腰椎假性滑脱的影像特征（附126例分析）

目的：探讨腰椎假性滑脱的影像及病理、生理特点。材料与方法：选择１２６例腰椎３假性滑脱病人进行Ｘ线平片及其中５０例进行ＣＴ检查。结果：腰椎假性滑脱都不超过Ｍｅｐｅｒｄｉｎ氏４度法的１度。结论：腰椎假性滑脱是退行性关节炎及退行性椎管狭窄的特殊类型。     

退行性腰椎滑脱30例临床X线分析

退行性腰椎滑脱３０例临床Ｘ线分析曾胜明１先玉芳２童开英１为了探讨退行性腰椎滑脱的临床Ｘ线特点。我们从１９８３年５月～１９９５年１２月收集退行性腰椎滑脱３０例，现将临床Ｘ线表现作一分析，报告如下。资料与方法１１临床资料本组３０例，男１４例，女１６...     

腰椎滑脱复位术后X线测量分析

目的 为探讨腰椎滑脱复位过程中椎体间适合撑开高度。方法 对15例腰椎峡裂，滑脱采用腰椎滑脱复位器行减压、撑开复位、内固定及植骨治疗患行1a以上的随访，予术后即时、3、6、12mo分别摄腰椎侧位片，测量椎体间高度且与术前对比，观察椎体间隙撑开高度的变化。结果 将15例据摄片所示分成断钉未断钉两组，发现两组术后即时椎体间撑开高度经t检验有统计学意义(p＜0．05)。内固定的断裂，复位的丢失主要发生在手术3mo后。结论 术后椎间隙的撑开高度在术后即时增加以不超过3．3mm为宜。     

手法加热敏灸治疗腰椎假性滑脱临床症状及影像学改变研究

目的:观察手法加热敏灸对腰椎假性滑脱治疗前后的临床症状及影像学的改变。方法:选取50例假性滑脱患者为研究对象,对其施予相应的手法及热敏灸治疗,7d为1个疗程,治疗2个疗程。结果:经2个疗程治疗后,痊愈28例,占56%;显效15例,占30%;好转7例,占14%;无效0例,占0%。结论:运用手法配合热敏灸治疗腰椎假性滑脱,疗效满意,值得深入研究并推广应用。     

骨盆兜布悬吊牵引治疗老年腰椎假性滑脱的临床疗效观察

目的：观察骨盆兜布悬吊牵引治疗老年腰椎滑脱的临床疗效。方法64例老年腰椎假性滑脱患者,按随机数字表法分为治疗组和对照组各32例,治疗组以骨盆兜布牵引配合针灸推拿治疗,对照组以针灸推拿治疗。观察两组的临床疗效、滑脱椎体治疗前后位移改变情况及治疗期间动态疼痛视觉模拟量表（ visual analog Scale ,VAS）评分。结果治疗后两组临床疗效、椎体移位情况比较,差异无统计学意义（P＞0.05）;治疗组疼痛缓解情况优于对照组,差异有统计学意义（P＜0.05）。结论骨盆兜布悬吊牵引治疗老年腰椎假性滑脱早期缓解患者腰腿痛,改善腰部活动功能,临床疗效肯定。     

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。     

CT对于腰椎滑脱病因分析的价值

腰椎滑脱是指上一腰椎在下一椎体上向前或向后滑动或脱位,亦有称之为腰椎前移症。临床上病人早期常缺乏症状,一般20或30岁开始有症状,表现下腰部间断性纯痛,步行或站立时加重,疼痛可发展到臀部及大腿,以后可伴有一侧坐骨神经痛,并有椎间盘突出所引起的感觉运动障碍。X线片对于滑脱的诊断、分型及严重程度的分     

腰椎假性滑脱的影像分析（附60例报告）

目的探讨腰椎假性滑脱的病因及诊断价值。方法分析60例腰椎假性滑脱患者的滑脱部位及腰椎退变的X线及CT表现。结果本组60例中均有不同程度腰椎退变征象，单椎体滑脱59例，多椎体滑脱1例，单椎体滑脱中以L4向前滑脱者居多。结论腰椎退变是导致腰椎假性滑脱的重要病因。     

腰椎退变性滑脱31例X线平片分析

目的回顾分析31例腰椎退变性滑脱X线平片，以提高对退变性滑脱的认识。方法31例腰椎退变性滑脱全部病例常规摄片，并进行测量与统计分析。结果单个椎体滑脱28例（90．32％），阶梯状滑脱2例（6．45％），错位状滑脱1例（3．23％），发生退变性滑脱的腰椎共34个。椎体向前移位22个，向后移位7个，向左移位3个，向右移位3个（其中有1个椎体属向前向右移位）。下腰椎向前移位多，上腰椎向后及向左右移位多，移位程度3．5～20mm（平均7．8mm），L3向前移位多见。结论X线平片对腰椎滑脱移位的程度，临床治疗及预后评估均有积极意义。     

CT对腰椎滑脱诊断的价值（附24例报告）

腰椎滑脱是腰腿痛的常见病因之一，分为真性滑脱和假性滑舰两种，真性滑脱系腰椎峡部不连引起，假性滑脱因小关节退变引起。通常以真性滑脱多见。腰椎滑脱平片检查即可诊断（图1），而CT检查能显示椎间盘及其对硬膜囊、神经根的影响（图2），对指导临床治疗有着重要意义。本文就24例腰椎滑脱病例的CT资料作回顾性分析。     

腰椎屈、伸位投照方法的研究(介绍一种投照支架及效果观察)

介绍笔者设计的腰椎屈、伸位投照支架，可达到Ｐｕｔｔｕｏ提出的规范投照效果，较简便易行。选择３６例腰椎间盘突出患者和１４例正常人同时摄传统法与支架法腰椎屈、伸位Ｘ线片。以Ｌ１－Ｓ１和Ｌ３－Ｓ１之间的曲度值及Ｌ３－Ｓ１之间的椎间角作为评价指标。结果表明以上指标支架法明显优于传统法，Ｘ２＞３６，Ｐ＜０．００５；腰椎平移≥４ｍｍ者支架法２４枚传统法１０枚，Ｘ２＝７．７６，Ｐ＜０．０１，支架法投照可为临床提供更多腰椎屈伸运动的Ｘ线信息。     

腰椎生物代偿性变化生物力学机理的实验研究

目的通过对青老年组腰椎三维运动范围的比较研究,探讨腰椎生物代偿性变化的生物力学机理及其与老年人腰椎稳定性的关系。方法选取１５具新鲜成人男性尸体分为两组：青年组（２０～３０岁）７例,老年组（６０～７０岁）８例。切取腰椎（Ｌ１－Ｓ１）,用加载系统和计算机三维空间力学系统测量Ｌ１－Ｓ１各节段的三维运动范围。结果老年组腰椎三维运动范围较青年组有减少趋势,在前屈时ＮＺ有显著性差异。结论老年人腰椎未因腰椎退变而失稳,稳定性反而加强,原因是腰椎退变刺激腰椎产生生物代偿性变化而重塑稳定。     

Mechanics of spinal joint manipulation in the thoracic and lumbar spine: a theoretical study of posteroanterior force techniques

Posteroanterior (PA) forces applied to the vertebrae are commonly used for the clinical assessment and treatment of vertebral column disorders. Three strategies for applying PA force in the thoracic and lumbar spine regions were studied. The components of the manipulative force which were directed along, and transverse to, the axis of the vertebra were calculated, and also the sagittal plane moment generated about the centre of the vertebra was determined. The three different strategies produced quite different loads on the vertebrae and all three strategies showed substantial variations across vertebral levels in at least one of the load components.     

The effect of nucleotomy on facet joint loading — a porcine in vitro study

Background

Lumbar facet joints have been cited as a possible origin of low-back pain. A relationship between disc height decrease and facet joint degeneration has been reported. Facet joint degeneration may also be triggered by nucleotomy, performed on prolapsed discs, which might change the natural load sharing between the anterior and posterior structures of the spine. In this study load bearing of the facet joints was compared between natural and nucleotomised spinal segments.

Methods

Nine porcine lumbar motion segments were tested quasi-statically in ± 1.5° extension–flexion under 700 N constant compression loading. The kinematics of the spinal segments were recorded as a response to the applied load. These kinematics were subsequently applied to the segments with the ligaments and disc sequentially removed and the reaction forces measured. This was performed in samples with and without nucleotomy. Comparison of the reaction forces allowed a direct comparison between healthy and pathological force transmission over the facet joints. Load sharing was related to the proportion of removed nucleus.

Findings

The proportion of applied compression force supported by the facets increased from a mean of 40.7% (standard deviation, SD 10.0%) to 82.0% (SD 7.2%) after nucleotomy averaged over the entire extension–flexion regime. No correlation was observed between facet loading and the proportion of the nucleus removed.

Interpretation

Increased facet loading after nucleotomy might cause greater cartilage wear, which may be related to facet joint degeneration. The independence of facet loading on the proportion of nucleus removed might be due to a complete pressure loss once the annulus is incised.     

胸椎直接数字X线摄影与传统X线摄影对比分析

目的评价直接数字X线摄影(DR)在胸椎的应用,以及与传统胸椎摄影的对比。方法抽取我院DR胸椎摄影影像和传统胸椎摄影照片各89例,由3位副主任医师及2名主管技师对影像进行分析,用2种方法统计:①按照片质量分甲、乙、丙、废片;②以胸椎侧位分为上、中、下3段显示比例评定。根据2种方法综合评价。结果按照片质量评定:DR影像甲片率74.1%、乙级片率20.2%、丙级片率5.7%、废片率0%;传统照片甲片率45%、乙级片率41.6%、丙级片率11.2%、废片率2.2%;按部位显示评定:DR影像上段胸椎显示率87.6%、中段显示率100%、下段显示率76.4%;传统照片上段胸椎显示率15.3%、中段胸椎显示率75.3%、下段胸椎显示率51.7%。经统计学处理,差异有非常显著性意义(χ2=15.823P<0.001)结论DR胸椎摄影的诊断图像质量明显好于传统胸椎摄影,尤其是上段胸椎显示率明显提高。DR系统成像快捷,操作简单,有利于提高放射科工作效率,有利于放射影像诊断。     

腰椎间盘退行性病变X线平片与CT对比分析

目的：进一步探讨平片诊断腰椎问盘退行性病变的价值。材料与方法：回顾分析109例腰椎正侧位片及CT扫描图像，总结椎问盘退行性病变的影像学表现。结果：腰椎顺列特征性改变，椎间隙变窄、前窄后宽和前后等宽，椎体上下缘骨质增生硬化，椎体后下角增生后翘，双凹征或单凹征等是椎问盘退行性病变的重要表现。结论：综合分析临床病止特点，好发年龄、部位以及平片特征，能够提高X线平片的诊断正确率。     

胸腰椎手术后脑脊液漏的防治

目的 探讨胸、腰椎手术合并硬脊膜破裂的处理及并发脑脊液漏的治疗措施.方法 回顾性分析64例硬脊膜破裂的处理及其9例脑脊液漏的治疗情况.结果 行硬脊膜修补52例,并发脑脊液漏5例;未行硬脊膜修补12例,并发脑脊液漏1例;术中未见硬脊膜损伤而术后发生脑脊液漏3例;9例脑脊液漏患者无一例行切口探查硬脊膜修补术,均经合理卧位、漏口缝合、取头低脚高位、局部加压等治疗痊愈.结论 硬脊膜破裂应积极修补;合理的卧位、头低脚高位对脑脊液漏的防治有十分重要的意义.     

Reduction of lumbar hyperlordosis in a pediatric: a Chiropractic Biophysics® case report

[Purpose] To demonstrate the reduction of lumbar hyperlordosis, sacral base angle and anterior thoracic translation posture in an 11-year-old female. [Participant and Methods] A pediatric patient presented with lumbar hyperlordosis and underwent Chiropractic BioPhysics^® treatment protocols to reduce her spinal deformity and correlated symptoms. Symptoms included thoracolumbar, hip, knee and ankle pains and lower extremity weakness. Radiographs confirmed lumbar hyperlordosis, increased sacral base angle and a forward translated thoracic posture. Spinal traction as well as corrective exercises and spinal manipulative therapy was performed over an 11-month period. [Results] After 57 treatments, there was a 13.4° reduction in L1-L5 lordosis, an 11.8° reduction in sacral base angle and a 13.8 mm reduction in anterior thoracic translation. The improved structural changes correlated with improved symptoms. [Conclusion] Lumbar hyperlordosis can be reduced in pediatric patients presenting with hyperlordosis and associated symptomatology. Routine radiography may be warranted in the diagnosis of lumbar spine deformities in pediatrics. Further research into the non-surgical reduction of lumbar spine hyperlordosis is needed.     

Impact response of the standing subject — a feasibility study

The feasibility of a pendulum impact method to establish the dynamic response of the standing subject was explored. Threaded k-wires were placed in the L₃ lumbar spinous process and in the posterior superior iliac spine. The gain and phase angle between the platform and the vertebra were established. The lower extremities were found to be very important in the attenuation of the impulse, while different shoes had little ability to attenuate the resonance peak.     

The effects of a global postural reeducation program on an adolescent handball player with isthmic spondylolisthesis

This report describes and evaluates a physical therapy intervention in a 15-year-old male handball player with low grade isthmic spondylolisthesis and associated spinopelvic misalignment (shear–stress type). Upon examination, increased lumbar lordosis, horizontal sacrum and anterior pelvic tilting were mainly associated with altered resting length and extensibility of the iliopsoas, hip adductors and erector spinae muscles. The intervention was directed at improving the muscles resting length and extensibility balance within a global postural alignment perspective (global postural reeducation). After the treatment period, lumbar lordosis, sacral slope and anterior pelvic tilting decreased 17.2°, 16.5° and 15.1° respectively. Global postural reeducation was effective in changing spinopelvic alignment related to low grade isthmic spondylolisthesis. This treatment option should be considered as a potential nonsurgical alternative for this condition.