腰椎曲度及下腰椎椎间盘高度MSCT负荷前后的比较

目的：对比分析负荷前后MSCT测量的腰椎曲度及下腰椎椎间盘高度变化并与立位X线片对照,检验自制腰椎应力器加压效果。方法：采用自制腰椎应力器对30例腰腿痛患者负荷前后各作一次MSCT扫描,并摄立位X线腰椎侧位平片。在负荷前后Topogram像、负荷前正中矢状面重组图及X线平片上分别测量Th12～S1相邻椎体间夹角、L1与S1夹角、腰椎椎体长度及下腰椎椎间盘高度。在正中矢状面重组图上沿椎间隙夹角平分线重组横轴面图像,测量L3～S1三个椎间隙平面硬膜囊面积并观察椎管内结构变化。结果：负荷前Topogram像与正中矢状面重建像及负荷后Topogram像与X线侧位片上Th12～S1相邻椎体间夹角、L1与S1夹角及腰椎长度、L3～S1椎间盘高度测量结果近乎相等,组间对应测量值比较差异无显著性意义。负荷后L3与L4椎体角显著增大（t=5.36,P〈0.01）,L4与L5、L5与S1椎体角无显著增大（t=2.59,P〉0.05）,其中L4与L5椎体角变化最小。负荷后仅L4-5椎间盘高度显著缩小（t=4.21,P〈0.05）,L3～S1各平面硬膜囊面积均显著缩小,腰椎长度缩短（t=2.37,P〉0.05）,椎间盘膨隆或突出更明显,黄韧带增厚,椎管内结构毗邻关系更密切。结论：自制应力器加压检查能有效模拟人体腰部直立位生理状态情形,对腰椎退变性病变早期诊断及病情的准确评价具有重要意义。

The changes of Lumbar spine curvature and lower lumbar intervertebral disc height before and after axial compression loading on MSCT

Objective：In order to test the effect of the axial loading examination with self-developed lumbar stress device the changes of the lower lumbar intervertebral disc height and spinal curvature before and after load compression were analysed,and compared with those on the upright X-ray films.Methods：Using the self-developed stress device,30 patients with low back pain、sciatica or neurogenic claudication underwent 16 slice spiral CT before and after the compression respectively and the upright lateral lumbar spine X-ray film was taken for comparison.Each intervertebral angle （Th12 to S1）、the angle between L1 and S1、the length of lumbar spine and the lower lumbar disc heights were measured in the Topogram before and after compression,including median saggittal reconstruction MSCT images and X-ray films respectively.The measurement of L3-S1 interactive dural sac cross-section area and the observation of the change of the structures in the transverse plane of lower lumbar spine canal before and after compression were made.Results：The median saggital reconstruction image and Topogram before compression in the upright X-ray film compared with that on Topogram after compression,the bisecting angles between each intewentral body （Th12 to S1,L1 to S1）、the length of lumbar spine and the height of disc from L3-S1 were almost equal,with no significant difference.After compression the angle between L3-L4 significantly enlarged （t=5.36,P〈0.01）,the angles between L4-L5 and L5-S1 showed no significant enlarge ment （t=2.59,P〈0.05）,and simultaneously with nearly no change of the angle between L4-L5;and only the height of the L4-5 disc significantly decreased.The dural sac cross-section area of L3-S1 decreased significantly,the length of lumbar spine shortened,with more conspicane disce bulging or herniation and thickenning of the ligamentum flavum,and together accurre of the structures in the spine canal more compact to each ather.Conclusion：The self-developed compression device can effectively and vistually present the lumbar condition under upright physiological state,which is more helpful for the early diagnosis and accurate evaluation of the disease of degenerated lumbar spine.