歼击机飞行员腰骶角增大与腰椎峡部裂关系探讨

目的探讨腰骶角增大与腰椎峡部裂的关系。方法研究组为18例患腰椎峡部裂的歼击机飞行员,取站立侧位X线片采用Ferguson方法测量腰骶角度;对照组为182例无峡部裂的歼击机飞行员,取站立侧位,X线片采用同样方法测量腰骶角。比较两组腰骶角的差异及研究组腰骶角与腰椎峡部裂的关系。结果研究组腰骶角平均为43.57±6.89°。对照组100例无滑脱腰骶角平均为37.51±6.340。两者比较差异有显著统计学意义P〈0.01。结论腰骶角增大是歼击机飞行员腰椎峡部裂的促进因素之一。     

中老年腰椎峡部裂与滑脱脊柱-骨盆矢状面X线测量参数的差异及临床价值

目的：观察中老年腰椎峡部裂与滑脱脊柱-骨盆矢状面 X测量参数的差异,探索 L5峡部裂发生滑脱的预测因素,为青少年腰椎峡部裂治疗提供影像学参考。方法回顾性分析在本院就诊的中老年 L5峡部裂与滑脱患者影像资料各60例,选择近期无腰骶部疼痛等症状的中老年志愿者60例为对照。测量骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰骶角(LSA)、腰椎前凸角(LL)、矢状面轴向垂直距离(SVA)等脊柱-骨盆矢状面参数。采用单因素方差分析,SNK-q 检验行统计学分析。结果滑脱组PI、PT、SS、LL显著大于峡部裂组和对照组,LSA显著小于峡部裂组和对照组,差异有统计学意义(P<0.05),滑脱组 SVA与峡部裂组和对照组相比较,差异无统计学意义(P>0.05);峡部裂组PI、PT、SS、LL、LSA、SVA与对照组相比较,差异均无统计学意义(P>0.05)。结论脊柱-骨盆矢状面 X测量参数(PI、PT、SS、LL、LSA)可作为 L5峡部裂发生滑脱的预测因素,可为青少年腰椎峡部裂的治疗提供参考。     

脊柱滑脱对腰椎峡部裂的诊断价值及两种测量方法比较

目的探讨脊柱滑脱对腰椎峡部裂的诊断价值,比较Meyerding与Taillard方法测量的准确性。方法以招收飞行学员的52例L5双侧峡部裂者作为研究对象,取立位腰椎侧位X线片,分别按Meyerding和Taillard方法测量L5椎体滑脱的程度,计算阳性率,分析滑脱对峡部裂诊断的意义。结果侧位片按Meyerding和Taillard方法测量,L5滑脱率分别为40.38%（21/52）和86.54%（45/52）,Taillard较Meyerding测量方法更精细准确（P〈0.05）。结论 L5脊柱滑脱是L5峡部裂诊断的重要间接X线征象,它不仅说明峡部裂的存在,也说明了双侧性;采用Taillard法测量L5滑脱较Meyerding法更准确。在招收飞行员体检和青年人腰椎疾病诊断中,侧位片脊柱滑脱高度提示相应椎体峡部裂的诊断。     

椎间隙中线-垂线的新测量方法及对脊柱滑脱的诊断价值

目的 探讨椎间隙中线-垂线X线测量诊断脊柱滑脱的新方法,研究其临床应用的价值和意义。方法研究组为88例腰5（L5）双侧峡部裂的招飞学生,对照组为157例无滑脱的同龄学生,取拍摄的站立侧位X线片,采用Meyerding、Garland、Taillard及笔者提出的椎间隙中分线三垂线测量方法（MIP）;以椎间隙中线作通过下位椎体后上缘的垂线,以此界定上位椎体后下缘的位点,对两组进行脊柱滑脱的测量,比较分析两组的阳性检出率。结果研究组：Meyerding法检出L5峡部裂并脊柱向前滑脱的阳性率为48．9％（43／88）,Garland法为77．3％（68／88）,Taillard法为81．8％（72／88）,MIP法为92．1％（81／88）,4种测量方法阳性率比较有显著差异（P〈0．05）,说明Meyerding、Garland和Taillard测量方法均存在不同程度的假阴性结果。对照组：只有Garland法检出L5脊柱向前滑脱12例（7．6％）,其他3种方法测量均无向前滑脱,因此证实Garland法有较高假阳性率,后3种测量方法诊断脊柱滑脱无假阳性结果。结论笔者提出的MIP法划线测量简单、应用范围广、诊断准确,且方法简便、准确、实用,为目前脊柱滑脱的各种测量方法中检出率最高、确定滑脱的距离数值更为精细的测量方法。     

歼击机飞行员腰椎峡部裂60例影像学分析（摘要）

目的探讨歼击机飞行员腰椎峡部裂影像学诊断。方法收集改装体检的歼击机飞行员腰椎峡部裂60例（62块病变腰椎）影像学资料,分析X线和部分CT、MRI表现以及其中20例6个月～7年随访复查的影像学变化。结果60例站立位x线腰椎正侧位和双斜位平片均显示峡部裂征象;仅3例x线显示单侧峡部裂,而CT证实为双侧。腰5椎峡部裂51／62块（82．26％）,其次为腰4椎峡部裂5／62块（8．06％）,腰3椎峡部裂3／62块）4．84％）,腰6椎（骶椎腰化）峡部裂2／62块（3．23％）,腰2椎峡部裂1／62块（1．61％）。60例中双侧峡部裂50块,其中伴有前滑脱者31块,     

腰椎峡部裂并脊椎滑脱的MRI表现及影像学比较

目的 :探讨MRI在腰椎峡部裂并脊椎滑脱症中的诊断价值。方法 :分析总结 5 3例腰椎峡部裂并脊椎滑脱症的传统X线片、CT、MR扫描表现并进行比较。结果 :传统X线平片表现为腰椎滑脱、峡部裂、局部骨质增生硬化 ;CT表现为峡部裂、局部骨质增生硬化、韧带肥厚、椎管狭窄及矢状径增大 (双管征 )、椎间盘变形 ;MRI表现为峡部骨髓信号连续性中断、局部骨质呈T1、T2 低信号、韧带肥厚、腰椎滑脱、椎间孔变形 (双叶征 )、神经根卡压、节段性椎管扩张和狭窄。结论 :MR扫描对腰椎峡部裂并脊椎滑脱症的诊断具有重要的临床应用价值     

鲁格氏装置脊柱内固定12例报告

鲁格氏装置用于脊柱内固定在国内外已有十余年历史.我们采用此装置治疗脊柱骨折及腰椎峡部不连共12例,疗效满意,报告如下.临床资料本组男8例,女4例;年龄22～56岁.脊柱骨折8例,其中腰1骨折6例、腰2、4骨折各1例(合并完全性截瘫3例,不全性截瘫5例,手术行后柱切除、硬脊膜切开减压、氢化可的松稀释液冲洗);腰4峡部不连Ⅱ°滑脱1例、腰5峡部不连滑脱Ⅰ°1例、腰5双侧峡部不连无滑脱2例.滑脱病例中1例伴有椎管狭窄表现,一例双下肢坐骨神经痛.单纯峡部不连病例有顽固性腰疼.2例滑脱采用病变部位上下椎板切除.本组病例全部使用鲁格氏装置内固定.手术方法备长度大小适宜的鲁格氏装置(Luque棒、环).病人俯卧或侧卧位.以定位为标志.上下显露各3个棘突.损伤部位行后柱切除,充分松解该部硬膜囊.根据病情需要切开硬膜,或探查椎间盘、神经根及脊     

腰椎峡部裂的MRI评价

目的 :描述腰椎峡部裂的MRI表现 ,探讨MRI在本病中的诊断价值。方法 :回顾性分析经X线平片或CT证实的 2 9例腰椎峡部裂患者 (单纯崩裂 5例、崩裂滑脱 2 4例 )及 2 5例退行性腰椎滑脱患者的MRI检查资料 ,并对崩裂滑脱与退行性滑脱的MRI表现进行对比分析。结果 :2 9例峡部裂患者双侧椎弓峡部均出现不规则状T1WI低信号、T2 WI低或高信号骨性缺损。单纯崩裂组椎管前后径 19.0mm± 2 .7mm ,不伴有脊柱滑脱、椎间盘假性膨出及椎间孔变形 ;3例患椎棘突基底部与硬膜囊之间存在脂肪间隙 ;所有患椎棘突基底部均位于上下棘突基底部连线前方。崩裂滑脱组椎管前后径2 5 4mm± 4 .4mm ,均伴有脊柱滑脱、椎间盘假性膨出、椎间孔变形 ;患椎棘突基底部与硬膜囊之间均存在脂肪间隙 ;患椎棘突基底部位于上下棘突基底部连线后方 2 3例 ,稍前方 1例。退行性滑脱组椎弓峡部完整 ,无骨性缺损 ;椎管前后径15 2mm± 1.6mm ,明显小于崩裂滑脱组 (t =10 .87,P <0 .0 1) ,2 5例均伴有椎间盘假性膨出及椎间孔变形 ;患椎棘突基底部与硬膜囊之间无脂肪间隙 2 4例 ,存在线状脂肪间隙 1例 ;患椎棘突基底部均位于上下棘突基底部连线前方。结论 :腰椎峡部裂有特征性MRI表现 ,MRI可为临床评价该病提供正确、全面的影像学证据     

螺旋CT多层面容积重建在腰椎峡部裂中的应用研究

目的:探讨螺旋CT多层面容积重建对腰惟峡部裂的诊断价值。方法:选取行腰椎螺旋CT检查的50例腰痛患者资料,根据椎弓有无峡部裂分成峡部裂组(25例,有峡部裂)和对照组(25例,无峡部裂),所得数据资料行t检验。结果:峡部裂主要发生在L5(18例,占72%),腰椎峡部裂常导致腰椎前滑脱(24例,占96%)。峡部裂组椎管矢状径明显大于对照组椎管矢状径,之间有显著性差异(P<0.01),峡部裂组峡部高小于对照组峡部高,之间有显著性差异(P<0.05)。结论:螺旋CT扫描MPVR重建图像可以从骨性和软组织两个方面为临床提供更多影像学信息。     

L_5椎体后缘连线与棘突上缘连线交角对腰椎峡部裂诊断的价值

目的探讨在招收飞行员腰椎峡部裂的X线诊断中,椎体后缘连线与棘突上缘连线夹角的诊断价值。方法选择33例诊断L5双侧峡部裂患者,采用CR或DR立位拍摄腰椎正、侧及双斜位X线片,8例加做腰椎CT扫描并二、三维重建,重点对侧位片L5椎体后缘连线与棘突上缘连线的夹角进行测量,其角度与L4同法测量的角度进行比较。结果观察组18例L5〈L4型,占54.55%（18/33）;15例呈L5〉L4型。正常对照组1例L5〈L4型,占2.13%（1/47）;46例呈L5〉L4型,两组L5〈L4型的发生率差异有显著的统计学意义（P〈0.01）。结论在腰椎峡部裂的X线诊断中,椎体后缘连线与棘突上缘连线交角的L5〈L4变化是诊断L5峡部裂的重要间接征象,尤其是在侧位片没有任何峡部裂诊断的直接征象时,更具有独特的提示诊断意义。     

Is the coned lateral lumbosacral junction radiograph necessary for radiological diagnosis?

The lumbar spine radiographs of 400 orthopaedic outpatients were reviewed to determine if the absence of the coned lateral lumbosacral junction radiograph would lead to a loss in diagnostic accuracy. In 84 (21%) patients the antero-posterior and lateral lumbar spine radiographs failed to visualize adequately the lumbosacral junction. In these patients the coned lateral lumbosacral junction radiograph resulted in 17 (4.5%) diagnoses which would otherwise have been missed. The diagnoses were spondylosis (11), spondylolisthesis (3), spondylolysis (1), Paget's disease (1) and infection (1). Absence of the coned lateral lumbosacral radiograph will result in inadequate demonstration of the lumbosacral junction and a loss in diagnostic accuracy.     

椎弓峡部裂在腰腿疼痛患者中的患病率及其与椎体滑脱的相关性

目的研究椎弓峡部裂在腰腿疼痛患者中的实际患病率,并探讨其与椎体滑脱的相关性。资料与方法筛选行MSCT扫描的5301例腰腿疼痛病例作为研究对象,详细记录有无椎弓峡部裂及椎体滑脱。结果 5301例中,发现椎弓峡部裂221例,其中男112例,女109例,男、女之间差异有统计学意义(χ2=220,P<0.001);在221例中有236个腰椎有椎弓峡部裂,其中单侧22个(9.95%),双侧214个。按照Meyerding分级,椎体Ⅰ度滑脱116个,Ⅱ度滑脱4个,无Ⅲ、Ⅳ度滑脱。双侧、单侧椎弓峡部裂滑脱发生率分别为55.14%、9.09%,二者之间差异有统计学意义(χ2=19.621,P<0.001,rs=0.277)。结论椎弓峡部裂在腰腿疼痛患者中的实际发生率约是4.17%(男性4.61%,女性3.80%),椎弓峡部裂与椎体滑脱呈低度相关。     

Radiographic abnormalities of the lumbar spine in college football players. A comparative analysis.

The purpose of this study was to make a direct comparison between lumbar spine radiographs of incoming college football players and of an age-matched control group to determine whether there is a higher prevalence of lumbar spine abnormalities in football players before competing at the Division I level. We reviewed 187 lumbar spine radiographs. Of these, 104 were taken as a standard part of the preparation physical examination for incoming college football players. The remaining 83 radiographs were taken during routine preemployment physicals at a local factory. Each radiograph was read independently by three separate orthopaedic radiologists in a blinded fashion. Data were collected and statistically evaluated for 13 variables. The rate of spondylolysis was only 4.8% in our group of athletes and 6.0% in the control group (not significantly different). Only in the category of degenerative changes was a significant difference found. The control group had a 16.9% incidence of disk space narrowing and spurring and the football players had a 6.7% incidence. The remainder of the variables were not significantly different between the two groups. Our findings differ from previously published reports and indicate that football players entering college at the Division I level may have a similar prevalence of radiographic lumbar spine abnormalities, including spondylolysis and spondylolisthesis, as age-matched controls.     

Radiological study of 305 cases of spondylolysis with or without spondylolisthesis]

Three hundred and five cases of spondylolysis with or without spondylolisthesis were reviewed. The concept of an acquired lesion must be retained even though a dysplastic lesion may be postulated to account for the familial incidence. The examination in erect position facilitates the diagnosis by favoring slipping. The vast majority of lesions are found at L5-S1. Spina bifida occulta is often found in association with spondylolisthesis. This lesion leads to apophyseal arthrosis and disc degeneration at the involved level. The accentuation of the lombosacral angle is not a predominent factor leading to spondylolysis. This angulation will increase with duration and degree of slipping. CT scan provides an excellent account of the state of the spinal canal at the affected level. Could pseudospondylolisthesis be a headed stage of spondylolysis?     

Diagnosis and evaluation of spondylolisthesis and/or spondylolysis on axial CT

A critical review was made of the CT findings in 300 patients who underwent axial CT of the lumbar spine in which spondylolysis and/or spondylolisthesis had been diagnosed. Findings indicate that axial CT is superior to conventional radiographs in several areas: (1) for consistent and accurate demonstration of spondylolysis, (2) for disclosing the various changes in the apophyseal joints associated with degenerative and reverse spondylolisthesis, and (3) for uncovering minimal degrees of spondylolisthesis by the presence of a pseudobulging disk in many cases with equivocal or negative radiographs. Axial CT is a highly accurate method for diagnosing and evaluating spondylolysis and all types of spondylolisthesis.     

Radiographic assessment of anatomic deviations in lumbar spondylolysis

A series of 202 patients (133 men, 69 women) with spondylolysis were examined with respect to radiographic variables describing lumbosacral lordosis, size of lumbar vertebrae, transverse processes and disc height. An age-standardized and sex-stratified comparison was made with a control group of 170 subjects (68 men, and 102 women) without lumbar spine disorders. The difference in lumbosacral lordosis between the spondylolysis and control groups was considered to be secondary to olisthesis, and to lack an etiologic role for the genesis of lysis. The lengths of the transverse processes and their distances to the crista iliaca posterior demonstrated no differences between the groups and therefore did not seem relevant to the context of the pathogenesis of spondylolysis. The fifth lumbar vertebra in the spondylolytic patients was more wedged and less wide than in the controls. The question of the primary or secondary nature of this change has not yet been clearly elucidated, and should be given further attention. The spondylolytic patients demonstrated a decrease in the height of the L5-S1 disc much earlier than the controls, and the degree of narrowing of the disc space was much more marked.