脊髓造影与CT脊髓造影对退行性腰椎侧凸性椎管狭窄的诊断价值

Values of myelography and CT myelography in the diagnosis of degenerative lumbar stenosis with scoliosis

目的:探讨脊髓造影与CT脊髓造影在退行性腰椎侧凸性椎管狭窄(degenerative lumbar stenosis with scoliosis,DLSS)中的诊断价值,并与MRI扫描、手术所见相比较。方法:选择2004-01/2007-06在北京协和医院骨科收治、并经手术证实的DLSS患者97例。所有患者均经脊髓造影和CT脊髓造影观察,其中43例同时行MRI扫描。通过脊髓造影与CT脊髓造影的影像进行分析,确定其椎管狭窄部位、病变范围和病变程度,并与术中所见及MRI比较。结果:①脊髓造影与CT脊髓造影的表现:DLSS对硬膜囊或神经根的压迫较退行性腰椎管狭窄症复杂,除与关节突肥大增生、黄韧带肥厚、椎间盘退变突出有关外,还与关节突关节半脱位、椎弓根移位压迫神经根等因素有关。②与手术所见的符合率:脊髓造影、CT脊髓造影的诊断正确率分别为87.6%和92.8%,二者联合应用的诊断正确率为95.3%;对于不同弯度的DLSS,二者的诊断正确率无明显差异。③与MRI比较:在弯度较大的DLSS中,脊髓造影与CT脊髓造影的诊断正确率高于MRI。结论:脊髓造影和与CT脊髓造影的联合应用于DLSS诊断正确率较高,对于弯度较大的DLSS诊断正确率优于MRI。

AIM： To assess values of myelography and computed tomography myelography （CTM） in the diagnosis of degenerative lumbar stenosis with scoliosis （DLSS） and compare with MRI scanning and operative findings. METHODS： Ninety-seven cases of DLSS admitted in Department of Orthopaedics, Beijing Union Hospital from January 2004 to June 2007 were selected. All patients underwent myelography and CTM, of which 43 undergone MR imaging at the same time. Imageology findings were analyzed to identify lumbar stenosis sites, and extent of disease, and compared with MRI and operative findings. RESULTS： （1）The myelography and CTM revealed that factors contributing to DLSS included not only zygapophysial joint hyperplasy, hypertrophic ligamentum flavum and intervertebral disc protrution which resulted in degenerative lumbar spinal stenosis, but also zygapophysial joint semiluxation and pedicle shift. （2）Compared to operative findings, diagnostic accuracy rate of myelography and CTM was 87.6% and 92.8%, and diagnostic accuracy rate of combination of myelography and CTM raised to 95.3%. The diagnostic accuracy rate of myelography and CTM was similar for DLSS with different curves. （3）Compared to MRI, the diagnostic accuracy rate of myelography and CTM was higher for DLSS with great curve. CONCLUSION： Myelography in conjunction with CTM shows high diagnostic accuracy rate of DLSS, and superior to MRI for great curve magnitude.