下颈椎失稳X线片极坐标测量法的分析及临床价值

目的探讨Ｘ线片极坐标测量法在诊断下颈椎失稳中的应用价值。材料与方法对５３例头颈部症状患者、３０例脊髓型颈椎病患者及３０例正常人行颈椎屈伸动态Ｘ线摄片,获得颈椎节段间６项运动参数的测量值。结果颈椎过屈时角位移和线位移三组间无显著性差异;过伸时症状组角位移和线位移均明显高于对照组（Ｐ＜０．０５）,屈伸角位移范围症状组明显高于对照组,而颈椎病组明显小于正常组（Ｐ＜０．０５）。结论颈椎失稳以后伸失稳为主,极坐标测量法符合颈椎实际运动轨迹。是一种诊断颈椎失稳更为可靠的方法。     

颈椎椎管矢状径对诊断颈椎病的临床意义

颈椎间盘发生退行性变时，能产生对神经和／或脊髓的压迫而产生症状，对此，X线摄片是最常应用的检查方法，继而X线片上具有颈椎间盘退变的病人可以无任何临床症状；相反，不少有严重的颈脊髓病者的X线片上可无明显的改变，这种床临床症状与X线变化的不一致。有人认为可能与病人椎管管径的大小有关（1－4）。为此，我们分别对100例颈椎病者的86例健康成人的颈椎侧位片进行了和对照观察，另外，对20例成人尸体颈椎按节段作横剖面的切开，并摄线片，以期进一步探究颈椎管与脊髓，周围软组织之间的关系。     

颈椎生理曲度测量改进法及参考常值

目的 改变目前临床放射科测量颈椎曲度的不精准、不合理方法,制订出逐个椎体的测量法并求出飞行员颈椎曲度的正常参考值。方法 坐位摄片,头稍后仰,X线管中心对准第4颈椎,投照距离1.8 m。在X线片上,从枢椎齿状突后上缘至第7颈椎后下缘作直线;沿各椎体后缘作弧线;测各椎体后缘中点至直线的距离,以毫米计量。结果 按此法对100例健康男性飞行人员、30例健康男性地面人员和30例患颈椎病的男性飞行人员进行测量,结果表明:健康飞行员组C_2为4.29±1.16 mm,C_3为8.68±2.42 mm,C_4为11.35±2.86 mm,C_5为12.07±3.02 mm,C_6为9.37±2.68 mm,C_7为4.58±1.65 mm。与健康地面人员组各相应椎体曲度无显著性差异(P>0.05),健康飞行员组和健康地面人员组与颈椎病组飞行员各相应椎体曲度存在显著性差异(P<0.01)。结论飞行人员颈椎生理曲度参考常值作为X线颈椎片测量的一个定量指标,对于飞行人员颈椎曲度的健康鉴定具有一定的意义。     

X线颈椎开口位齿状突象在评价非创伤性病变中的作用

作者收集了几所医院1033例非创伤性颈椎系列摄片的门诊资料,回顾性复习其临床特点、拍片指征和X线评价,以明确非创伤性病变在C_1-C_2水平的发生率和这些病变在标准开口位齿状突象的检出率,进而对开口位齿状突象在非创伤性颈椎系列摄片的作用进行严谨和客观的评价。 颈椎X线摄片作为一种基本诊断手段,在严重外伤所致颈部疼痛患者中有较多的适应证。由于单纯颈椎水平X线侧位往往有高达25％的假阴性率,     

飞行员脊柱健康评价--X线、CT、MRI所见及临床调查

目的 探讨歼击机飞行员脊柱健康的评价标准。方法 顺序采集46名歼击机飞行员特别设定的体检资料，包括脊柱临床评价，全脊柱立位X线前后位及侧位摄片，腰椎双斜位摄片，颈椎MRI，腰椎CT等资料。将脊柱的生理曲度及异常曲度情况，结构退变情况和脊柱临床评价都给予量化，并进行统计分析，比较各项指标之间关系。结果 ①飞行员的年龄和飞行时间与其颈椎和腰椎问题的大小都具有显著的相关性。②颈椎曲度异常和脊柱侧弯情况普遍存在，但与脊柱临床评价并无相关性。③脊柱退变的各项指标(包括椎间隙狭窄、椎间盘突出、椎体楔形变、椎体骨刺等)之间都有一定的相关性，但与脊柱的临床评价并不相关。结论 歼击机飞行员的脊柱健康的临床评价与其结构形态的退行性改变并不平行；单纯以脊柱结构的改变来确定飞行员脊柱健康的标准值得商榷。     

颈椎病性吞咽障碍的X线诊断

近几年,吞咽功能异常的发病率显著增加[1].本文收集57例因吞咽障碍或异物感及颈椎病症状而行咽食管钡餐检查及摄颈椎正侧位X线片,另将57例只有颈椎病症状的受检者设为对照组,检查方法相同.通过研究颈椎骨质增生的部位、程度及咽食管钡透征象与临床症状的关系,探讨颈椎病性吞咽障碍的X线诊断与鉴别诊断依据.     

300例症状性颈椎曲度异常的神经科临床表现与X线相关分析

目的　探讨症状性颈椎曲度异常患者的神经内科临床表现和颈椎 X线特点和相关性。　方法　 30 0例患者根据年龄分为 A组 (170例≤ 35岁 )和 B组 (130例 >35岁 ) ,分析对比两组的神经科临床症状、体征和颈椎 X线片特征以及二者的关系。　结果　头晕在两组均多见 ,头痛阳性率和积分、颈椎单纯曲度异常者 A组高于 B组 (P<0 .0 5～ 0 .0 1) ;肢麻无力、血压增高、颈椎各类退行性变 (增生、间盘病变、钙化、椎间孔变形 )以及受累椎体数 B组显著高于 A组 (P<0 .0 5～ 0 .0 1)。主要受累椎体 A组为 C4 、C5,B组为 C5、C6 。A组颈曲异常与头痛、眼耳症状和阳性霍夫曼征、闭目难立征、收缩期和舒张期血压呈显著正相关 ;B组仅与阳性闭目难立征、收缩期血压密切相关。全部患者的颈曲异常与受累椎体总数、颈椎序列差和颈椎退行性变呈显著性正相关 (P<0 .0 5～ 0 .0 1) ,B组为著。环枢椎位置改变与 A组的心慌胸闷和 B组的晕厥发作显著相关 ;颈椎的退行性变主要与肢麻无力、心慌胸闷以及颈肩部症状密切相关 (P<0 .0 5～ 0 .0 1)。　结论　症状性颈椎曲度异常在不同年龄组患者中表现的神经科症状体征存在差异 ,这种差异与年龄以及颈椎合并其它退行性变有关     

歼击机飞行员颈椎X线平片分析

为了解飞行对颈椎的影响，我们自2001年5月至2003年5月，从健康疗养的歼击机飞行员中进行了颈椎X线摄片检查，并与地面无症状人群对照比较，结果如下。     

青少年症状性颈椎曲度异常的X线分析和临床表现(附166例报告)

目的探讨有临床症状的青少年颈椎曲度异常患者的颈椎X平片特点和主要临床症状体征.方法根据X线颈椎曲度异常的程度,将166例12～35岁的患者分为轻度(55例)、中度(65例)、重度(46例)三组,比较受累椎体的百分比,病程,临床症状(头痛程度、头晕、晕厥、记忆力减退的发生率等),体征(血压、Hoffmann征、闭目难立征).结果随颈椎曲度异常程度加重,受累椎体的百分比,临床症状、体征异常增加,轻中重各组有显著差异(P＜0.05～0.01);颈椎曲度异常与头痛的程度和病程密切相关(P＜0.01);结论颈椎曲度异常与青少年头痛头晕、晕厥等症状的发生以及阳性HOFFMAN征和闭目难立征密切相关,可能是有上述症状体征者一个不可忽视的潜在病因.     

歼击机飞行员颈椎X线检查分析

目的探讨我国歼击机飞行员经受的过载作用对其颈椎组织可能产生的影响及其有效防护措施。方法对１１６名现役歼击机飞行员和同期６２名地勤人员作颈椎结构关系异常出现率和颈椎退变情况的对比分析。结果飞行员颈椎结构关系异常出现率为４７．４１％，地勤人员为２２．５８％，前者明显增高；飞行员中颈椎曲度异常、骨质增生、椎管和椎间隙狭窄者均较地勤人员显著增多；本组飞行员的年龄和飞行总时间对颈椎的退变和颈痛的发生也有明显影响，即高年资、飞行总时间长的飞行员，其颈部病患程度也较重。结论持续过载作用可致颈椎退变提前发生；颈椎退变程度与飞行员年龄和飞行总时间相关     

Cervical and lumbar MRI findings in aviators as a function of aircraft type

BACKGROUND & AIMS: Neck pain and lower back pain (LBP) are frequently reported by military helicopter pilots (HP) and fighter pilots. A small number of studies have used imaging methods to evaluate spinal cervical degenerative findings in pilots exposed to high +Gz, with results indicating an increase in cervical disk protrusions in this population. We evaluated the cervical and lumbar spine with magnetic resonance imaging (MRI) to assess the prevalence of degenerative changes in three subpopulations of pilots. METHODS: Fighter pilots (FP), transport pilots (TP), and HP (10 pilots in each group) underwent cervical and lumbar MRI. Degenerative pathologic changes (disk herniation, cord compression, foraminal stenosis, and the presence of osteophytes) were evaluated in each group by two independent experienced radiologists. RESULTS: Cervical spine degenerative changes seemed to be associated with older age rather then aircraft type, affecting the older group of TP (8/10 pilots) more than the younger FP group who were exposed to high +Gz (3/10 pilots). In contrast, for lumbar spine degenerative changes, we found an uncommon pattern of lumbar spine degeneration in HP, affecting the upper part of the lumbar spine (10/13 disks found at L1-L4). CONCLUSIONS: The results of this study suggest that HP may have detectable degenerative lumbar findings. More research is needed to validate these findings as well as to explore the possible pathophysiological link between occupational exposures and the specific involvement of the upper lumbar spine.     

+Gz associated stenosis of the cervical spinal canal in fighter pilots

Previous magnetic resonance imaging (MRI) studies have shown that repeated exposure to +Gz forces can cause premature degenerative changes of the cervical spine (i.e. a work-related disease). This paper reports on two clinical cases of +Gz-associated degenerative cervical spinal stenosis caused by dorsal osteophytes in fighter pilots. Conventional x-rays and MRI were used to demonstrate narrowing of the cervical spinal canal. The first case was complicated by a C6-7 intervertebral disk prolapse and a congenitally narrow spinal canal. The second case involved progressive degenerative spinal stenosis in the C5-6 disk space which required surgery. The findings in this case were confirmed by surgery which showed posterior osteophytes and thickened ligaments compressing the cervical medulla. These two cases suggest that +Gz forces can cause degenerative spinal stenosis of the cervical spine. Flight safety may be jeopardized if symptoms and signs of medullar compression occur during high +Gz stress. It is recommended that student fighter pilots undergo conventional x-rays and MRI studies in order to screen out and reject candidates with a congenitally narrow spinal canal. These examination methods might be useful in fighter pilots' periodic medical check-ups in order to reveal acquired degenerative spinal stenosis.     

空军招飞体检颈椎X线检查异常情况分析及建议

目的 异常中,曲度反向占颈椎异常的30.6%,合并其他异常占43.3%.序列异常占20.5%,发育异常占34.7%,骨质增生占6.8%. 结论 颈椎异常常引发颈肩不适、头痛、眩晕和晕厥等诸多临床症状,对飞行人员健康造成危害,甚至危及飞行安全.在招飞体检时,颈椎异常除单纯颈椎曲度直外,其他颈椎曲度反向、序列异常、骨质增生、寰椎沟环、颈椎融合、颈肋及颅底凹陷均应确定为不合格.     

歼击机飞行员无症状腰椎间盘突出的CT,X线检查分析

目的探讨歼击机飞行员经受的过荷作用对其腰椎和间盘组织可能产生的影响及其临床意义。方法同期采集一组歼击机飞行员和一组地勤人员的腰椎Ｘ线摄片及常规ＣＴ腰椎间隙扫描资料，进行腰椎间盘突（膨）出比率及与腰椎结构关系的比较分析。结果本组飞行员有明确的一节以上椎间盘突出者达２７％，若含膨出则高达４２％，远较地勤对照组（１８．５％）及以往所报告的普通正常人群（约１９％左右）为高。飞行员腰椎侧弯出现率较地勤人员也明显偏高，但两组对腰椎侧弯的代偿并无区别。研究还发现，椎间盘突出对腰椎结构有明显影响，飞行员组中有突出者的局部腰椎结构异常较无突出者更为显著，腰痛史亦更为明确。就突出椎间盘组织而言，本研究未发现其大小和位置与腰椎结构紊乱的相关关系。结论①过荷是加速腰椎退变因素之一，但因此而致的腰椎间盘突出一般可为飞行员代偿接受；②完善的腰椎功能状态很可能是结构代偿的基础；③虽然腰椎间盘突出椎管内占位一般可被代偿容纳，但仍不失为能引发椎管外腰椎结构紊乱的重要因素，需要引起康复保健医师的格外重视。     

高性能战斗机飞行员脊柱损伤与退变及其临床意义

目的 概述关于高性能战斗机飞行员脊柱损伤与退变研究概况。资料来源与选择国内外近二三十年来相关文献报道。资料引用 相关文献19篇。资料综合 对脊柱生物力学及临床实验研究、脊柱X线平片研究、脊柱局部CT扫描的研究、临床症状学分析等诸方面问题都做了详细论述。结论 高性能战斗机飞行员工作环境具有加速脊柱(尤其是颈椎)退变的作用。但是，高性能战斗机飞行员脊柱提前退变的实际临床意义仍然不是十分清楚。     

MRI cervical spine findings in asymptomatic fighter pilots

MRI of the cervical spine for evaluation concerning degenerative lesions was performed on asymptomatic experienced military high performance aircraft pilots (mean age 42 yr with mean accumulated flying time of 2600 h), and for comparison on age-matched controls without military flying experience. Young military high performance aircraft pilots (mean age 23 yr with 220 h of flying per person) were also examined. There were significantly more osteophytes, disk protrusions, compressions of the spinal cord and foraminal stenoses in the experienced pilots than in the age-matched controls. Low frequency of low grade degenerative lesions was found in the young and inexperienced pilots.     

飞行员环椎椎动脉沟环与颈性眩晕的关系

目的 探讨飞行员椎动脉沟环与颈性眩晕的关系,以期改进飞行员选拔方法。方法 分析１９７５￣１９９９年间因眩晕或疑诊颈椎疾病飞行员的颈椎Ｘ线片。结果 在３４６例飞行员中发现５６例有椎动脉沟环存在,其与眩晕的临床症状,体征有密切的关系。结论 有环椎椎动脉沟环者在飞行学员选拔中应作为一种负性因素。     

Spinal MRI in fighter pilots and controls: a 13-year longitudinal study

INTRODUCTION: Although it is known that some degenerative changes occur in the spines of fighter pilots, it is not clear whether their frequent exposure to high acceleration is associated with premature development of such changes. This case-control study was designed help answer that question. METHODS: There were 12 Finnish Air Force pilot cadets and their controls who were examined using cervical and lumbar magnetic resonance imaging (MRI) before the pilots started fighter training (baseline) and 13 yr later (follow-up) when the pilots had accumulated a total of 1200 +/- 470 h in fighter aircraft. RESULTS: No statistical differences were found between groups with respect to the frequency of degenerative changes in either the cervical or lumbar spine. Cervical changes in pilots were for the most part observed in the lower part of the neck, while controls showed more variability as to location. In the lumbar region, pilots showed a non-significant tendency toward more changes in disks L4-S1, including changes in signal intensity, height, protrusions, and end plates. CONCLUSION: Occupational exposure to acceleration in fighter aircraft did not cause significant radiological changes in the spinal column during the first 13 yr of a fighter pilot's flying career. Assessments for the need of a fighter pilot's follow-up imaging should be based on clinical outcome, not on periodic imaging.     

歼击机飞行员腰椎退行性病变随访观察

目的评价歼击机飞行员腰椎退行性病变状况。方法对4年前作过CT检查的无症状歼击机飞行员（A组，平均年龄42岁，平均累计飞行时间2400h；B组，平均年龄27岁，平均累计飞行时间930h），和相应年龄无飞行经验的对照组人员（C组）进行复查。结果与4年前CT结果比较，各组的椎间盘突出数明显增加，而对照组的骨赘、A组老飞行员的椎管狭窄数明显增加。与4年前比较，老飞行人员与C组问的CT差别明显降低。结论歼击机飞行员腰椎退行性病变的发展较地面人员早。随着年龄的增加，与对照组的差别逐渐缩小。     

战斗机飞行员颈椎退变研究

目的 了解战斗机飞行人员颈椎退变情况。方法对5年前作过MRI检查的战斗机飞行员（甲组,平均年龄47岁,平均累计飞行时间2100h,乙组,平均年龄27岁,平均累计飞行时间830h）。和无飞行经验年龄相仿的对照组人员（丙组）进行复查。结果与5年前MRI结果比较,每组的椎间盘突出数增加,但丙组的骨赘、老飞行员的椎管狭窄数明显增加。与5年前比较,老飞行人员与丙组间的MRI差别降低。结论战斗机飞行员的椎间盘退行性病变的发展可能较早。但是,随着年龄的增加,与对照组的差别逐渐缩小。