颈椎椎间关节X线摄影方法探讨

颈椎椎间关节Ｘ线摄影方法探讨王粮钢张正方笔者依据颈椎椎间关节的解剖，并对关节面倾斜度进行了ＣＴ测量和标本摄影，摸索出两种Ｘ线摄影方法，经临床应用，效果良好。一、资料、方法与测量结果在美国ＧＥ公司Ｓｙｔｅｃ３０００型全身ＣＴ检查中，随机的１００例非颈椎...     

颈椎外伤的X线诊断

对疑有急性颈椎外伤的病例，X线检查之前，病人全身情况必须稳定，病人仰卧，头部保持在中立位而且不能随意搬动，直至骨折排除后方可移动，检查时应十分小心，避免损伤脊髓，只须常规的X线设备，一部好的手提式X线机即可。     

正常颈椎管率的X线测量

在Ｘ线侧位片上，颈椎管与其相应椎体矢状面直径的比率称为颈椎管率。笔者采用Ｔｏｒｇ等方法测量１００名正常国人颈椎管率的结果表明，Ｃ３为０．９６±０．０８，Ｃ４为０．９５±０．０８，Ｃ５为０．９６±０．０９，Ｃ６为０．９７±０．１０，平均为０．９６±０．０９。统计学分析显示Ｃ３～６间颈椎管率均无显著性差异（Ｐ＞０．０５）；男女颈椎管率则有非常显著性差异（Ｐ＜０．００１）。颈椎管率作为Ｘ线的一个定量指标     

歼击机飞行员颈椎退行性改变X线检查分析

目的：了解歼击机飞行员颈椎退行性改变情况。方法：对歼击机飞行员240例进行颈椎X线检查,分析颈椎曲线改变、骨质增生、侧弯、椎间隙变窄、颈椎棘突错位等发病情况。结果：颈椎曲线改变发病率57．1％,骨质增生22．9％,颈椎棘突错位72．0％,主要发生于颈椎中下段。结论：歼击机飞行员颈椎退行改变发生率较高,应加强日常保健和定期检查。     

颈椎关节突关节滑动移位的X线分析

颈椎病是中老年人的常见病，一般认为软骨退行性变及继发的失稳是致病的根本原因。软骨退行性变可发生在椎间盘、钩椎关节或关节突关节的关节软骨。而颈椎关节突关节滑动移位乃是颈椎病中多见的一个主要X线征象，也是引起颈椎病临床症状及体征的原因之一。我们随机抽查125例颈椎病X线平片进行了回顾性分析，以提高对颈椎关节突关节滑动移位的认识，现报告如下：     

颈椎过伸性损伤X线片与MRI比较分析

目的：评价对比X钱片与MRI对颈椎过伸性损伤的诊断价值。材料和方法：回顾性分析收治入院的53例颈椎过伸性损伤患者的临床特点、X线片、MRI特点。结果：X线片提示损伤34例，占总数的64．15％；MRI表现有推前血肿和水肿、积液、脊髓受压变形、脊髓内水肿、前纵韧带断裂、椎间盘水平性撕裂、椎间盘突出、脊髓部分及完全性横断等以及椎管狭窄、OPLL、颈椎病等，所有患者的MRI均发现不同的损伤征象，还发现7例椎动脉损伤。结论：MRI优良的软组织成像能力使之对于颈椎过伸性损伤的检出、损伤机制和损伤程度描述均优于其他方法，是目前的最佳方法，对治疗方法的选择亦具有很好的指导意义。     

X线颈椎体裂隙征的临床意义

颈椎体裂隙征为颈椎病的一种X线表现,其形成原因为钩椎关节间隙变窄,其上下缘骨赘形成及关节面硬化,在颈椎侧位片上,当变窄的关节间隙和硬化的骨关节面及骨赘成轴位投影于颈椎的中下部时,即表现为横行线样透明影,酷似颈椎体骨折.     

颈椎体假骨折的X线诊断

颈椎体假骨折是指沿颈椎体后下方有一横行“透亮带”，其X线表现酷似颈椎休横行骨折，本文复习我院近两年来临床资料保存完整的颈椎侧位片500例次，其中有假骨折23例（占4．6％），现分析报告如下。     

CT在颈椎损伤中的诊断价值

目的：探讨CT扫描在颈椎损伤中的诊断价值。方法：回顾性分析32例颈椎损伤的CT与平片检查资料。结果：骨折28例（其中6例伴脱位）,单纯脱位4例,合并伤10例。结论：CT对颈椎损伤的检出率明显高于平片,能清晰显示其损伤的细节,并对判断失稳及椎管狭窄的程度均有重要价值。     

The incidence and prognostic significance of radiological abnormalities in soft tissue injuries to the cervical spine

The radiographs and initial clinical findings of 73 patients who had sustained trauma to the cervical spine without bony injury in vehicle collisions were reviewed. The patients were also re-examined clinically two years after the injury. Forty eight (65.8%) had abnormal radiographs at presentation — prevertebral soft tissue swelling in 15 (20.6%), degenerative changes in 15 (20.6%), and an angular deformity between two adjacent vertebral bodies in 27 (37.0%). Prevertebral soft tissue swelling was found to have no significance with respect to clinical outcome and showed no association with the presence of an angular deformity. Degenerative changes are associated with a poor prognosis. The presence of an angular deformity was found to carry a good prognosis in this group of patients. The exact mode of injury is not associated with any specific radiographic appearance except that roll overs and side collisions are more likely to cause angulation in the cervical spine.     

Imaging of cervical spine injuries of childhood

Cervical spine injuries of children, though rare, have a high morbidity and mortality. The pediatric cervical spine is anatomically and biomechanically different from that of adults. Hence, the type, level and outcome of cervical spine injuries in children are different from those seen in adults. Normal developmental variants seen in children can make evaluation of the pediatric cervical spine challenging. This article reviews the epidemiology of pediatric cervical spine trauma, normal variants seen in children and specific injuries that are more common in the pediatric population. We also propose an evidence-based imaging protocol to avoid unnecessary imaging studies and minimize radiation exposure in children.     

Hyperextension injuries of the cervical spine

Eleven patients with acute cervical hyperextension injury underwent magnetic resonance examination. Magnetic resonance was particularly helpful in diagnosing both intrinsic cord contusion and extradural compression. When spinal cord compromise was present, surgery was undertaken without resort to myelography.     

Normal cervical spine variations mimicking injuries in children

Evaluation of the cervical spine is a constant problem. This communication deals with the various normal variations and congenital anomalies that are frequently misinterpreted for traumatic lesions. Emphasis is on how to identify these anomalies and how to differentiate them from traumatic injuries of the cervical spine.     

颈椎不稳症的影像诊断(附50例报告)

目的探讨颈椎不稳症的影像学诊断。方法回顾性分析50例经临床证实的颈椎不稳症患者的X线平片、CT和MRI检查资料。结果50例中上颈椎不稳16例,其中,寰枕关节不稳2例,表现为枕底—齿突线和斜坡—齿突线不连续,14例为寰枢关节不稳,其中,寰枢关节脱位7例;下颈椎不稳34例,其中,前屈不稳20例,后伸不稳14例。结论X线平片、CT和MRI综合分析能对颈椎不稳症作出准确的诊断。     

Adequacy of plain radiography in the diagnosis of cervical spine injuries

Our hypotheses were (1) that plain radiography of the cervical spine in the evaluation of low risk patients with minor blunt trauma is accurate and (2) that computed tomography (CT) of the cervical spine in the evaluation of low risk patients is unnecessary. This study evaluates those hypotheses. We prospectively recorded findings of all patients with blunt trauma who underwent imaging over a period of 70 days. Injury status was determined by review of all radiographic studies obtained on each patient. Chart reviews were performed to determine mechanism of injury and neurological status. Patients were divided into three groups: very low risk, low risk, and high risk. Study end point was fracture. The study included 219 patients. The very low risk group had 107 patients, none of whom had fractures found on CT (projected specificity of plain radiography: 100%). The low risk group contained 78 patients who had no fractures seen on plain radiography or CT (specificity of plain radiography and CT: 100%). The high risk group consisted of 34 patients; 15 had fractures demonstrated on CT. Plain radiography missed one fracture out of 15. In low risk patients, plain radiography is an efficient diagnostic exam with a specificity of 100%. In high risk patients, plain radiography is a good adjunctive screening exam in conjunction with CT scan, with a sensitivity of 93.3% and specificity of 95%.     

The value of retropharyngeal soft tissue measurements in trauma of the adult cervical spine

Widening of the retropharyngeal soft tissue space (RSTS) has been interpreted as a sign of cervical spine trauma. Widely differing measurements are reported in the literature. However it is clear that, using the currently acceptable limits of normal, a large number of patients without spinal injury are subjected to further tests. The RSTS on lateral cervical spine radiographs of 318 patients with a history of cervical spine trauma were measured at the C2–C4 level. The values for patients found to be normal or with fractures/dislocations were evaluated. Statistical analysis of the results demonstrates a considerable overlap in the RSTS of normal and abnormal patients. Therefore we suggest that RSTS measurements are of limited diagnostic value. Using the statistical probability of abnormality, guidelines that indicate which patients may require additional study are suggested.     

Lateral hyperflexion injuries of the cervical spine

Injuries secondary to lateral hyperflexion forces are an unusual and commonly unrecognized entity. Patients demonstrate a wide range of symptoms and physical findings and may incur years of chronic pain if the lesion is not appreciated. Careful evaluation of historical evidence, mechanism of injury, and physical examination supplements interpretation of frontal and oblique radiographs of the entire cervical spine. Because the majority of patients reviewed sustained more than one fracture, careful scrutiny, especially of the vertebral arch, is recommended.Presented as an exhibit at the American Roentgen Ray Society Meeting, Boston, Massachusetts, September, 1977     

The significance of prevertebral soft tissue swelling in extension teardrop fracture of the cervical spine

The purpose of this study was to assess the relationship of prevertebral soft tissue (PVST) swelling and cervical spinal cord injury in extension teardrop fracture (ETF). Cervical spine radiographs and the clinical courses of 36 adult patients who sustained extension teardrop fracture(s) were reviewed retrospectively. Radiographic and neurologic findings were correlated. Thirty-two of 36 patients (89%) showed no evidence of cervical spinal cord injury throughout their clinical course, whereas 4 of 36 patients (11%) had a cervical myelopathy. In 30 patients with ETF and in whom the PVST shadow could be assessed, 7 (23%) had minimal or no PVST swelling, 18 (60%) had focal swelling, and 5 (17%) had diffuse/marked PVST swelling. Of the patients with ETF and no, minimal, or focal PVST swelling, none had cervical myelopathy. Four of 5 patients (80%) with ETF and diffuse/marked PVST and/or prior endotracheal intubation had cervical myelopathy. We conclude that diffuse/marked PVST swelling, or prior endotracheal intubation, was significantly associated with cervical spinal cord injury (P<0.05). There was no statistically significant correlation between minimal or focal PVST swelling and spinal cord injury.