下腰椎小关节退行性病变的X线、CT、MRI影像学比较

目的探讨X线、CT和MRI对下腰椎小关节退行性病变的诊断价值及局限性。方法收集41例明确有下腰椎小关节退行性病变的X线、CT和MRI影像学资料,包括腰椎正、侧、斜位及过伸、过屈位片,L3～S1段椎小关节CT横断位及MRI横断、冠状、矢状位扫描图像。结果X线平片对腰椎小关节的显示仅限于对关节面骨质及关节间隙宽窄度改变的观察。CT对椎小关节突骨质、关节面平整度及关节面下骨质、关节间隙、关节囊钙化等改变的显示明显优于X线平片及MRI（均P〈0．05）。MRI在显示关节面软骨、关节囊肿胀、滑膜囊肿及滑膜囊疝等方面明显优于X线平片和CT（均P〈0．05）。结论X线平片、CT、MRI三种影像学检查方法在显示椎小关节退行性病变方面各有优缺点,综合应用和合理选择影像学检查方法可为临床正确诊断和治疗腰椎小关节病变提供可靠依据。     

下腰椎小关节退行性病变在X线、CT、MRI成像特征

目的:探讨下腰椎小关节退行性病变在X线、CT、MRI成像特征。材料与方法:以回顾性方法,选取我院2014年5月至2015年5月间确认的40例下腰椎小关节退行性病变患者,对其X线、CT、MRI影像学资料进行分析、比较,并进行总结。结果:X线平片,对腰椎小关节的显示,局限于关节面骨质、关节间隙宽窄度改变方面;CT对椎小关节突骨质、关节面平整度、关节面下骨质、关节间隙、关节囊钙化等显示方面,优于X平片、MRI,经比较,差异显著,具有统计学意义(P0.05);MRI对关节面软骨、关节囊肿胀、滑膜囊肿、滑膜囊疝等显示方面,优于X线平片、CT,差异显著,具有统计学意义(P0.05)。结论:X线、CT、MRI三种影像学检查方法,在对下腰椎小关节退行性病变的显示方面,各具优势与缺点,可以通过综合应用三种方法,为临床诊断下腰椎小关节退行性病提供可靠依据。     

腰椎间盘吸收综合征的X线及CT诊断

目的讨论X线平片及CT诊断腰椎间盘吸收综合征（IDR）的临床价值。方法对20例患者行腰3／4、4／5及腰5／骶1椎间盘平面CT扫描，层厚3．75mm，对腰椎正侧位片及横断面CT图像进行综合分析。结果20例患者诊断为腰椎间盘吸收综合征，其中腰4／5椎间盘3例，腰5／骶1椎间盘17例，腰椎正侧位片均可见孤立性腰椎间隙狭窄、邻近椎体终板硬化、椎体骨质增生，CT表现为椎间盘膨出及突出6例，硬膜囊受压17例，侧隐窝及椎间孔狭窄14例，椎间盘真空现象17例，小关节硬化13例。结论腰椎间盘吸收综合征的诊断主要依靠影像学检查，X线及CT扫描可以显示此征全部细节，对临床诊断及治疗具有重要价值。     

强直性脊柱炎的X线、CT、MRI诊断价值

目的:探讨强直性脊柱炎X线、CT、MRI表现及其诊断价值.方法:对50例诊断为强直性脊柱炎的影像学资料进行了回顾性分析和总结.结果:50例均行X线检查,平片发现Ⅲ级以上的骶髂关节改变,主要表现为关节面破坏、间隙狭窄和关节强直,其中43例行CT检查发现Ⅲ级以下骶髂关节的改变,15例MRI检查显示关节腔、关节软骨、骨髓信号及关节囊等改变.结论:强直性脊柱炎具有特征性的影像学表现,三种检查方法各有优势,影像学检查仍以X线平片为首选方法,若诊断有困难或需要与其他疾病鉴别时则考虑有选择性地应用CT或MRI检查.     

军人腰椎峡部裂并滑脱的X线、CT诊断探讨

目的：探讨对腰椎椎弓峡部裂并滑脱的X线、CT征象认识。方法：对25例诊断为腰椎椎弓峡部裂的X线、CT资料作回顾性分析。结果：X线表现为：“八字征”腰椎体前移，“猎狗征”，CT表现为双侧关节突间部不规则骨性缺损伴骨质增生。椎管前后径延长，终板呈双边征，于相邻椎体层面，椎间盘呈反方向突出椎体边缘。结论：X线可诊断腰椎椎弓峡部裂并滑脱，CT不仅可以发现X线平片所显示的病变，且可同时显示合并的脊椎滑脱以及椎小关节、椎间盘、骨性椎管，椎间孔硬膜囊、黄韧带、神经根的改变。     

普通X线与CT对腰椎小关节综合征诊断的对照研究

目的:探讨腰椎小关节综合征的普通X线及CT征象。材料与方法:通过85例腰椎小关节综合征常规摄取X线片正侧位及双斜位片,CT常规扫描加向头侧,足侧扫描层面。结果:腰椎小关节综合征X线及CT共同征象为小关节突肥大、骨赘形成、关节间隙变窄。结论:X线片及CT综合对照研究不仅提高了腰椎小关节综合征的准确率,而且为早期诊断、临床有效治疗及观察术后疗效提供客观依据。     

色素沉着绒毛结节性滑膜炎的临床影像学研究

目的:探讨色素沉着绒毛结节性滑膜炎(PVNS)的影像学(X线、CT、MRI)表现及诊断要点.方法:回顾分析我院经手术及病理证实的47例PVNS患者的影像学表现.结果:X线平片能显示关节面下的骨侵蚀或骨缺损及其周围硬化及关节囊的肿胀;CT可清晰显示骨改变及关节囊突向关节腔的软组织结节;MRI 对显示关节滑膜增厚、软组织结节、关节积液敏感,特别是其中色素沉着结节具有特征性信号.结论:X线、CT可提示PVNS,MRI具有特征性影像表现,明显优于X线平片及CT,是诊断PVNS最佳影像学方法.     

CT在真性腰椎滑脱和假性腰椎滑脱鉴别中的价值

背景：真性、假性腰椎滑脱时的影像学表现有许多不同之处,CT能显示小关节的形态学变化,具有普通X射线平片没有的优势。目的：通过观察和测量腰椎滑脱患者的影像学资料的特点,推测小关节改变与滑脱之间的关系,评价CT在诊断真性滑脱和假性滑脱中的应用价值。设计、时间及地点：对比观察实验,于2004-07/10在河北医科大学第三医院脊柱外科临床实验室完成。参试者：河北医科大学第三医院2003-01/2004-06收治156例住院的腰椎滑脱患者,其中真性滑脱48例,假性滑脱108例。方法：全部病例均采用美国GE公司生产的Prospeed AⅡ型CT机进行常规轴面扫描,计算机X射线成像或数字放射成像拍腰椎正侧位及双斜位片。主要观察指标：两种腰椎滑脱椎小关节面的角度,椎小关节在影像学上的病理改变。结果：假性滑脱腰椎小关节面角呈较明显的矢状方向改变。椎小关节的病理变化包括：关节间隙狭窄不平、骨赘形成、软骨下骨骨质疏松、关节真空、关节囊钙化等,这些病理变化在假性滑脱的发生率均明显高于真性滑脱。结论：CT不但能显示椎体滑脱椎弓峡部的缺损情况,而且可显示椎管内的改变及小关节的改变情况,是确诊真、假性滑脱的重要手段。     

X线平片联合MRI诊断腰椎关节退行性病变

回顾性分析2008年3月~2009年12月46例有明确腰椎关节退行性病变患者的X线平片及MR I影像学资料。X线平片包括腰椎正位、侧位、斜位以及过伸位、过屈位片等;MR I图像包括横断位、冠状位以及矢状位扫描等。结果X线平片能对腰椎关节面骨质、关节间隙宽窄的改变及关节的稳定性进行客观反映;但由于X线平片的局限性,故MR I在显示关节面下囊变、关节面软骨退变、关节囊肿胀以及滑膜囊肿等方面均明显优于X线平片(P均0.05)。     

CT平扫与X线平片诊断腰椎间盘突出症价值

目的：比较CT平扫与X线平片诊断腰椎间盘突出症的准确性。方法：回顾性分析198例腰椎间盘突出症患者的CT和X线平片影像资料。结果：CT平扫诊断腰椎间盘突出症192例(97.0％),X线平片诊断135例(68.2％)。结论：X线平片可显示腰椎骨质改变,适用于腰腿痛患者初诊检查,CT平扫诊断腰椎间盘突出症准确率高。     

CT导引下的骶髂关节造影及其临床意义初探

目的探讨ＣＴ导引下的骶髂关节造影术及其临床意义。方法对５例骶髂关节病变患者和１５例腰腿痛的志愿者进行ＣＴ导引下的骶髂关节造影,造影后行ＣＴ扫描、Ｘ线拍片并填写疼痛图。结果骶髂关节ＣＴ扫描显影良好,Ｘ线片影像欠清晰。２例有骶髂关节病变患者的ＣＴ扫描发现有造影剂外溢及隐窝。本组共１４例感造影后穿刺侧臀部及大腿后上方酸痛,５例骶髂关节病变患者诉造影术引发的疼痛与术前疼痛部位相同。结论ＣＴ导引下的骶髂关节造影术与传统的造影方法相比,即避免了过多接触Ｘ线照射引起的伤害,又提高了工作效率,为临床诊断和开展相关研究提供了有意义的影像学信息。     

腰椎小关节病的CT检查和表现

目的 对腰椎小关节病ＣＴ表现作出归纳,提高对此病作为腰腿痛的重要病因的认识。方法连续２００例腰腿痛患,主要作了腰椎Ｌ４－５和Ｌ５－Ｓ１的小关节ＣＴ平扫,并运用骨窗和软组织窗对图像进行分析和测量。结果 有１３５例（占６７．５％）患表现为不同节段的腰椎小关节病,ＣＴ表现为：骨赘形成;小关节突增生肥大;关节间隙变窄;关节真空现象以及关节囊的钙化等。腰椎小关节病常伴有其它腰椎疾病。讨论 腰椎小关节病是     

Unilateral septic arthritis of a lumbar facet joint secondary to acupuncture treatment--a case report

This report describes a case of septic arthritis of the lumbar facet joint probably as a result of acupuncture treatment. A 48 year old man with a long history of back pain presented with a two week history of increasing pain following a third session of acupuncture. Examination revealed tenderness in the right lumbosacral area and laboratory investigations revealed raised inflammatory markers with negative blood cultures. A bone scan and MRI scan showed evidence of septic arthritis of the right L5/S1 facet joint. An x ray computed tomography guided biopsy was carried out which isolated staphylococcus aureus. The patient was initially treated with intravenous antibiotics. A repeat MRI scan demonstrated persistent septic arthritis with adjacent early abscess formation. Surgical debridement of the facet joint was therefore performed. The patient had resolution of his symptoms and the inflammatory markers returned to normal. He regained a full range of movement of the lumbar spine. Very few cases have been reported of lumbar facet joint septic arthritis and this condition is rare in association with acupuncture treatment. A high index of suspicion needs to be maintained and if conservative management fails then debridement can result in an acceptable outcome.     

X线平片、CT、ECT诊断骨转移瘤的比较分析

目的：比较分析X线平片、CT、发射计算体层摄影（ECT）诊断骨转移瘤。材料与方法：50例骨转移瘤均经手术病理证实,所有病例均先后作了X线摄影,CT及ECT全身骨扫描。所用仪器为东芝500mAX线机,东芝L3000CT扫描机及法国Sopha公司SDX型发射计算体层摄影仪。结果：诊断转移性骨肿瘤灵敏度：ECT（97．2％）高于CT（69．7％）、X线平片（59．3％）;精确度：ECT（88．0％）亦高于CT（78．0％）、X丝平片（68．0％）;假阴性率：ECT比X线平片、CT均低的多;特异性;ECT（64．3％）明显低于CT（94．1％）及X线平片（92．9％）;假阳性率：ECT均比CT及X线平片高。ECT的阴性预测值较高,而X线平片及CT扫描的阳性预测值较高。结论：ECT能更早显示出病灶、是骨转移瘤较好的筛选方法。X线平片、CT检查特异性较强是骨转移瘤最基本的检查方法,三种方法具有互补作用。     

Does osteoarthritis of the lumbar spine cause chronic low back pain?

The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages. Despite these similarities, questions remain regarding the lumbar spine facet joints as a source of chronic back pain. The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis. Patients who do not have osteoarthritis of the facet joints on magnetic resonance scan do not have back pain. Single photon emission computed tomography scans of the axial skeleton are able to identify painful facet joints with increased activity that may be helped by local anesthetic injections. Low back pain is responsive to therapies that are effective for osteoarthritis in other locations. Osteoarthritis of the lumbar spine does cause low back pain.     

Are Diagnostic Lumbar Facet Injections Influenced by Pain of Muscular Origin?

Introduction: Nonradicular low back pain can be a difficult entity to accurately diagnose and treat. Facet joints, muscle, ligaments, and fascia have all been reported to be etiologies of acute and chronic low back pain. However, the facet joint as a source of low back pain is controversial. The diagnosis of facet joint pain is made by diagnostic facet joint or median nerve branch injections with a local anesthetic. The purpose of this study was to determine if the results of diagnostic facet joint injections are influenced by the technique used to perform these injections. Methods: Seventy‐five male patients aged 45 years or younger and 18 years or older who were injured while performing heavy work with nonradicular low back pain were included in this study. Diagnostic injection therapy was performed following Institutional Review Board approval and the patient's informed consent. Patients were assigned to one of five groups to receive diagnostic injections in a double‐blinded fashion as follows: Group I: facet joint injection with continuous lidocaine administration from the skin to the facet joint as the needle was advanced; Group II: facet joint injection with saline administration from the skin to the facet joint as the needle was advanced; Group III: median nerve branch injection with a lidocaine advancing needle technique; Group IV: median nerve branch injection with saline advancing needle technique; and Group V: injection of the paraspinous muscles with local anesthetic and steroid following noted areas of pain diagnosed with saline injection and radiopaque contrast. After one week, the patients in Groups I to IV who had no pain relief with facet joint or median nerve block injections subsequently received paraspinous muscle injections, while the patients in Group V who had no long‐term relief with muscle injections were given facet joint injections. The appropriate parametric and nonparametric tests were performed with statistical significance defined as P ≤ 0.05. Results: There were no differences among the groups demographically. The incidence of pain relief was significantly higher in subjects who had a continuous injection of local anesthetic into their musculature than in those individuals who received continuous saline followed by an injection of local anesthetic into their facet joint or median nerve branch. Discussion: The results of this study demonstrated that local anesthetic injections are useful for the diagnosis of nonradicular low back pain but may yield false positive results with respect to lumbar facet pain depending upon the technique utilized.     

腰椎小关节不对称与小关节综合征关系CT研究

目的：本文对84例临床诊断为腰椎小关节综合征病例的临床、CT资料进行了回顾性分析。CT能够清晰地显示椎小关节增生肥大、骨赘形成、关节间隙狭窄、关节对合不良、关节面改变、关节面倾角异常等椎小关节病变,特别能发现小关节的不对称现象及其并存症;探讨了腰椎小关节综合征与小关节不对称的相关机理,提出小关节不对称是引起本征的重要原因之一。CT对小关节不对称发现及本征的诊断和临床治疗具有重要价值。     

应用神经阻滞方法验证臀上皮神经卡压综合征存在另一卡压点

目的通过试验性神经阻滞的方法证实臀上皮神经卡压除了存在入臀点的卡压外,还存在椎后关节处的卡压。方法对34例臀上皮神经卡压综合征患者进行神经阻滞以分析卡压点。首先阻滞臀上皮神经在髂嵴入臀点处,10min后患者自行评定疼痛缓解明显列为A组;余患者再次对L1～2、L2～3的患侧椎后关节外侧阻滞脊神经后支,10min后评定疼痛缓解明显列为B组;仍不明显者列为C组。记录可能造成臀上皮神经卡压的各种体征,其中小关节紊乱的体征包括棘突偏斜、条索状韧带剥离硬结、棘突侧方压痛等;入臀点处的体征包括入臀点压痛、入臀点附近皮下痛性硬结。盲法统计分析各组患者的性别、年龄、病史和体征。结果18例患者仅阻滞臀上皮神经在髂嵴入臀点则疼痛明显缓解,提示臀上皮神经卡压点位于该点或该点以下(归为A组)。12例患者需要对椎后小关节部位阻滞后疼痛才明显缓解,证实椎后关节存在另一卡压点(归为B组)。4例患者疼痛仍无明显缓解,推测可能卡压点仍存在于椎后关节以上如椎间孔处,或者脊神经后支的阻滞不完全所至(归为C组)。A组与B组之间年龄、性别、病史无显著性差异,B组具有关节紊乱的体征较A组明显为多(P<0.01)。结论椎后关节紊乱可以造成脊神经后支卡压,也是造成臀上皮神经卡压的因素。     

股骨头缺血性坏死的影像诊断(附24例CT,X线对照分析)

目的 分析AVN的CT表现,了解CT检查对AVN的价值。方法 采用西门子DR—H全身扫描,对24例33个股骨头CT表现与X线对照分析。结果 早期AVN CT表现为股骨头星状征消失,滑膜肿胀,关节积液。晚期股骨头囊状变,股骨头变形,关节面模糊,关节间隙狭窄等。结论 CT检查对早期AVN及晚期AVN有一定临床诊断价值。     

Audit of conservative management of chronic low back pain in a secondary care setting--part I: facet joint and sacroiliac joint interventions

The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16-40% and 13-19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.