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CT引导椎间盘造影术在多节段腰椎间盘退变中的临床价值 总被引:1,自引:0,他引:1
[目的]探讨CT引导下椎间盘造影术在治疗多节段腰椎间盘退变疾患中的临床价值.[方法]2005年1月~2008年1月对28例多节段腰椎间盘退变疾患行CT引导下椎间盘造影术,其中男12例,女16例;年龄30~56岁,平均38.2岁.腰椎间盘退变节段:L3、4和 L4、5突出9例,L4、5和 L5S1突出15例,L3、4、L4、5和 L5S1三节段突出4例.造影节段:28例共计92个椎间盘,L2、3间隙10例,L3、4间隙28例,L4、5间隙28例,L5S1间隙26例.按照阳性椎间盘造影的诊断标准,筛选出致痛性椎间盘(责任间盘),对这些病变间隙行相应的椎间融合术治疗.[结果]28例患者92个间隙共筛选出32个责任间盘.VAS≥6分组中Ⅱ+Ⅲ级间盘(Dallas分级)和退变间盘(Pearce分级)所占的百分比明显高于VAS<6分组(P<0.05).手术前后ODI指数评分比较有显著性差异(P<0.05).随访12~36个月,平均25.2个月.Charles疗效评定,术后优22例(78.6%),良5例(17.9%),一般1例(3.6%),差0例.所有病例均未发生与椎间盘造影有关的并发症.1例椎间融合器下沉,1例植骨融合不良,1例术后病变侧伸母肌力减退,再次手术行椎弓根螺钉调整术,术后2个月肌力恢复.[结论]CT引导下椎间盘造影术对于多节段腰椎间盘退变疾患中责任间盘的选择具有重要的临床意义. 相似文献
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Comparison of high-resolution computed tomography with discography in the evaluation of lumbar disc herniations 总被引:1,自引:0,他引:1
After failure of conservative treatment, 100 patients with symptoms suggestive of lumbar herniated nucleus pulposus (HNP) but without objective deficits were investigated both by high-resolution CT (without intravenous or intrathecal contrast) and by discography. The L4-L5 and L5-S1 discs were investigated by both techniques in all patients. In addition, the L3-L4 disc was investigated in 20 patients. The 220 investigated discs were sorted out into 6 CT categories according to morphologic and technical criteria. They were also classified into 3 discographic groups according to morphologic and clinical criteria. Based on morphologic considerations alone, the false-negative CT rates varied from 0 to 64% and the false-positive rates varied from 0 to 19%, depending on the category under consideration. Based on both morphologic and clinical consideration, the false-negative CT rates varied from 34 to 57% and the false-positive CT rates varied from 23 to 50%. Thus, high-resolution CT does not constitute an adequate means of investigation for this category of patients and discography appears justified before considering any form of radical therapy. 相似文献
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Abnormality of the bony structures of the spinal canal can be seen clearly with computed tomography (CT). Earlier utilization of CT to diagnose disc herniation was limited because of difficulty in obtaining a detailed image. Since 1978 we have used the General Electric CT/T-X2 scanner, and with this, disc abnormalities are clearly visible. In this paper, we demonstrate the findings and differences of lumbar disc abnormalities in operated and nonoperated cases. 相似文献
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Summary Ninety patients suspected to have a herniated lumbar disc were examined by myelography and computed tomography (CT). Of these, 37 were subjected to surgery. The surgical findings were in agreement in 21 patients (57%) with the myelograms and in 28 patients (76%) with the CT examinations. False-positive CT examinations were found in only one patient. CT is as reliable as myelography in the primary diagnosis of disc herniation. 相似文献
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腰椎间盘突出CT扫描三维定位诊断 总被引:2,自引:0,他引:2
目的:研究椎间盘突出的三维定位,为腰椎间盘突出患者提供更精确的诊断依据。方法:对40例椎间盘突出CT扫描后进行多平面重建,得到矢状位图像。用1-4四个数字代表突出髓核在横断位上的位置,在横断位或矢状位上测量髓核后突的程度,在矢状位上测量髓核上下移位的长度。按照左右、前后、上下的顺序来描述髓核突出的部位、后突程度和长度,并与手术结果对照。结果:三维定位提供的部位、程度和长度与手术结果相符。结论:多平面重建图像和三维定位方法是可靠的,可为椎间盘突出的诊断提供更精确可靠的依据。 相似文献
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P Gillstr?m K Ericsson T Hindmarsh 《Archives of orthopaedic and traumatic surgery. Archiv für orthop?dische und Unfall-Chirurgie》1986,106(1):12-14
Ninety patients suspected to have a herniated lumbar disc were examined by myelography and computed tomography (CT). Of these, 37 were subjected to surgery. The surgical findings were in agreement in 21 patients (57%) with the myelograms and in 28 patients (76%) with the CT examinations. False-positive CT examinations were found in only one patient. CT is as reliable as myelography in the primary diagnosis of disc herniation. 相似文献
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[目的]应用椎间盘造影术探讨腰椎间盘突出症患者临床腰痛来源.[方法]137例椎间盘突出症患者根据造影术前MRI表现将椎间盘分为:正常、突出和退变.患者腰痛和腿痛的严重程度应用疼痛视觉模拟评分(VAS评分)判定,分为三组:(1)腰痛为主组;(2)腿痛为主组;(3)腰腿痛并重组.对所有退变的腰椎间盘及至少1个作对照的正常椎间盘进行椎间盘造影检查,如造影过程中诱发一致性腰痛,即认为椎间盘造影阳性.[结果]137例患者总共427个椎间盘行造影检查,其中104个造影阳性.椎间盘造影阳性患者腰痛与腿痛VAS评分无明显差异(P>0.05),而阴性者腿痛评分高于腰痛评分(P<0.05).腰痛为主组,腿痛为主组,腰腿痛并重组其造影阳性率分别为79.2%,18.6%,71. 7%.MRI表现为正常、突出和退变的椎间盘其造影阳性率分别是1.4%、48.3%、21.6%(P<0.05).[结论]盘源性腰痛可能是腰痛明显的椎间盘突出症患者腰痛的主要原因,这种腰痛主要来源于椎间盘突出节段和或邻近退变节段. 相似文献
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Eighty patients with operatively proven lumbar disc herniation or lumbar spondylosis were preoperatively evaluated with metrizamide myelography followed by metrizamide-enhanced computed tomography (CT). The x-ray films were reviewed without knowledge of the operative findings, and the patients were subdivided into those with disc extrusions, spondylosis, or recurrent abnormalities. For the group as a whole, CT was correct in 82% and myelography was correct in 77%. Both CT and myelography together were accurate in 91%, a significant improvement (P less than 0.02). The authors conclude that, if both studies are performed, the percentage of cases correctly diagnosed is increased. Therefore, both metrizamide myelography and metrizamide-enhanced CT should be obtained in selected cases. A review of the literature is included. 相似文献
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The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography 总被引:6,自引:0,他引:6
H Vanharanta B L Sachs M A Spivey R D Guyer S H Hochschuler R F Rashbaum R G Johnson D Ohnmeiss V Mooney 《Spine》1987,12(3):295-298
The CT/discographic findings from 225 discs in 91 low-back pain patients were compared to the pain provocation during the injection of contrast into the disc. The radiographic appearance of disc deterioration demonstrating disc degeneration and annular disruption of each disc was classified separately using a fourpoint scale: normal, slight, moderate, or severe. Pain reaction to the discogram at each level was recorded as follows: no pain, dissimilar pain, similar pain, or exact reproduction of the patient's clinical pain. This more precise analysis demonstrated a significant relationship between pain and deterioration of discs. The CT/discogram presents an axial view of the disc that allows a subgrouping of disc deterioration that can discriminate between peripheral deterioration (degeneration) and internal deterioration (disruption). The disruption supposedly occurs earlier and is more likely to be the source of exact pain reproduction. 相似文献
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Magnetic resonance imaging,computed tomography,and myelography in the diagnosis of recurrent lumbar disc herniation 总被引:1,自引:0,他引:1
M. J. Albeck L. Kjær J. Præstholm A. Vestergaard O. Henriksen F. Gjerris 《Acta neurochirurgica》1990,102(3-4):122-126
Summary Thirteen patients with recurrent symptoms after lumbar discectomy were evaluated. All the patients were enrolled in the study on the basis of clinical symptoms and signs only. The patients were examined with MRI, CT, and myelography in order to compare a) the clinical findings with the imaging investigations, b) the predictive value of the different investigations, and c) the clinical and investigative results with the operative findings. All patients were operated upon according to the clinical findings, and the surgical results were used as the final diagnosis. In six patients a new disc herniation was detected. In the remaining cases surgery revealed either scar tissue or nothing to explain the recurrence of the symptoms. The three imaging modalities were analysed by receiver operating characteristic (ROC) curves. The areas under the ROC curves were 0.68 for MRI, 0.83 for CT, and 0.43 for myelography. The difference in areas between CT and myelography was significant (p<0.05). The results indicate that CT has the highest predictive value for demonstrating the recurrence of a lumbar disc herniation. 相似文献
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目的 探讨硬膜内腰椎间盘突出症的诊断与手术治疗方式,并对其发病机制进行讨论.方法 对5例硬膜内腰椎间盘突出症患者进行了手术治疗,男3例,女2例,年龄28~52岁,平均42岁,并经CT、MRI和手术证实,手术中采用半椎板切除或全椎板切除术,切开硬脊膜和蛛网膜,显露突出的椎间盘髓核组织,并仔细予以摘除,缝合硬脊膜切口,用脂肪、肌肉、或纤维蛋白凝胶覆盖.结果 尽管患者术前都有明显的神经症状,术后患者都取得了良好的效果,对病人进行了1~5年的随访,术前腰痛、下肢痛均缓解,明显改善了工作和生活质量.3例患者效果良好,恢复了原工作,其他2例患者术前出现了马尾综合征,仍残留一些神经症状,尿频尿急,会阴部感觉丧失,肌肉萎缩.结论 硬脊膜腹侧与后纵韧带粘连是造成硬膜内腰椎间盘突出的主要因素,硬膜内腰椎间盘突出术前很难诊断,通常诊断是在术中确定的,术前诊断应强调MRI的重要性,患者多需要紧急手术,因为神经预后与神经症状出现的时间有关,早期诊断和适当的手术治疗对于取得良好的效果是非常重要的. 相似文献
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