腰椎轴向负荷的CT、MR检查对腰椎退行性病变的诊断价值

The diagnostic value of axial loading imaging of the lumbar spine during CT and MR examination in patients with degeneration disorders

目的评价腰椎轴向负荷的 CT、MR 检查对腰椎退行性病变的诊断价值。方法对100例腰腿痛的患者(79例表现为坐骨神经痛,20例为下腰痛,1例为神经性跛行)分别行腰大肌放松体位(PRP)和腰椎轴向负荷仰卧位(ACE)的 CT 或 MR 检查。其中 CT 检查40例,MR 检查60例。硬膜囊面积在 ACE 检查中较 PRP 明显减小(>15 mm^2)并降到75 mm^2以下、侧隐窝和(或)椎间孔狭窄、椎间盘突出程度增加及出现滑膜囊肿为腰椎轴向负荷检查的附加信息(AVI)。结果 40例 CT检查的患者中,16例发现 AVl。其中硬膜囊面积减小13例,椎间盘突出程度增加7例,侧隐窝和(或)椎间孔狭窄4例,未见滑膜囊肿的病例。60例 MR 检查的患者中,19例发现 AVI,其中硬膜囊面积减小13例,椎间盘突出程度增加10例,侧隐窝和(或)椎间孔狭窄8例,未见出现滑膜囊肿的病例。79例坐骨神经痛的患者中32例(40.5%)出现 AVI,20例下腰痛的患者中2例(10.0%)出现 AVI(χ~2=7.45,P<0.05)。结论与常规腰椎 CT、MR 方法比较,腰椎轴向负荷的 CT、MR 检查更能反映腰椎直立状态下的椎间盘、硬膜囊、侧隐窝的状态。

Objective To estimate the diagnostic value of axial loading imaging of the lumbar spine during CT and MRI＇ examination in patients with degenerative disorders. Methods One hundred patients were examined in psoas-relaxed position （PRP） and axially compressed in extension （ACE） supine position of the lumbar spine. Forty patients were examined with CT and 60 patients were with MRI. If a significant decrease （ 〉 15mm^2） of dural sac cross-sectional area to values smaller than 75 mm^2 was found during examination in axial loading, or if a suspected disc herniation, narrow lateral recess, narrow intervertebral foramen, or intraspinal synovial cyst changed to being obvious at the axial loading examination, they were regarded as additional information. Results After axial loading CT examination, AVI was found in 16 of 40 patients. A significant decrease of dural sac area was found in 13 patients. Intervertebral disc herniation was more severe in 7 patients, lateral recess or interverbral foramen narrowed in 4 patients, no intraspinal synovial cyst was found. After axial loading MRI examination, AVI was found in 19 of 60 patients. A significant decrease of dural sac area was found in 13 patients. Intervertebral disc herniation became severe in 10 patients, lateral recess or interverbral foramen narrowed in 8 patients, no intraspinal synovial cyst was found. AVI was found in 32 of 79（40. 5% ） patients with sciatica and 2 of 20（ 10. 0% ） patients with low back pain （X^2 = 7. 45 P 〈 0. 05）. Conclusion Compared with PRP examination, the ACE of CT or MRI can reflect the status of disc, dural sac and lateral recess or interverbral foramen of the lumbar spine in the erect position.