腰椎间盘疝的平片和CT影像分析（附72例手术对照）

作者报道了７２例腰椎间盘疝的平片和ＣＴ表现，并与手术结果作了对照分析，术前诊断符合率分别为ＣＴ９２．７％、平片３７．８％。并对本病平片和ＣＴ检查价值等问题进行讨论，指出平片征象以椎间隙狭窄伴前窄后宽和椎体后角骨质增生等表现意义较大，ＣＴ检查是本病定位定性诊断较可靠的检查方法，能够直观地揭示椎间盘、侧隐窝、关节突和椎管内外结构的变化，具有普通ｘ线诊断无可比拟的价值。     

腰椎间盘突出致腰腿痛的影象研究

作者回顾性分析了６２例腰椎间盘突突出症的Ｘ线平片ＣＴ,椎管造影及磁共振成象的表现,并与手术结果作了对照分析,术前诊断符合率分别为平片３８．７％,ＣＴ９１．９％,椎管造影８５％,ＭＲＩ１００％,并就本病影象学各方法诊断价值及相关性进行了讨论,指出平片征象的椎间隙狭窄伴前窄后宽和椎体后角骨质增生等意义较大。椎管造影和ＣＴ检查是本病定位定性诊断较可靠的检查方法,能够直观揭示椎间盘,侧隐窝,关节突和椎管内     

X 线摄片和 CT 扫描在脊柱骨折中的应用价值比较

目的：比较Ｘ线摄片和ＣＴ扫描在脊柱骨折中的应用价值。方法：分析了我院１９９３～１９９５年４６例脊柱骨折者的Ｘ线和ＣＴ表现，男３０例，女１６例，年龄２２～８０岁。结果：Ｘ线摄片和ＣＴ扫描发现，Ｘ线片对脊柱单纯屈曲压缩型骨折、椎体脱位、半脱位容易确诊，而对某些类型骨折较易误诊和漏诊，诊断符合率８１．６％。ＣＴ扫描可显示骨折部位、类型、骨折片的移位以及骨折片突入椎管，椎管狭窄，还能显示多节段椎体骨折和附件骨折。椎体骨折均为粉碎性。椎体后缘骨折片不同程度突入椎管，占４８％，与椎体骨折类型有关。ＣＴ扫描诊断符合率达９８．６％。结论：在脊柱损伤的诊断中必须Ｘ线摄片和ＣＴ扫描相结合才能提高脊柱损伤的诊断水平。     

胸腰椎骨折的CT诊断及与X线平片对照分析(附72例报告)

目的：提高ＣＴ诊断脊柱损伤价值的认识。方法：对照分析７２例胸腰椎骨折的Ｘ线平片与ＣＴ表现。结果：７２例９５节胸腰椎骨折中,单椎体骨折者５４例,多椎体骨折者１８例。单纯屈曲压缩型２１例,爆裂型４１例,骨折脱位型１０例。结论：Ｘ线平片是脊柱损伤的基本检查手段。有时仅凭Ｘ线平片表现较难区分单纯屈曲压缩型和爆裂型。椎体后缘线异常是Ｘ线平片诊断爆裂骨折的重要指征。ＣＴ是检查脊柱损伤必要的补充手段,能明确区分单纯屈曲压缩型和爆裂型骨折;对骨折分型、判断脊柱失稳、椎管受累程度以及制定治疗方案均有重要价值。     

脊柱结核的影像学诊断

目的：评价X线平片、CT、MRI在脊柱结核的诊断价值。方法：回顾40例经手术病理或临床结果证实为脊柱结核病人的X线平片、CT、MRI影像表现。结果：X线平片可了解椎体破坏、塌陷、椎间隙变窄情况，及脊柱是否后凸畸形。40例CT均可较清楚显示椎体骨质破坏的数目（有21例分别两个椎体受累）、范围及病变是否进入椎管，其中19例形成寒性脓疡。9例行MRI均可显示椎体骨质破坏，周围软组织肿胀、寒性脓疡范围，及椎管、脊髓情况。结论：X线平片结合CT平扫可对脊柱结核进行较全面细致的观察并做出诊断。与肿瘤不易鉴别时需加CT增强扫描。若有神经症状时应补充MRI检查。     

脊柱转移瘤的CT诊断：附41例分析

笔者报告４１例脊柱转移瘤的ＣＴ表现。原发灶以肺癌、乳腺癌和肝癌较多见。ＣＴ表现主要呈溶骨性（６８．３％），亦可呈成骨性（１４．６％）或混合性（１７．１％）。本组４１例中２０例作平片Ｘ线检查。ＣＴ扫描在发现和估价病变方面较平片Ｘ线检查为敏感，如ｘ线平片发现骨破坏仅为５５％，ＣＴ扫描为１００％；Ｘ线平片显示椎管受累为１４％，ＣＴ扫描为６５％。对脊柱转移瘤的ＣＴ表现、ＣＴ诊断和鉴别诊断价值等进行了讨论。     

50例脊柱结核的CT及X线平片表现分析

选择５０例经ＣＴ诊断及手术病理证实的脊柱结核，对ＣＴ及Ｘ线平片表现进行回顾性分析，结果表明：ＣＴ发现椎体及附件骨破坏特别是较小较轻微的骨破坏及椎管内侵犯的能力、显示死骨及局限性脓肿的能力优于平片，能区别脓肿及肉芽肿。而Ｘ线平片显示椎间隙狭窄、脊柱滑脱等优于ＣＴ。结合文献讨论了与脊柱转移瘤的鉴别诊断。     

环枢椎脱位的CT及平片诊断

目的：研究环枢椎脱位平片及ＣＴ表现，比较它们的诊断价值。方法：２０例正常人，１３例环枢椎脱位和２例旋转性半脱位。均作常规ＣＴ扫描，５例加作功能性的ＣＴ扫描。结果：１５例环枢椎脱位和半脱位，平片诊断１５例，ＣＴ诊断１４例，漏诊１例。ＣＴ除显示环枢椎脱位外，还清楚显示合并的椎体多发性骨折部位、范围、骨性椎管的大小及畸形。结论：平片及ＣＴ均是诊断环枢椎病变的重要手段。平片难以显示复杂性骨折及骨性椎管形态的改变；ＣＴ对无移位的齿状突骨折和轻度环枢椎脱位不敏感。功能性的ＣＴ扫描是鉴别生理性和病理性环枢椎脱位的有效方法。     

强直性脊柱炎髋关节病变的影像学对比研究

目的：研究强直性脊柱脊髋关节病变的Ｘ线平片、ＣＴ及核素显像表现及其早期征象。材料与方法：对１０３例强直性脊柱炎累及髋关节的病例进行平片检查，其中２３例做了ＣＴ和核素显像检查，并与平片作对照研究，总结其表现，并对三者的相互关系作统计学分析。对强直性脊柱脊髋关节病变的ＣＴ及核素显像表现进行了分期。结果：髋臼囊变为强直性脊柱炎髋关节病变的早期表现。ＣＴ对囊变的检出率明显高于平片（χ＾２＝１４．０６，Ｐ〈     

脊椎损伤的X线诊断

目的：提高X线诊断脊柱损伤价值的认识。方法：分析158例脊柱骨折的X线表现与CT表现。结果：158例207个椎体骨折中,单纯椎体骨折106例,多个椎体骨折32例,单纯屈曲压缩型133例,爆裂型21例,骨折脱位型4例。结论：X线平片是检查脊柱损伤的基本方法,X线平片表现较难区分单纯屈曲压缩型和爆裂型骨折,侧位片上椎体后缘线不连续（成角、后移）是诊断爆裂型椎体骨折较可靠的征象。CT检查是脊柱损伤必要的补充手段,能明显区分单纯屈曲压缩型和爆裂型骨折,对骨折的分型、判断脊柱失稳、骨性椎管受损,脊髓压迫程度及对制定治疗方案均有重要价值。     

几种影像方法对脊柱转移瘤诊断的比较

目的 :分析 93例脊柱转移瘤的MRI、ECT、SCT、X线平片征象 ,以提高脊柱转移瘤的早期诊断率。方法 :回顾性分析 93例经手术病理或随访证实的脊柱转移瘤的MRI、ECT、SCT、X线平片表现。结果 :93例脊柱转移瘤共发现2 79个椎骨异常、184处椎管受累、12 0处椎旁软组织肿块、12 0处椎体病理性骨折。MRIT1 WI表现为低信号 73 .3 %( 198/2 70 ) ,T2 WI表现为高信号 62 .2 %( 168/2 70 ) ,FS T2 WI表现为高信号 85 .2 %( 2 3 0 /2 70 ) ;ECT检出的 2 61处病灶表现为多处放射性浓聚或单发放射性浓聚 ;CT检出 184处病灶表现为局限性或大片骨质破坏 ;X线平片检出的 92处表现为骨质破坏。结论 :MRI及ECT敏感性高于SCT和X线平片 ,MRI、SCT、X线平片特异性高于ECT ;MRI是诊断脊柱转移瘤一种高敏感性和特异性的方法 ,优于ECT、SCT、X线平片 ;脊柱转移瘤首选ECT并结合X线检查 ,必要时SCT或 /和MRI检查。     

脊柱结核的CT诊断

目的探讨脊柱结核的CT表现及脊柱结核CT检查的重要意义。方法对30例临床和病理确诊的脊柱结核病例的CT表现进行回顾性分析。结果脊柱结核的CT表现包括:(1)椎体及附件不规则虫蚀样和囊状骨质破坏。(2)沙砾样和斑片样死骨形成。(3)椎间盘坏死及椎间隙狭窄、消失。(4)椎旁脓肿、纵隔脓肿、腰大肌脓肿。(5)椎体后部的骨质破坏产生的碎骨片和坏死物质可进入椎管压迫硬膜囊和神经根。(6)椎体塌陷呈楔形。结论CT对脊柱结核的诊断和鉴别诊断有重要价值,尤其脊柱结核对椎体附件和椎管的累及范围、程度可清楚地显示,对指导手术治疗和判断预后有重要意义。     

X线平片和CT在脊柱骨折诊断中的联合应用价值

目的：评价常规X线和CT扫描二种影像方法在脊柱骨折诊断中联合应用的价值。方法：对120例X线平片和CT扫描诊断为脊柱骨折的病例进行对照分析。结果：120例中椎体骨折共144个，76例X线侧位片椎体后缘连线（PVBL线）光滑，44例有不同程度异常。CT扫描稳定性骨折59例，不稳定性骨折61例，三柱骨折中椎管无狭窄10例，狭窄23例。结论：脊柱外伤性骨折影像诊断应注重常规X线平片和CT扫描检查的互补作用。X线片仍是首选检查方法，有利于多个椎体连续或跳跃性同时骨折的检出，发现有椎体骨折均应做CT扫描，以判断骨折的稳定性与半发症情况，有利于临床及正确处理。     

The radiographic characterization of burst fractures of the spine

A retrospective review of 75 burst fractures of the spine was performed to define the radiographic features found on high-resolution CT, polytomography, and plain radiography and thereby allow full characterization of this uncommon spinal injury. Characteristic components of the injury include: centripetally oriented disruption of the vertebral body, unilateral or bilateral laminar fractures that abut the spinous process, marked anterior wedging, vertically oriented vertebral fracture emanating from the basivertebral foramen, increased interpediculate distance, and significant spinal canal narrowing by characteristic retropulsed fragments. Nearly all bursts occurred from T9 to L5; double bursts were present in less than 10% of cases. The usually present neurologic deficit nearly always corresponded to the level of the burst rather than to the frequently found noncontiguous associated spine fracture. Recent literature suggests that these complex fractures, which were initially thought to represent stable injuries, are often unstable. A subcategorization of burst fractures and their variants is proposed to explain this instability. An approach to the radiographic diagnosis of the spinal burst is proposed, and plain film clues to distinguish the burst fracture from the more common compression fracture are discussed. Representative cases are illustrated.     

A new classification for cervical vertebral injuries: influence of CT

Objective. Computed tomography (CT) has been demonstrated to be superior to radiography in identifying cervical vertebral injuries. However, many of these injuries may not be clinically significant, and require only minimal symptomatic and supportive treatment. It is therefore imperative that radiologists and spine surgeons have criteria for distinguishing between those injuries requiring surgical stabilization and those that do not. The authors propose a new classification of cervical vertebral injuries into two categories: major and minor. Design and patients.  A data base, acquired on 1052 separate cervical injuries in 879 patients seen between 1983 and 1998, was reviewed. Four categories of injury based on mechanism [hyperflexion (four variants), hyperextension (two variants), rotary (two variants), and axial compression (five variants)] were identified. ”Major” injuries are defined as having either radiographic or CT evidence of instability with or without associated localized or central neurologic findings, or have the potential to produce the latter. ”Minor” injuries have no radiographic and/or CT evidence of instability, are not associated with neurologic findings, and have no potential to cause the latter. Results and conclusions.  Cervical injury should be classified as ”major” if the following radiographic and/or CT criteria are present: displacement of more than 2 mm in any plane, wide vertebral body in any plane, wide interspinous/interlaminar space, wide facet joints, disrupted posterior vertebral body line, wide disc space, vertebral burst, locked or perched facets (unilateral or bilateral), ”hanged man” fracture of C2, dens fracture, and type III occipital condyle fracture. All other types of fractures may be considered ”minor”. Received: 22 July 1999 Revision requested: 7 October 1999 Revision received: 21 December 1999 Accepted: 30 December 1999     

比率法判定颈椎管狭窄的应用价值

作者对经临床确诊为颈椎管狭窄的２００例影像学资料，包括Ｘ线平片和ＣＴ扫描片各１００份，测量Ｃ＿（４－５）椎管与椎体的矢状径与横径。将椎管矢状径为１１ｍｍ及其以下者（绝对值法）和椎管下矢径／椎体中矢径之比率值为０．７１及其以下者（比率法），暂作为颈椎管狭窄的判定标准。分析并比较两种方法对颈椎管狭窄的检出率。结果提示，比率法平片组与ＣＴ组均明显优于绝对值法。运用比率法诊断颈椎管狭窄，Ｘ线平片与ＣＴ扫描同样有效。     

Computed tomography of posterior lumbar apophyseal ring fractures

Lumbar apophyseal fracture is an uncommon injury that occurs during adolescence. We described two cases in young adults with back pain. The radiographic findings were distinctive. In both cases CT demonstrated characteristic bony fragments displaced posteriorly into the spinal canal and a corresponding defect in the posteroinferior aspect of the vertebral body rim. Recognition of this entity is important in evaluating back pain in both adolescents and adults.     

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)。     

腰椎体后缘软骨结节椎管狭窄的CT诊断

目的 :探讨腰椎后缘软骨结节 (LPMN)椎管狭窄的CT诊断价值。材料和方法 :回顾性分析 2 7例腰椎后缘软骨结节的临床及CT表现。结果 :LPMN的CT表现为 :( 1)椎体后上缘或下缘局限性骨缺损 ,缺损区周围骨质硬化 ;( 2 )缺损区后突入椎管内的骨块 ;( 3 )在矢状位上见骨块“翘起”征 ,缺损区呈“V”形或类三角形 ;( 4 )椎管狭窄 ,多伴有椎间盘突出。结论 :CT能明确诊断LPMN导致的椎管狭窄 ,并为手术治疗提供可靠依据。