飞行人员年度体检和改装体检颈腰椎病症比较

目的比较飞行人员年度体检和改装体检颈腰椎病症特点，为规范飞行人员颈腰椎病症的诊治和医学鉴定提供依据。方法12809名飞行人员年度体检时，对有颈腰椎病史者行查体和颈腰椎X线检查；978名飞行员改装体检时，全部行颈腰椎x线和L4、L5螺旋cT检查；统计两组颈椎病症、腰椎弓峡部裂和其他腰椎病症的检出率。结果1）飞行人员年度体检颈腰椎病总检出率为3．7％（477／12809），低于改装体检影像学普查颈腰椎病症28．3％（277／978）的总检出率（χ2=1063．53，P〈0．01）。2）飞行人员年度体检腰椎弓峡部裂检出率为0．2％（29／12809），低于改装体检腰椎弓峡部裂6．9％（67／978）的检出率（χ2=576．63，P〈0．01）；飞行人员年度体检颈椎病和其他腰椎病检出率分别为2．3％（297／12809）和1．2％（151／12089），均低于改装体检颈椎病症5．2％（51／978）和其他腰椎病症16．3％（159／978）的影像学检出率（χ2=30．97vsχ2=939．95，P〈0．01）。3）飞行人员年度体检因颈腰椎病造成暂时飞行不合格比率为0．3％（34／12809），低于2．4％（23／978）的改装体检不合格比率（χ2=91．06，P〈0．01），但与0．2％（2／978）的改装体检暂时飞行不合格比率差异无统计学意义（χ2=0．001，P〉0．05）。结论飞行人员颈腰椎影像学检查的异常征象率高，但有许多并不构成疾病诊断。年度体检时依据病史、查体和选择性x线检查可满足需求；但改装体检时，应全部行颈腰椎x线及L4、L5螺旋CT检查，才能满足诊断和医学鉴定需求。

Cervical and lumbar disorders found in pilots and in those flying a modified aircraft during annual physical examination

Objective To provide the evidence for the diagnosis, treatment and medical identification of cervical and lumbar disorders in pilots and in those flying a modified aircraft by comparing their characteristics during annual physical examination. Methods A total of 12 809 pilots with a history of cervical and lumbar disorders underwent X-ray examination during their annual physical examination and 978 pilots flying a modified aircraft underwent X-ray examination and spiral CT scanning of L4 and L5 during annual physical examination. The detection rates of cervical and lumbar disorder, lumbar vertebral arch fissure, and other lumbar disorders were compared. Results The detection rate of cervical and lumbar disease, lumbar vertebral arch fissure and other lumbar disorders was significantly lower in pilots during annual physical examination than in those flying a modified aircraft during physical examination （3.7% vs 28.3%, χ2=1 063.53; 0.2% vs 6.9%, χ2=576-63; 2.3% and 1.2% vs 5.2% and 16.3%, χ2=30.97 and 939.95; P〈0.01）. The temporarily grounded rate was significantly lower in pilots due to cervical and lumbar disorder found in annual physical examination than in those flying a modified aircraft due to cervical and lumbar disorder found in physical examination （0.3% vs 2.4%,χ2=91.06, P〈0.01）. However, no significant difference was found in temporarily grounded rate of pilots and those flying a modified aircraft due to cervical and lumbar disorder detected in annual physical examination （χ2=0.001, P〉0.05）. Conclusion Radiography shows a high abnormal rate of cervical and lumbar vertebrae, but the diagnosis of cervical and lumbar disease cannot be established according to it. The diagnosis of cervical and lumbar disease can be established according to its history, annual physical examination and selective X-ray examination. However, its diagnosis can be made in those flying a modified aircraft according to the X-ray examination and spiral CT scanning of L4 and L5 findings.