新战士100名强化训练前后腰椎椎弓峡部断裂情况调查

背景：新战士在新兵训练期间出现腰椎椎弓峡部断裂发病率较高并影响了正常训练。 目的：分析部队新兵中腰椎椎弓峡部断裂的发病率与训练及其腰部原有病变的关系。 设计：随机抽样调查。单位：解放军第九十七医院骨科。 对象：某部2003年入伍的新兵100名。男性。平均年龄18．7岁。 方法：对100名新兵全程追踪随访。于训练前及100d强化训练后分别摄腰部X射线正、侧位和双斜位片进行对照观察。 主要观察指标：椎弓峡部断裂病例发病率。原有断裂者有无滑脱等加重现象。 结果：调查对象100名均进入结果分析。①新兵训练前、后椎弓峡部断裂发病率：训练开始前的入伍新兵。L5椎弓峡部断裂5例。发病率为5％。100d训练结束时，腰椎椎弓峡部断裂8例。发病率增加至8％。②新兵训练前、后X射线检查结果：100名新战士X射线片训练开始前。左侧L5椎弓峡部变细2例。右侧L3椎弓峡部变细1例；双侧L5椎弓峡部断裂5例，其中1例呈Ⅰ度滑脱。100d训练结束时，原双侧L5椎弓峡部断裂5例中Ⅰ度以内滑脱3例，另3例原腰椎椎弓变细者均发生断裂。 结论：腰椎椎弓峡部断裂发病率与训练强度有关。建议加强入伍新兵脊柱体检。常规加拍腰椎正、侧位和双斜位X射线片检查项目。     

以腰椎峡部裂快速定位椎弓根螺钉的进钉位置

背景:目前腰椎峡部裂引起滑脱的患者术中由于峡部裂,腰椎移位明显,局部解剖结构发生改变,给椎弓根定位造成困难,因此有必要找到新的定位方法来解决。目的:通过腰椎峡部裂快速定位椎弓根螺钉位置,减少术中软组织显露,减少手术时间和出血量。方法:通过解剖影像学正侧位测量,分析峡部裂部位与椎弓根中心的位置关系,以椎弓根中心向峡部裂作一垂线,测量L4及L5根弓根中心与峡部裂的距离。选择40例峡部裂伴腰椎滑脱患者,根据峡部裂来定位椎弓根螺钉,记录手术时间、手术出血量及置钉准确率,并与既往传统的AO置钉法对比分析。结果与结论:L4及L5椎弓根中心与峡部裂的平均距离为(8.2±3.6)mm。利用腰椎峡部裂快速定位椎弓根螺钉位置,可减少术中软组织显露,减少手术时间和出血量,置钉过程中及置钉后未发现神经根损伤表现。     

多层螺旋CT对腰椎滑脱并椎弓崩裂的诊断价值

目的:探讨多层螺旋CT对腰椎滑脱并椎弓崩裂的诊断价值。方法:选取我院2016年3月-2017年2月89例腰椎滑脱并椎弓根崩裂患者,通过多层螺旋CT予以诊断,观察其滑脱及崩裂情况与影像特点。结果:在89例患者中,L3滑脱14例,L4滑脱65例,L5滑脱10例,共有前滑脱71例,后滑脱18例;双侧峡部裂75例,单侧峡部裂14例;Ⅰ度滑脱80例,Ⅱ度滑脱9例。多层螺旋CT检测影像资料较为清晰。结论:多层螺旋CT可清晰观察到腰椎滑脱并椎弓崩裂情况,具有较高的临床诊断价值。     

多层螺旋CT对腰椎滑脱并椎弓崩裂的诊断价值

目的:探讨多层螺旋CT对腰椎滑脱并椎弓崩裂的诊断价值。方法:本研究选择我院外科2015年1月至2017年1月之间收治184例腰椎滑脱并椎弓崩裂患者的临床资料进行统计分析,全部患者均接受多层螺旋CT检查,回顾分析患者的临床检查情况。结果:I度滑脱164例,II度滑脱20例。L3滑脱30例,L4滑脱132例,L5滑脱22例。前滑脱148例,后滑脱36例。单侧峡部裂30例,双侧峡部裂154例。结论:腰椎滑脱并椎弓崩裂患者接受多层螺旋CT检查和诊断,具有较高的准确性,能够为患者的临床治疗提供依据。     

36例椎弓断裂的临床与X线表现

36例椎弓断裂患者中31例为双侧峡部断裂,5例为单侧峡部断裂。X线表现为裂隙征、关节突之间距离缩短、椎弓根部结构紊乱、椎弓根密度增高、腰率减小。腰椎斜位片更有助于椎弓断裂的诊断。     

腰椎峡部裂的螺旋CT表现

腰椎峡部裂（spondylosehisis，SS）是指腰椎椎弓峡部关节间部骨质缺损，亦称椎弓崩裂或椎弓峡部不连；峡部裂可发生于一侧或两侧，大约95％的病人发生在腰5椎峡部；腰椎峡部裂是引起腰腿痛的原因之一，国内报道发病率5％～7％日。X线平片虽为一种必要的检查手段，但容易出现假阴性情况出现漏诊；单纯的椎间盘CT扫描亦不能发现未出现椎体滑脱的腰椎峡部裂；螺旋CT扫描基本可避免出现遗漏，在诊断腰椎峡部裂方面有独特的优势。     

椎弓崩裂与脊椎滑脱CT诊断

椎弓崩裂系指椎弓关节间部缺损或称椎弓峡部骨性缺损。脊椎滑脱系指因椎弓的关节间部缺损、分离而引起椎体向前滑脱。普通Ｘ线检查只能确定腰椎峡部裂的骨性改变 ,ＣＴ检查不仅能确定其骨性改变 ,而且能发现并发的软组织异常 ,使诊断更加明确 ,现就 36例椎弓崩裂与脊椎滑脱的ＣＴ表现分析如下。1　材料与方法1 1　一般资料　 36例中男性 2 3例 ,女性 13例 ,年龄2 2～ 62岁 ,平均年龄 38岁。病程 5个月～ 2 3年。主诉腰痛 2 1例 ,腰痛并下肢放射痛 16例 ,腰部外伤史者17例。腰5峡部裂 2 6例 ,腰4 峡部裂 10例。单侧峡部裂 8例 ,双侧峡部裂 2 …     

16层螺旋CT三维重建对腰椎峡部裂的诊断价值

腰椎峡部裂是临床上常见的一种脊椎病变，约5％的成人可患此病，它又称为腰椎椎弓崩裂，为椎弓上下关节突之间的狭细部分的断裂．由椎弓峡部裂及其所致的脊椎滑脱是引起腰腿痛的常见原因之一。传统的X线平片和CT轴位平扫是诊断该病的常用检查手段，这方面的报道较多。但由于腰椎峡部与三维空间上的任何一个平面均不平行，常会出现漏诊的情况。随着近年来多层螺旋CT在临床的广泛应用，明显提高了该病的诊断率，拓展了人们对该病的认识。本文通过对38例峡部裂患者进行16层螺旋CT扫描及三维重建．旨在提高对峡部裂CT重建图像征象的认识．     

青少年腰椎峡部断裂的手术治疗

腰椎峡部裂是指腰椎上下关节突之间的峡部断裂,又称为椎弓根崩裂或峡部不连。青少年峡部断裂多数存在发育性因素。可能由于他们的椎弓骨化不完全,疲软时限低。椎间盘弹性好,更多的剪切力作用于关节突,再有大部分年轻人可能比成年人更加经常从事剧烈的活动导致疲软时限较快到达。2004-2008年本科对11例青少年腰椎椎弓峡部断裂合并Ⅰ-Ⅱ度滑脱患者采用椎弓根内固定及枢法模人工骨椎板及峡部断裂处植骨方法治疗,效果满意。     

128层螺旋CT及其多模式的后处理技术在腰椎弓峡部裂诊断中的价值

腰椎峡部裂（SS）又称为腰椎椎弓崩裂,为椎弓上下关节突之间的狭细部分的断裂,是椎体滑脱症的主要病因之一。此部位解剖结构特殊,以往对腰椎弓峡部裂的诊断主要依靠腰椎双斜位X线片,但双斜位片受技师的投照技术及医师阅片熟练程度的影响较大,对其诊断存在较高的假阴性率及漏诊率,在同一层面上同时显示椎弓峡部裂隙和小关节间隙是CT提高病变检出率和鉴别诊断的关键。     

Radiological diagnostic of lumbar spondylolysis

Summary. Spondylolysis involves disruption of the bone structure at the vertebral arch at the isthmus. Various methods are utilized in diagnosing spondylolysis, such as plain radiography, computed tomography (CT), magnetic resonance (MR), and scintigraphy. Plain radiography with anteroposterior (A-P) and lateral views is a useful method in the initial diagnostics of low back pain. Although lateral views have great value in the assessment of the progression of slippage, dynamic views are useful for the determination of vertebral stability, while oblique views seem be less precise. There is evidence that CT has the greatest value in the diagnosis of spondylolysis and lumbar spine evaluation generally. The use of multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction have increased the reliability and value of CT examination, when only axial sections are analyzed. CT examination with MPR and 3D reconstruction enables reliable, diagnosis of spondylolysis and attendant complications, such as nucleus pulposus herniation, spondylolisthesis, and narrowing of intervertebral foramina and the vertebral canal. MR imaging is useful is assessing soft tissues, and should be utilized primarily in neurological complications. Scintigraphy does not seems to have any practical importance in evaluating spondylolysis.     

后路360°植骨融合椎弓根钉棒系统内固定置入治疗腰椎椎体滑脱症48例

回顾性分析2006-02/2007-10应用后路椎弓根钉棒系统复位内固定、椎间Cage植骨及后外侧植骨360°融合治疗腰椎椎体滑脱症患者48例,其中单节段融合30例,二节段融合10例,三节段融合8例。置入前、置入后3d及最终随访时常规摄腰椎正、侧、双斜位片及过伸过屈侧位X射线平片;并分别测量滑移率、滑移复位率和植骨融合率;根据下腰痛JOA评分标准计算其恢复率。全部患者均获随访,结果显示恢复率为71.2%,滑移复位率为91%,植骨融合率为100%。X射线平片示滑移椎均全部复位,所有患者均未出现切口感染及局部炎症反应、排异反应等宿主反应,腰椎融合后,腰部伸屈功能部分受限。提示后路椎间360°植骨融合、椎弓根钉棒系统内固定可有效提高滑脱椎体复位及融合,改善患者临床症状。     

Familial development of lumbar spondylolysis: a familial case report of 7- and 4-year-old brothers and their father

The incidence of lumbar spondylolysis is affected by sex, race, and congenital abnormalities. These differences suggest a genetic component to the etiology of spondylolysis. However, no definitive evidence has been presented regarding the inheritance of lumbar spondylolysis. We report familial cases of lumbar spondylolysis in 7- and 4-year-old brothers and their father, each of whom visited our clinic complaining of low back pain. Spondylolysis in the fifth lumbar vertebra (L5) was identified in both boys and their father from clinical, radiographic, computed tomographic, and magnetic resonance imaging examinations. Conservative treatment was provided for both boys. No bony union of any spondylolytic lesions was obtained, but they returned to sports activity without low back pain. Frequent development of spondylolysis, even at younger ages, in all male family members might indicate an underlying genetic etiology in lumbar spondylolysis, primarily in the form of autosomal dominant inheritance. However, information on patients and their parents should be considered carefully, as bony union with conservative therapy is not expected in such patients.     

多层螺旋CT多平面容积重建诊断腰椎峡部裂的价值

目的探讨多层螺旋CT诊断腰椎峡部裂的检查合理方案及其价值。方法对连续540例无明确外伤史的腰腿痛患者行多层螺旋CT腰椎容积扫描,范围从胸12至骶1。所有病例均利用容积数据重建腰椎间盘横断位、全腰椎横断位、矢状位及冠状位图像。观察有无明确的椎弓峡部裂。结果540例中,5.37%(29/540)能明确显示共54处峡部裂。20例伴相应椎体滑脱。矢状位清晰、直观显示了所有裂隙的特征及伴随改变。全腰椎横断位亦显示了所有裂隙,但效果较矢状位差。冠状位、椎间盘横断位分别显示51.85%、7.41%的裂隙。结论多层螺旋CT全腰椎矢状位容积重建是显示腰椎峡部裂的最好方法,应将其列为腰腿痛患者腰椎多层螺旋CT检查的常规重建项目。     

64层CT不同角度MPR图像诊断腰椎弓峡部裂的对照研究

目的研究64层CT不同角度MPR图像诊断腰椎弓峡部裂的价值。方法利用64层CT扫描的50例腰椎弓峡部裂病例的各向同性扫描的容积数据,采用不同角度的多平面重组(MPR)方式进行图像后处理并对照分析:利用MPR模拟出四种扫描模式:①常规的椎间盘扫描方式的断面图像;②腰椎横断面图像;③沿椎弓峡部方向的斜横断位(椎弓反角度扫描)图像;④沿腰椎长轴的矢状断面图像。分析四种方法的峡部裂隙检出率、峡部裂断端错位检出率、碎骨片检出率、假关节形成检出率。结果峡部裂隙检出率以矢状位MPR图像、斜横断位MPR(100%)最高(u=8.51,P<0.05);峡部裂断端错位检出率以矢状位MPR图像(90%)最高(u=4.18,P<0.05);碎骨片检出率以斜横断MPR(28%)和矢状位MPR图像(20%)最高(u=2.08,P<0.05);假关节形成检出率以斜横断MPR(18%)最高(u=2.237,P<0.05)。结论64层CT MPR可以从不同角度不同平面分析椎弓峡部裂的各种征象,对于提高CT对该病的诊断水平具有重要价值。     

滑脱腰椎椎体间接触面积变化规律在临床应用中的价值

背景:腰椎滑脱直接导致滑脱椎体与下位椎体间接触面积的减少,滑脱椎体间接触面积是决定椎间应力和腰椎退变的重要因素.腰椎椎体截面是不规则的肾形,没有成熟的数学公式可以直接计算出椎体间接触面积的变化规律.目的:观察腰椎滑脱时椎体间接触面积的变化规律,并分析其临床意义.方法:采集25套L4椎体下表面和L5椎体上表面的图像,在二维平面上均分为14步模拟腰椎滑脱过程,Image-ProPlus软件计算每一滑脱点(n)椎体间重叠面积Sn,取平均值后再换算成百分面积,Sn%=Sn/S×100%,观察0～100%滑移时椎体间接触面积的变化规律.根据此规律提出新的腰椎滑脱临床分期,并应用其指导治疗56例腰椎滑脱患者.结果与结论:腰椎滑脱过程中,Sn%的变化是一个双曲线:滑脱率0～23%阶段,Sn%降低较缓慢;23%～44%阶段,Sn%的变化明显加快;44%～100%阶段,Sn%的变化再次变缓,拐点分别出现在一维滑脱率的(23±2)%和(44±2)%处.48例腰椎滑脱患者获得随访,临床疗效按Staufee标准优良率达90%左右.提示腰椎滑脱时椎体间接触面积的变化是非线性的,有助于腰椎稳定性评估并指导腰椎滑脱的临床治疗.

Abstract：

BACKGROUND: Lumbar spondylolisthesis directly reduces contact areas between dislocated vertebral body and subjacent vertebral body, which is an important factor that decides intervertebral stress and lumbar degeneration. The cross section of lumbar is irregular reniform shaped and there is no mathematical formula to calculate changing regularity of intervertebral contact areas of lumbar spondylolisthesis directly.OBJECTIVE: To study changing regularity of intervertebral contact areas during lumbar spondylolisthesis and to analyze its clinical significance. METHODS: Super-surface of L5 vertebra and sub-surface of L4 from 25 cases were taken by a digital camera and computer simulation spondylolisthesis process and every intervertebral contact areas (Sn) were measured by Image-Pro Plus software. The mean value was obtained and converted into percentage area according to Sn%=Sn/S×100%. The change rules of vertebral bodies were observed from 0 to 100% spondylolisthesis. Based on this regularity, a new clinical stage of lumbar spondylolisthesis was proposed and guided for treatment of 56 cases with lumbar spondylolisthesis. RESULTS AND CONCLUSION: During lumbar spondylolisthesis process, Sn% changes like a hyperbola. Sn% lost slowly during spondylolisthesis rate at 0-23% and quickly during 23%-44%, and then it become slowly once again after spondylolisthesis rate at 44%-100%, the inflection points appeared at (23±2)% and (44±2)%. Totally 48 patients were followed up, according to Staufee standard rate, the clinical curative effect reached approximately 90%. It suggests that the intervertebral contact areas present with a non-linear change, which is helpful to judge the stability of lumbar spine and guide the treatment of lumbar spondylolisthesis.     

腰椎棘突截骨再植椎板弓形切除术的临床应用(附36例报告)

作者采用腰椎棘突截骨再植、椎板弓形切除术治疗腰椎间盘突出症及腰椎管狭窄症36例，术中解决了暴露椎管与维持脊椎稳定性的矛盾，术后32例随访1年以上，优良率达100％。     

腰椎滑脱不同融合术式的三维有限元研究

目的通过建立腰椎后路椎间(PLIF)和后外侧(PLF)两种融合术的三维有限元模型,比较并判断融合后融合节段的稳定性以椎弓根螺钉和融合器上的应力及椎体位移有无显著性差异。方法利用健康志愿者L1～L5CT扫描的DICOM数据,通过计算机软件重建腰椎模型,进行有限单元网格划分,在腰4/腰5间置入椎弓根钉内固定系统,然后分别在椎间置入融合器生成腰椎后路椎间融合术式三维有限元模型,在横突间植入自体骨生成腰椎后外侧融合术式三维有限元模型。通过对模型进行轴向加压、前屈,后伸、侧弯及轴向扭转五种加载方法进行实验。结果建立L4/L5腰椎滑脱模型及后路腰椎椎间融合及腰椎后外侧融合的有限元模型,①观察对模型分别施加轴向压缩、侧弯、前屈、后伸、旋转载荷,PLF应力多集中在椎弓根钉与钛棒连接处、PLIF内固定系统应力为Cage所分散,未见明显应力集中;②对比在五种载荷下两种不同内固定位移PLIF组均小于PLF,P0.05。结论①建立了L4/L5滑脱不同后路融合术式的三维有限元模型。②在前屈、后伸、压缩、侧弯及扭转载荷下,相比PLF,PLIF位移更小,证实椎体间融合的稳定性优于和椎弓根螺钉内固定加后外侧植骨融合;③PLF应力多集中在椎弓根钉与钛棒连接处、PLIF内固定系统应力为Cage所分散,未见明显应力集中。     

国产通用型脊柱内固定系统置入治疗腰椎滑脱55例随访

回顾性分析2002-01/2007-12海南省人民医院骨病外科收治的腰椎滑脱患者64例,男19例,女45例.年龄26～73岁病程1～15年.所有患者均有反复腰痛伴下肢放射痛、间歇性跛行(50～300 m).腰椎椎弓峡部裂并滑脱59例,其中L3 Ⅰ度滑脱3例;L4 Ⅰ度滑脱31例,Ⅱ度滑脱13例;L5Ⅰ度滑脱9例,Ⅱ度滑脱3例.腰椎退行性变L4假件滑脱5例.全部患者均采用保留棘突的全椎板切除减压或椎管开窗减压、国产通用型脊柱内固定系统置入固定、复位、椎问植骨融合.本组55例获得随访,失访9例.随访时间平均3.1年,按Steffee临床疗效分级标准进行疗效评估,优28例,良19例,优良率85.5%.置入后1蒯内摄X射线平片复奁,28例获完全复位,36例部分复位,椎体间植骨融合率为100%.表明国产通用型脊柱内固定系统结构简单,操作方便,同定坚固,能使滑脱的椎体复位,明显提高脊柱植骨融合率.     

3D CT imaging of the lumbo-sacral spine after surgical treatment of L5-S1 spondylolisthesis by postero-lateral spondylodesis

Background. The aim of the study is the evaluation of the spatial imaging computed tomography (3D CT) of lumbo-sacral spine after surgically treated spondylolistesis L5-S1 with the postero-lateral spondylodesis using autogenic bone grafts.
Material and methods. Material comprises 9 patients treated surgically due to I degrees spondylolistesis caused by the L5 vertebra spondylolysis. In all cases postero-lateral spondylodesis was performed using autogenic bone grafts, taken from the iliac crest, placed on the transverse processes of the L5 vertebra and the sacral bone. The CT examination was performed in the period between 6 months up to 2 years after operation due to overloading lumbar pain.
Results. The bone grafts was localized correctly in 8 patients. In 1 person the upper side of the one bone graft was localized incorrectly, on the prominent transverse processus of the S1 vertebra, instead of the L5 one. The spatial reconstruction reveal the presence of osteophytes surrounding the ends of the bone grafts or the localization the fissure of the arch. In 2 cases the bone grafts were bigger on the left side, and the wide lower ends were connected with the dorsal surface of the sacral bone and were connected with the shorten due to surgery iliac crest
Conclusions. The CT examination with the use of the spatial option is very valuable in the lumbo-sacral spine imaging in patients treated with the postero-lateral spondylodesis due to spondylolisthesis L5-S1. The spatial images 3D CT are especially useful in imaging of the localization of the bone grafts, assessment of the wide of spinal canal and intervertebral foramens. The use of spatial imaging 3D is valuable supplement of standard CT examination in diagnosis of the patients complaining of the lumbar pain, treated surgically due to spondylolistesis.