颈椎病的X线诊断

目的：探讨颈椎病的X线诊断。方法：对265例颈椎病的X线征象进行分组分析。结果：生理曲度改变190例，占71．7％；颈椎稳定性改变71例，占26．8％；椎体骨质及椎间盘退行性改变166例，占62．6％；韧带钙化58例，占21．9％。结论：颈椎X线平片是颈椎病诊断的主要方法。     

颈椎病的X线诊断——附200例临床X线分析

本文总结了颈椎病２００例，从临床及Ｘ线表现进行了分析，并对Ｘ线诊断意义，病理机制，Ｘ线检查方法进行了讨论。     

颈椎病X线诊断48例分析

1 临床资料 48例中男25例,女23例。30～78岁,40岁以上33例。颈椎病症状表现多样,根据临床症状,一般分为4型:神经根型、脊髓型、椎动脉型及交感神经型,以神经根型最常见,各型之间常合并发生。神经根型系侧后方突出物刺激或压迫神经根所致,有颈、肩疼痛和上肢麻木感,若压迫脊髓,表现为感觉和运动障碍、肢体和躯干麻木无力,以及上运动神经原损害体征。椎动脉受压表现为椎动脉供血不足症状,如头晕、恶     

The epidemiology of cervical spondylotic myelopathy

Objectives

This is an observational study looking at the epidemiology of cervical spondylotic myelopathy of patients presenting to our hospital.

Materials and methods

The notes and MRI scans of 41 patients presenting to the Leicester General Hospital with a clinical diagnosis of cervical myelopathy between January 2004 and December 2008 were reviewed retrospectively.

Results

Cervical myelopathy was found to be more common in male patients to the ratio of approximately 2.7:1, with an average age at diagnosis of 63.8?years. Multi-level disease was seen in the majority of patients, with C5/6 being the most commonly affected level.

Conclusions

Cervical myelopathy predominantly affects men in their 7th decade of life. It is often a multi-level disease with C5/6 being the most commonly affected. It has little in common with cervical radiculopathy and is more analogous to lumber spinal stenosis.     

椎动脉型颈椎病的MRA分型探讨

目的：探讨椎动脉型颈椎病的NRA分型、发病机制及临床意义。方法：48例临床诊断椎动脉型颈椎病的病人行椎动脉NRA检查，依据临床资料和NRA改变对该病进行分型，并据此选择不同的治疗方式。结果：根据NRA的表现可将椎动脉型颈椎病分为五型：神经一血管型(18例)、椎动脉牵拉型(10例)、椎动脉压迫型(9例)、椎动脉硬化型(5例)、椎动脉发育不良型(6例)。随防1-3年疗效满意。结论：上述分型有利于揭示椎动脉型颈椎病的发病机制，并对治疗方法的选择起到重要的指导作用。     

CT、MRI对脊髓型颈椎病的诊断分析

目的探讨CT、MRI对脊髓型颈椎病（CSM）的诊断价值。方法对32例CSM患者的CT、MRI资料进行回顾性分析。结果 32例患者中,CT显示骨性椎管狭窄5例,其中先天性狭窄3例,椎体缘骨质增生22例,钩突和关节突关节增生20例,有不同程度椎间盘突出23例,后纵韧带及项韧带钙化13例。MRI显示椎间盘突出、变性28例,后纵韧带增厚21例,黄韧带增厚7例,全部病例脊髓不同程度受压,其中脊髓变性6例。结论 CT、MRI是重要的检查CSM的方法,能为临床治疗提供确切依据。     

颈髓CT横断面测量对脊髓型颈椎病的诊断价值初探

目的 :评价颈髓CT横断面测量对于诊断脊髓型颈椎病的应用价值。方法 :异常组选取 76例临床明确的脊髓型颈椎病的病人 ,正常 (对照 )组选取 6 8例临床排除脊髓型颈椎病及CT证实无椎管狭窄的正常人。全部进行C4～ 5　和C5～ 6　椎间盘螺旋CT扫描 ,并测量相关层面颈髓的矢状径和颈髓的横断面积。结果 :异常组的C4～ 5　椎间盘水平颈髓矢状径均值为 5 .90± 0 .78mm ,颈髓的横断面积均值为 76 .91± 11.5mm2 ,C5～ 6椎间盘水平颈髓矢状径均值为 5 .83± 0 .73mm ,颈髓的横断面积均值为 6 9.5 1± 10 .9mm2 ;正常组相对应的数据为 7.87± 0 .89mm ,95 .2 9± 12 .4mm2 ,7.75± 0 .82mm和 86 .35± 12 .0mm2 。上述两组数据两两比较有显著差异 (P <0 .0 0 1)。结论 :CT测量颈髓的矢状径和横断面积对于脊髓型颈椎病的诊断具有重要价值     

颈椎过屈过伸X线检查在颈椎病诊断中的应用

目的:探讨过屈过伸功能位摄片在颈椎病X线诊断中的应用价值。方法:对200例颈椎病患者进行过屈及过伸颈椎侧位片检查,测量其前屈角、后伸角及相对角,观察颈椎向前及/或向后滑移情况和棘突分离或相互靠近情况。结果:前屈角为82°~156°,平均128°。后伸角为45°~89°,平均64°。相对角36°~96°,平均65°。过屈位颈椎椎体前移者138例,后移者9例,部分椎体前移部分椎体后移者2例;过伸位颈椎椎体后移者154例;颈椎不稳主要发生在C2~C3和C3~C4;过屈位局部棘突不能分离者28例,过伸位局部棘突不能靠近者83例。结论:过屈过伸功能位能发现常规颈椎正侧斜位片未能显示的颈椎失稳和功能改变;有时还能发现常规片中未能显示或显示不清楚的解剖结构性改变;对X线观察颈椎运动,记录局部韧带损害,颈椎失稳及用以估计治疗后功能恢复的程度有重要作用。     

DTI在评价脊髓型颈椎病颈髓压迫损伤中的作用

目的:评价DTI的相对各向异性(relative FA,rFA)、相对表观扩散系数(relative ADC,rADC)对脊髓型颈椎病中颈髓压迫损伤的诊断价值。方法:收集颈髓不同压迫程度的脊髓型颈椎病98例和对照组17例健康志愿者,应用1.5T MR行常规和DTI检查,分别测量对照组(A组)C4⁵、C65、C6⁷节段和病变组(B7节段和病变组(B^D组)病变节段FA值和ADC值,并与自身同层面C2节段颈髓比较,计算出rFA值和rADC值,分析组间的差异;观察各组在颈髓纤维束图的变化。结果:AD组)病变节段FA值和ADC值,并与自身同层面C2节段颈髓比较,计算出rFA值和rADC值,分析组间的差异;观察各组在颈髓纤维束图的变化。结果:A^D组rFA值分别为0.92±0.06,0.89±0.07,0.76±0.10,0.58±0.09;rADC值分别为1.06±0.09,1.10±0.17,1.35±0.19,1.42±0.13。结论:DTI的参数变化能够量化脊髓型颈椎病颈髓受压后微细结构的变化,颈髓纤维束的图像重建能直观显示纤维束的完整性,可更加准确地评估脊髓型颈椎病的颈髓损伤。     

严重脊髓型颈椎病的围手术期护理

脊髓型颈椎病是颈椎退行性疾病的一种,是退行性颈椎疾病中最常见、最严重的类型之一,是以椎间盘退行性变为基本病理基础,相邻椎体后缘骨赘形成,以此构成对脊髓和支配脊髓血管的压迫导致不同程度的脊髓功能障碍的疾病。Bern—hardt等认为,脊髓型颈椎病的致压物主要来自前方,少数病例是由于动态因素,如椎间盘退变突出及骨赘形成或黄韧带退变丧失弹性折皱后进入椎管,引起椎管前后狭窄或形成对脊髓“卡压”作用。因此,手术解除颈脊髓压迫已成为广大学者共识。严重脊髓型颈椎病多为高龄、体弱患者,手术难度及风险大。笔者回顾性分析我科收治的21例严重脊髓型颈椎病患者的治疗护理效果,介绍如下。     

Intradiscal corticosteroid injections in spondylotic cervical radiculopathy

The purpose of this study was to evaluate treatment outcomes with intradiscal injection of corticosteroids (IDIC) in cervical spondylotic radiculopathy. Twenty consecutive patients were treated with intradiscal injection of 25 mg of acetate of prednisolone under fluoroscopic control. All patients had previously received a nonsurgical treatment for at least 3 months without success. Outcomes were assessed 1, 3 and 6 months after IDIC. Radicular pain reduction as scored on a visual analogue scale (VAS 100-mm length) was statistically significant at 1 month (19.0±28.0 mm; p=0.008), 3 months (25.2±27.5 mm; p=0.002), and 6 months (24.6±28.4 mm; p=0.001). In all, 40% of treated patients described at least 50% pain improvement 6 months after treatment. Four patients had complete relief of radicular pain. In conclusion, IDIC should be an alternative in the nonsurgical management of cervical spondylotic radiculopathy.