonly coexist on MRI and are typically not associated with ligament instability.     

Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients

PURPOSE: To investigate the histopathologic anatomy of calcium pyrophosphate dihydrate (CPPD) crystal deposition in and around the atlantoaxial joint and the association between CPPD crystal deposition and subchondral cysts, erosions, and fracture involving the odontoid process of the axis. MATERIALS AND METHODS: One adult cadaver demonstrating calcification in the retro-odontoid area at computed tomography (CT) was selected for further radiography, CT, and magnetic resonance (MR) imaging at the C1-2 level. Anatomic sectioning and histologic evaluations were performed in the specimen. For clinical study, radiographs (n = 5), CT scans (n = 8), and MR images (n = 6) in nine patients (mean age, 74.4 years) with odontoid process fractures and CPPD crystal deposits in and around the atlantoaxial joint were reviewed. RESULTS: In the cadaveric specimen, radiography and CT demonstrated calcifications in the transverse ligament; histologic evaluation confirmed that these calcifications were CPPD crystal deposits. In all nine patients, radiography (n = 5) and CT (n = 8) also showed calcification in areas adjacent to the odontoid process, which included the transverse ligament. T1- and T2-weighted MR imaging showed a retro-odontoid mass of low signal intensity that compressed the cervical cord in six patients. CT, MR imaging, or both demonstrated subchondral cysts, osseous erosions, or a type 2 odontoid fracture in all patients. CONCLUSION: CPPD crystal deposition disease involving the C1-C2 articulation can be a clinically important entity that may place affected patients at increased risk of pathologic fracture of the odontoid process.     

寰枢关节退变性骨关节病的影像学表现及与临床的相关性

目的　探讨寰枢关节退变性骨关节病 (AAOA)的影像学表现及与临床的相关性。方法　对 164例主要接受头颅CT检查病人的寰枢 (AA)关节行CT扫描 ,部分加摄X线张口位片。结果　AAOA的影像表现为关节间隙变窄、骨赘及关节周围钙化。AA外侧关节退变与枕颈区痛有相关性。结论　CT较X线能更好地显示AAOA的病理改变 ,对于有单侧枕颈区痛的 5 0岁以上患者 ,应考虑是否有AA外侧关节骨关节病     

脊椎滑脱的影像学研究

脊椎滑脱病因主要有:先天发育不良、椎弓峡部裂、退行性变,其申后者最多见。真性滑脱主要是指椎弓峡部裂,假性滑脱主要包括退行性腰椎滑脱和先天发育不良性滑脱。大多数脊椎滑脱没有症状,患者脊椎稳定性较差时出现疼痛。平片侧位、左右斜位对病因诊断十分重要,但定性诊断率较低;叨横断面对椎弓峡部裂的检出有作用,但易将峡部裂隙与正常小关节间隙混淆而漏诊;椎弓反角度扫描技术有利于更好的显示和检出椎弓峡部裂,但需另行扫描,增加扫描次数和剂量;多层CT可一次各向同性扫描后采用多平面重组的后处理技术,在不增加扫描剂量的前提下,获得所有椎体椎弓及小关节横断面图像、斜横断(椎弓反角度)图像和矢状位图像等多种图像,从各种角度,特别是矢状长轴断面明确显示小关节及惟弓峡部状态,便脊椎滑脱的影像学研究提高了一大步。     

腰椎椎间关节退变的CT表现及临床意义

目的加强对腰椎椎间关节退变的认识和重视。方法总结60例腰椎椎间关节退变的cT表现,所有病例均行常规cT平扫,层厚、间隔均为3-5him。结果CT扫描表现为：31例关节面不对称,58例关节突增生硬化、骨赘形成,45例关节间隙狭窄、糜烂、软骨下骨质改变,11例关节出现真空现象,12例关节囊及关节周同钙化（12例）。结论CT能对椎间关节退变作令面观察,对下腰痛患者．很有必要做cT检查以排除腰椎问关节退变。     

膝关节韧带损伤与胫骨平台骨折Schatzker及AO分型的相关性分析

目的分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。方法选取2018年1月至2019年6月厦门大学附属福州第二医院骨科收治的28例胫骨平台骨折合并膝关节韧带损伤患者作为研究对象,根据Schatzker分型及AO分型系统对胫骨平台骨折进行分型,同时判定前交叉韧带(anterior cruciate ligament,ACL)、后交叉韧带(posterior cruciate ligament,PCL)、内侧副韧带(medial collateral ligament,MCL)及后外侧角(posterior lateral corner,PLC)的损伤情况,并采用Spearman相关系数分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。结果Schatzker分型与AO分型(仅以关节外、部分关节内和完全关节内3种类型计算)对应分析结果显示,两者具有显著相关性(P=0.000)。Schatzker分型及AO分型与韧带损伤类型Spearman相关分析结果显示,Schatzker分型及AO分型与ACL、MCL及PLC损伤均呈显著相关性(r=-0.465、-0.639、0.756,P=0.013、0.000、0.000;r=-0.588、-0.420、0.532,P=0.001、0.026、0.004),但若AO分型以关节外、部分关节内和完全关节内3种类型计算,则仅与ACL损伤呈显著相关性(r=-0.465,P=0.013)。结论膝关节损伤时膝关节相关韧带之间有一定协同作用,故胫骨平台骨折多合并膝关节韧带损伤,且随着Schatzker分型与AO分型等级的增高,ACL、MCL及PLC损伤的可能性均增大。     

强直性脊柱炎骶髂关节病变的CT表现特点

目的探讨强直性脊柱炎(AS)骶髂关节改变的CT特点,协助临床评估病变程度,以提高其鉴别诊断水平。资料与方法回顾性分析68例AS患者的骶髂关节CT表现特点。结果AS骶髂关节CT表现特点为病变累及骶髂关节滑膜部髂骨侧为主,软骨钙化、关节间隙改变、关节面及面下骨结构改变以及骶髂韧带钙化。结论AS骶髂关节CT表现多种多样,但有一定的规律性。