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     

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     

腰椎峡及其部裂X临床线诊断意义

目的：探讨腰椎峡部裂X线影像学改变及其临床意义。方法：回顾52例腰椎弓峡部裂X线影像学表现并结合文献加以分析。结果：本组52例中，发现腰椎峡部裂61个。双侧峡部裂12个．单侧37个。X线正位片显示椎弓峡部可见由内下至外上“裂隙征”者12个，占19．67％；X线侧位片显示椎弓峡部可见“裂隙征”的25个，占40．98％；腰椎标准双斜位摄片为腰椎峡部裂最佳显示体位，本组61个腰椎峡部裂显示58个，占95．08％。结论：腰椎X线平片摄影简便、费用低廉，其标准斜位像上“狗颈项圈征”X线影像学表现为峡部裂最直观依据，具有一定的临床价值。     

“环裂征”：腰椎峡部裂的CT特征

腰椎峡部裂并滑脱是引起腰腿痛的原因之一［１］,成人发病率约６％［２］,但少见腰椎峡部裂特征ＣＴ表现的报道,尤其对单纯性峡部裂的ＣＴ诊断研究较少。本研究通过１７３例腰椎峡部裂ＣＴ表现的分析及２０例无症状者腰－３至骶－１椎ＣＴ表现的观察,探讨腰椎峡部裂的ＣＴ特征性表现。１材料和方法１．１一般资料（１）病例组：本院１９８９－０３～１９９８－０２ ＣＴ诊断腰椎峡部裂１７３例（不包括有骨痂形成愈合期的病例）,男１１２例,女６１例,年龄１３～７６岁,平均４２．３岁。（２）对照组：１９９６．０７～１９９７－０…     

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,     

腰椎峡部裂并脊柱滑脱的CT诊断

笔者分析了腰椎峡部裂（３１例）并脊柱滑脱（２２例）患者的ＣＴ表现，总结为以下几点：（１）关节突部部的骨性缺损；（２）神经孔畸形；（３）椎管狭窄；（４）侧隐窝狭窄；（５）椎间盘变形。还讨论了腰椎峡部裂并脊柱滑脱的ＣＴ扫描技术及鉴别诊断。     

腰椎峡部裂的CT诊断

目的　提高对腰椎峡部裂CT征象的认识。方法　用Elscint 2 40 0CT机进行检查。对 3 2例峡部裂患者的CT征象进行分析。结果　峡部裂的特征性CT表现为“环裂征”。 2 5例合并椎体滑脱患者CT的特征性表现为椎管矢状径增长、夹心征、椎管变形、椎间盘假性后脱。其它还有小关节不对称等。结论　“环裂征”是峡部裂的特征性表现 ,对于无椎体滑脱峡部裂患者的诊断有重要意义     

腰椎峡部裂的CT扫描技术及其诊断探讨

目的：探讨椎弓峡部CT扫描的最佳方法，正确认识腰椎峡部裂的CT表现、诊断价值。方法：将45例X线诊断椎弓峡部裂患者随机分成三组，分别用不同的方法进行CT扫描，将扫描结果进行对比、分析。结果：45例峡部裂中L32例，L418例，L5 25例。双侧裂44例，单侧裂1例。四表现有：裂隙征，假性椎间盘膨出，双关节征．双边征，椎管冗长征，椎管、侧隐窝及椎间孔狭窄。以椎弓的平行线为CF扫描基线组显示椎弓最完整，最直观。结论：应以椎弓的平行线为椎弓CT扫描基线，“裂隙征”是椎弓峡部裂的特征表现，且CT也是检查腰椎峡部裂的首选方法。     

腰椎峡部裂平行椎弓CT扫描的技术探讨及临床应用

目的：探讨平行于椎弓CT扫描对腰椎峡部裂的诊断价值及临床应用。方法：采用与椎弓平行扫描，包括整个椎弓，层厚3—5mm、层距3—5mm，以骨窗观察为主；对照正常CT表现，分析51例腰椎峡部裂的CT表现。结果：51例均显示腰椎峡部透光裂隙，边缘呈锯齿状并有增生硬化，密度增高，裂隙周围有大小不一，数目不等的碎骨块。当有脊椎滑脱时，椎管矢状径被拉长，呈长椭圆型或葫芦型。结论：平行于椎弓CT扫描诊断腰椎峡部裂简便易行，图像直观，解剖关系明确，是目前诊断腰椎峡部裂的重要手段之一。     

不同CT检查方法对腰椎峡部裂的诊断

目的 分析不同CT检查方法对腰椎峡部裂的诊断价值.方法 回顾分析55例腰椎峡部裂在CT常规轴位、反角度CT(RGCT)、多层螺旋CT(MSCT)后重组图像的表现特征,比较3种不同CT检查方法对腰椎峡部裂特征性表现的显示差异,并与一组30例正常腰椎、30例腰椎退行性变伴滑脱的CT表现进行对照.结果 对峡部裂隙征、双关节或多关节征等特征性表现的显示,CT常规轴位各为33例(34个椎体)、11例(11个椎体),分别约占74%、24%;RGCT均为23例(24个椎体),MSCT后重组技术均为33例(37个椎体),显示率均为100%.MSCT后重组技术尚能100%显示"猎狗项圈"征、"蝙蝠折翼"征、"阶梯"征、椎管冗长征及其他伴随征象.对照组中无1例显示峡部裂隙征、双关节或多关节征等.结论 MSCT后重组技术是目前诊断腰椎峡部裂较为理想的成像方法.     

Proper protocols key to CT of lumbar spine

MRI is clearly superior to CT in imaging the lumbar spine for evaluation of the postoperative back. The one area in which CT has been shown to be superior to MRI in the lumbar spine is in diagnosing spondylolysis. Pars defects can be very difficult to appreciate with MRI, yet are easily seen with CT. Other than spondylolysis, the postoperative spine, and bone marrow imaging, CT and MRI appear to be diagnostically equivalent.     

Single photon emission computerized tomography and reverse gantry computerized tomography findings in patients with back pain investigated for spondylolysis.

BACKGROUND: Athletes with low back pain may have sustained a bone stress injury in the lumbar neural arch, including spondylolysis. Single photon emission computerized tomography (SPECT) and reverse gantry computerized tomography (rg-CT) help localize bone stress response and spondylolyses. OBJECTIVES: To describe the SPECT and rg-CT findings in those patients suspected of suffering from a spondylolysis. STUDY DESIGN: Large retrospective case series. SETTING: Secondary and tertiary care center in England. PATIENTS: A total of 213 patients presenting to the Spinal Unit and Sports Medicine Clinics between 1995 and 2000 with low back pain and subsequently investigated for spondylolysis by SPECT and rg-CT. METHODS: An experienced consultant musculoskeletal radiologist reported the SPECT and rg-CT, and these results along with data from the patient's medical records were analyzed. MAIN OUTCOME MEASURES: Sites and sides of increased scintigraphic activity in the lumbar neural arch seen on SPECT and complete and incomplete spondylolyses were recorded. RESULTS: Single photon emission computerized tomography scan showed increased scintigraphic uptake in 145 patients, mostly (42.3%) at L5. Marked increase in scintigraphic uptake was noted on the left side of the neural arch in 31 patients and on the right in 17 (chi; P < 0.05). Spondylolysis was identified on rg-CT in 81 patients. Spondylolyses were bilateral on 44 occasions, but unilateral lesions occurred in the left pars 36 times and on the right 16 times (chi; P < 0.01) CONCLUSIONS: Spondylolyses were a frequent finding on rg-CT in young athletes with low back pain. The sports most commonly associated with this stress response in the pars interarticularis were cricket and soccer. The lower lumbar levels are more likely to show abnormalities on SPECT and computerized tomography. Among those investigated for spondylolysis, left-sided lower lumbar pain was more common than right, and a marked increase in scintigraphic uptake was noted on the left more often than the right. Although bilateral spondylolyses were common, left-sided spondylolyses were more common than right. The asymmetric repetitive movements of certain sports may be responsible. In particular, fast bowlers developed spondylolysis on the opposite side of the body to their bowling arm.     

Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease. Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease. Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease. Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. Received: 2 May 2000 Revision requested: 18 July 2000 Revision received: 25 August 2000 Accepted: 1 September 2000     

Spondylolysis in Athletes

The high occurrence of spondylolysis in these athletes suggests that certain sports actions predispose athletes to fractures in the neural arches of the lumbar vertebrae.     

SPECT in the management of patients with back pain and spondylolysis

PURPOSE: Single photon emission computed tomography (SPECT) bone scans of the lumbar spine were evaluated in the management of patients with low back pain and suspected spondylolysis. MATERIALS AND METHODS: Thirty-three patients (mean age, 30 years) with high clinical suspicion of pars interarticularis defects were included in the study. The results of lumbar radiographs and SPECT bone scintigraphy were compared and the influence of these results on patient management was evaluated. RESULTS: Twenty-six of the 33 patients had abnormal results of lumbar radiographs. Of the 21 patients with radiographs indicating spondylolysis, six had abnormal uptake in the pars regions on bone scintigraphy. One patient with normal results of lumbar radiographs had a SPECT bone scan showing uptake in the region of the pars interarticularis. CONCLUSIONS: SPECT bone scanning of the lumbar spine has a role in the treatment of patients with symptomatic spondylolysis.     

腰椎峡部裂的CT诊断、临床意义及其扫描技术的改进

目的探讨CT在腰椎峡部裂诊断中的临床价值及其扫描技术的改进.方法分析了20例腰椎峡部裂的CT表现及其引起的腰神经受压的CT表现.结果CT扫描能显示峡部裂,及其引起的椎管狭窄,侧隐窝及椎间孔狭窄等并发改变.结论CT对峡部裂的诊断以及治疗方式的选择具有重要意义,改进后的扫描技术能更加客观地反映峡部裂的特征.     

Repair of pars interarticularis defect by segmental wire fixation in young athletes with spondylolysis

BACKGROUND: Although segmental wire fixation has been successful in the treatment of nonathletes with spondylolysis, no information exists on the results of this type of surgery in athletes. PURPOSE: To evaluate the outcome of surgical repair of pars interarticularis defect by segmental wire fixation in young athletes with lumbar spondylolysis. METHODS: Between 1993 and 2000, 20 athletes (6 women and 14 men; average age, 23.7) with lumbar spondylolysis were treated surgically with this technique. They were actively engaged in sports such as baseball, tennis, and golf. Nineteen athletes had one level of spondylolysis and one athlete had two levels. The level of spondylolysis was L4 in 2 athletes and L5 in 19. The average follow-up period was 3.5 years (range, 1.3 to 8.6). Surgical outcome was evaluated by radiographic examination, the Japanese Orthopaedic Association score, preoperative and postoperative sports activity levels and intensities, and the presence of complications. RESULTS: Bony fusion at the site of spondylolysis was obtained in all cases, and the Japanese Orthopaedic Association score was increased significantly after surgery (preoperatively, 21.2 +/- 3.9; postoperatively, maximum 27.7 +/- 1.0; recovery rate, 80.4%). All of the patients returned to their sports activities, although at varying degrees. No severe complications were noted. CONCLUSION: We recommend this technique in cases of lumbar spondylolysis in athletes who hope to resume their sports activities.     

腰椎峡部裂的CT表现和临床意义

探讨ＣＴ在腰椎峡部裂诊断中的临床价值。分析了３４例腰椎峡部裂的ＣＴ表现，对腰椎峡部裂导致腰神经嵌压的ＣＴ表现与其临床症状进行比较。ＣＴ能显示峡部裂所致的椎管狭窄，侧隐窝和椎间孔狭窄及其他并发改变，ＣＴ表现与临床症状相符为７６％。ＲＰ