腰椎管狭窄症的CT诊断

腰椎管狭窄症可分为原发性和继发性两大类,本文主要分析继发性腰椎管狭窄症,临床上多见.笔者自1995～2003年共搜集180例腰椎管狭窄症病例,回顾分析其临床特点及CT表现,以提高对本病的认识.     

腰椎管狭窄的影像学检查

腰椎管狭窄的定义为任何类型的腰椎椎管、神经根管或椎间孔的狭窄 ,其典型临床特点为神经源性跛行或根性痛。笔者拟对腰椎管狭窄的影像学检查作一综述 ,同时讨论其临床特征、病因学及病理生理学。1　腰椎管狭窄的分类腰椎管狭窄可从解剖和病因两方面进行分类 ,任何病例完整的诊断都应包括部位和病因两方面的诊断。1 .1　腰椎管狭窄的解剖学分类腰椎管在纵切面和横切面上分为不同的区域。在纵切面上分为椎弓根平面、椎体平面及椎间盘平面 ;在横切面上分为中央管、侧隐窝及椎弓根区。神经根管位于侧隐窝内 ,而椎间孔位于椎弓根区。因此 ,根据…     

X线平片检查腰椎管狭窄症的价值

本文通过29例腰椎管狭窄症病人的腰椎平片与其手术结果及55例无腰椎管狭窄的平片对照分析,探讨了腰椎管狭窄症的平片表现及诊断价值。     

腰椎管狭窄症的CT分型

目的 探讨腰椎管狭窄症的ＣＴ分型。材料与方法 对７４５例腰椎管狭窄症的术前ＣＴ分型与手术结果进行对比分析。结果 ＣＴ分为３组,Ｉ型：中心椎管狭窄型;Ⅱ型：脊神经根管狭窄型;Ⅲ型：混合型（即Ｉ、Ⅱ型并存）。其中Ｉ型１０４例（１３．９６％）,Ⅱ型１５８例（２１．２１％）,Ⅲ型４８３例（６４．８３％）。ＣＴ分型与手术符合率为９２．２１％,不符多见于Ⅲ型。结论 ＣＴ分型对腰椎管狭窄的手术治疗具有指导意义,     

肺隔离症的影像学诊断

肺隔离症是一种少见的肺部发育畸形，常规X线检查难以确诊，X线平片常可发现病变，但定性诊断有时较困难。胸部CT扫描。特别是病灶范围薄层增强扫描，不仅能显示病变的形态特征及周围组织的变化，而且容易显示异常供血动脉，从而大大提高诊断的正确性，本文收集了12例经手术与病理证实的患者，结合有关资料进行讨论。     

腰椎管狭窄症的CTM研究

本文报告36例腰椎管狭窄症.着重对照其CTM所见与手术中发现.CTM是检查此症的理想方法.它能直接显示椎间盘、硬膜囊、神经根袖和硬膜外间隙的细微改变.     

腰椎管狭窄症的X线检查及诊断探讨（附31例X线手术对照研究）

腰椎管狭窄症可为局限性，节段性或广泛性病变，由骨或软组织侵入椎管和／或椎间孔所致的管腔狭窄（1），本症因神经根及马尾受压而出现一系列临床症状，但以腰腿痛就诊者最多，而慢性腰腿痛就包括多种疾病，易被误诊，本文报道经手术证实的腰椎管狭窄症31例，就其X线检查及其诊断探讨如下。     

腰椎管狭窄症的诊断及治疗研究进展

随着人口老龄化及影像诊断技术的飞速发展,腰椎管狭窄症患病率明显升高,已成为老年人腰腿痛的重要原因。本文就近年来国内外对腰椎管狭窄症的研究,包括诊断、影像学检查、治疗及预后等作一综述,并对腰椎管面积测量与临床之间的相关性进行探讨。     

1360例腰椎间盘突出症和腰椎管狭窄症的手术疗效

目的：通过1360例手术治疗腰椎间盘突出症和腰椎管狭窄症,总结手术方法的选择及体会。方法：术前经过各种检查方式严格定性诊断,对病人病变部位给予精确定位,手术方式采取因人而异的个性化选择,手术中精心操作及术后防粘连及抗感染等措施,达到预期目的。结果：（1）患者症状消失,优良率达97．9％。（2）手术方式以单侧显露为主,做半椎板切除或开窗扩大法;特殊病变,特殊方式;（3）手术必须彻底解除侧隐窝狭窄及压迫。结论：对用非手术疗法无效或反复加重者,手术治疗是唯一的选择,且手术效果良好,手术方案以解除病变,减少创伤为原则。     

双管大通道椎板间内镜术式治疗腰椎管狭窄症

目的 提出双管大通道椎板间内镜术式治疗腰椎管狭窄症(lumbar spinal stenosis,LSS),并探讨其临床疗效。方法 借助椎间盘镜手术工作通道,应用操作水介质椎板间脊柱内镜进行椎管减压,即为双管大通道椎板间内镜术式。回顾性收集分析海军总医院康复医学科及脊柱微创中心应用双管大通道椎板间内镜术式治疗17例LSS患者的临床资料。所有患者分别于术后即刻、6个月及末次随访进行疗效评估,记录视觉模拟评分、腰椎疾患日本骨科协会评估治疗评分、Oswestry功能残障量表及SF 36生活质量量表评定分值,比较不同时间点的治疗结果,并计算临床治疗优良率。结果 平均随访(12.5±7.3)月,术后6个月治疗优良率为70.59%,末次随访治疗优良率达82.35%。随访显示临床症状大都有较满意改善,腰腿疼痛缓解、生活质量提高、社会活动适应性增加,无严重并发症发生。结论 应用双管大通道椎板间内镜术式治疗LSS疗效肯定、安全可靠,具有临床实用价值及意义。大宗病例、多中心研究有待进一步深入开展。     

The MRI finding of the nerve root sedimentation sign: Its clinical validity and operative relativity for patients with lumbar spinal stenosis

Background

Lumbar spinal stenosis (LSS) is increasingly being recognised as a cause of disabling low back and lower extremities pain in adult population. Advanced spinal imaging thought as confirmation tool for the diagnosis and as preoperative tool to delineate the extent and precise location of the pathology. Nerve roots normally sediment, due to gravity, to the dorsal part of the dural sac, which was known as negative sedimentation sign. If there is MRI finding of nerve roots in the ventral part of the dural sac the sedimentation sign is positive.

Objectives

To evaluate the presence of the MRI finding of positive sedimentation sign in patients clinically suspected to have lumbar spinal stenosis and to follow up operated cases to identify the absence of the radiological signs in the operated cases.

Material and methods

70 patients clinically suspected to have lumbar spinal stenosis evaluated by MRI lumbosacral spine in supine position. A panel of two radiologists reviewed radiological data. MRI features were agreed by both radiologists in 48 patients. Out of these 48 patients; 25 were operated upon for central decompressive laminectomy, partial medial facetectomy and foraminotomy with instrumented fusion and fixation if indicated. Visual analogue score (VAS) collectively preoperative and postoperative was compared and the walking distance postoperative was reported and follow up MRI studies were done one year after the operation.

Results

Operated patients’ mean age was 58.2 years; nineteen patients were operated upon for simple decompressive laminectomy for the affected levels. Walking distance preoperative range 100–700 metres, improved postoperative to be 1474.0 ± 601.1. VAS for pain preoperative was 9.28 ± 0.84, improved at 12 month follow up to be 0.84 ± 0.62. Postoperative MRI done to evaluate the cross sectional area (CSA) became more than 80 mm² in the absence of the sedimentation sign and was negative in 22 cases.

Conclusion

The MRI finding of positive sedimentation sign is a good positive sign to rule in lumbar spinal stenosis with high specificity and sensitivity; negative sedimentation sign can be used in postoperative follow up of decompression patients.     

CT引导硬膜外皮质类固醇注射治疗腰椎椎管狭窄

目的评价CT引导经神经孔硬膜外皮质类固醇注射治疗腰椎椎管狭窄的短期及长期疗效。方法经CT证实存在腰椎椎管狭窄且保守治疗无效的36例患者,于CT引导下行硬膜外皮质类固醇注射治疗。通过患者治疗前、治疗后2周及治疗后1年的视觉模拟疼痛评分以评价其疗效。结果对所有36例患者行治疗后2周及1年随访,19例(52．8％)患者有较好短期疗效,其中15例(41．6％)患者有较好长期疗效。15例患者(41．6％)对此治疗短期疗效表示满意。12例(33．3％)患者对其长期疗效表示满意。结论CT引导经神经孔硬膜外类固醇注射可以缓解部分腰椎椎管狭窄患者的疼痛症状并改善患者的生活质量。     

50例腰椎管狭窄症临床及影像学研究

目的 探讨影像学在椎管狭窄诊断中的价值。方法 对50例腰椎管狭窄的X线、CT、MRI表现进行回顾性分析。腰椎管狭窄分为四度：0度、I度(轻度)、Ⅱ度(中度)、Ⅲ度(重度)。结果 椎管狭窄位于L3，4平面6例，L4，5水平者29例，位于L5，S1平面者15例。CT及MRI显示单纯黄韧带肥厚者12例；椎间盘突出并黄韧带肥厚致腰盘黄间隙狭窄13例；椎体后缘骨质增生突入椎管者8例，椎体后缘增生并小关节突增生肥大16例，后纵韧带骨化1例。椎管狭窄I度26例，Ⅱ度10例，Ⅲ度14例。结论 腰椎管狭窄是临床常见病和多发病。传统X线检查有其局限性，CT和MRI无创，能够准确显示腰椎管狭窄的解剖学和部分组织学改变。     

减压联合融合、内固定治疗腰椎管狭窄的近期疗效观察

目的：观察减压联合融合、内固定治疗腰椎管狭窄（lumbar spinal stenosis,LSS）的近期疗效。方法抽取西安市红会医院接受减压联合融合、内固定治疗的LSS患者35例为联合组,选择同期行单纯减压治疗患者30例为单纯减压组,术后随访12～32个月,比较2组手术时间、术中出血量、临床疗效、术前及末次随访VAS评分、相对椎间隙高度、腰椎前凸角及中文版腰椎管狭窄问卷（CSSS）评分变化,同时统计联合组末次随访邻近节段退变（adjacent segment degeneration,ASD）发生率。结果单纯减压组平均手术时间、术中出血量明显低于联合组（P＜0.05）。末次随访单纯减压组治疗优良率,与联合组比较差异无统计学意义（P＞0.05）。末次随访单纯减压组相对椎间隙高度均显著低于联合组,差异有统计学意义（P＜0.05）。2组末次随访VAS评分较术前均明显下降（P＜0.05）;但2组治疗前后腰椎前凸角比较差异无统计学意义（P＞0.05）。联合组末次随访时症状严重程度、术后满意度评分均明显低于单纯减压组（P＜0.05）。联合组发生率为8.57%。结论减压联合融合、内固定治疗腰椎管狭窄中期疗效与单纯减压术类似,但前者在维持较高椎间隙高度、减轻症状严重程度上有明显优势,联合术后随访有ASD发生。     

Dynamic global sagittal alignment in patients with lumbar spinal stenosis: Analysis of the effects of decompression surgery on gait adaptations

BackgroundLumbar spinal stenosis (LSS) leads patients to adapt their posture and walking parameters. Pelvic retroversion might be a compensation mechanism of pain. Pelvic and lower limbs compensations during gait are still not precisely understood, as well as the effect of a surgical decompression on them. These dynamic parameters can be studied through three-dimensional gait analysis.Research questionIs the dynamic pelvic tilt modified after decompression surgery in LSS patients compared to asymptomatic subjects?Material and methods50 asymptomatic subjects (C-group) and 37 patients operated on for lumbar decompression underwent a three-dimensional gait analysis one month before (M0) and six months after (M6) the surgery. 3D gait analysis was performed and hip and knee flexion, trunk kinematics, walking speed, stride length and pelvic tilt during gait or dynamic pelvic tilt (dPT) were recorded. Health-related quality of life (HRQL) scores (Oswestry Disability Index (ODI) and Visual Analogic Scales (VAS)) and radiological assessment were performed preoperatively and postoperatively.ResultsMean values of maximum and minimum dPT in the LSS-group preoperatively were significantly higher compared to the C-group (respectively 10.9 (6.2)° versus 7.3 (5.6)°, p = 0.003; 7.7 (6.1)° versus 4.8 (5.8)°, p = 0.011), and were significantly lowered at M6 (respectively 10.9 (6.2)° versus 8.1 (4.8)°, p = 0.0087; and 7.7 (6.1)° versus 5.1 (4.7)°, p = 0.012), and became similar to the C-group. The dPT range of motion at M0 and M6 were similar, and were both significantly higher than control values. Mean values of maximum and minimum hip flexion were significantly higher at M0 compared to the C-group, and were significantly lowered at M6. No difference was found between the pre- and postoperative radiographic pelvic tilt. The VAS for lumbar pain, the VAS for radicular pain and the ODI were significantly decreased at M6.SignificanceCompared to asymptomatic people, LSS patients walked with a pelvic anteversion, a hip flessum and a knee flessum before surgery, which tended to disappear after the surgical decompression. These differences were not noticed on static radiographs.     

Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT

The aim of this study was to investigate the correlation of vertebral dimensions with somatometric parameters in patients without clinical symptoms and radiological signs of central lumbar spinal stenosis. One hundred patients presenting with low back pain or sciatica were studied with CT. In each of the L3, L4 and L5 vertebra three slices were taken with the following measurements: 1. Slice through the intervertebral disc: (a) spinal canal area; (b) interarticular diameter; (c) interligamentous diameter. 2. Slice below the vertebral arcus: (a) dural sac area; (b) vertebral body area. 3. Pediculolaminar level: (a) anteroposterior diameter and interpedicular diameter of the spinal canal; (b) spinal canal area; (c) width of the lateral recesses. The Jones-Thomson index was also estimated. The results of the present study showed that there is a statistically significant correlation of height, weight and age with various vertebral indices. The conventional, widely accepted, anteroposterior diameter of 11.5 mm of the lumbar spinal canal is independent of somatometric parameters, and it is the only constant measurement for the estimation of lumbar spinal stenosis with a single value. The present study suggests that there are variations of the dimensions of the lumbar spinal canal and correlations with height, weight and age of the patient. Received 9 July 1997; Revision received 11 February 1998; Accepted 11 March 1998     

老年人腰椎椎管狭窄的CT评估

目的：描述６０岁以上老年人脊椎狭窄的有关ＣＴ表现及测量,探讨老年人脊椎狭窄的特征。方法：采用ＣＴ横断而簿层扫描,并测量硬膜囊矢状径、黄韧带前间隙、侧隐窜宽度,分析他们与脊央和／或神经根受压的关系。结果：硬膜囊矢状径≤１０ｍｍ、黄韧带前间隙〈５ｍｍ,侧陷窝宽度≤３ｍｍ,常提示压迫脊髓或神经根。结论：老年人椎管狭窄多有椎骨小关节及侧隐窝狭窄,而黄韧带前间隙〈５ｍｍ是神经根压迫较为可靠的依据。     

两种TLIF手术方法治疗腰椎滑脱合并椎管狭窄症的疗效比较

目的比较两种TLIF手术方法治疗腰椎滑脱合并椎管狭窄症的临床疗效。方法回顾性分析及随访53例腰椎滑脱伴椎管狭窄症患者,其中A组（22例）采用Wiltse人路经椎间孔椎体间融合（transforaminal lumbar interbody fusion,TLIF）＋椎管潜行减压术,B组（31例）采用后正中入路改良经椎间孔椎体间融合＋椎管潜行减压术。记录两组的手术时间、术中出血量、术后引流量、JOA腰痛评分、疼痛视觉模拟评分（visnal analogue scale,VAS）、影像学评价,并进行统计分析。结果A组术中出血量、术后引流量均小于B组（P〈0．05）,两组手术时间差异无统计学意义。在VAS评分及JOA评分方面,术后各时期较术前均有显著改善（P〈0．05）,术后1周B组的腰痛VAS评分和JOA评分较A组差异有统计学意义（P〈0．05）。两组影像学评价差异无统计学意义（P〉0．05）。结论Wiltse入路组术中出血量及术后引流量少,患者术后腰腿疼痛缓解迅速,但远期的随访评分与后正中入路组比较无明显差异。改良TLIF在保持腰椎术后生物力学恢复方面优于常规TLIF。