腰椎滑脱21例影像学分析

The imaging diagnosis of spondylolisthesis of 21 cases

目的分析脊柱滑脱的X线、CT影像表现,探讨不同检查方法对诊断和指导治疗的价值。方法回顾性分析确定诊断为腰椎滑脱的病例21例,全部病例行腰椎正侧位片摄影,其中17例行腰椎过伸、过屈位摄影,16例行腰椎双斜位摄影,11例行腰椎CT扫描,采用与椎间盘平行的角度,自病变椎体的上一椎体下缘扫描至下一椎体上缘,层厚5 mm,间隔5 mm。结果21例病例中真性滑脱9例,其中X线腰椎双斜位摄影7例,确诊6例,腰椎过伸过屈位摄影8例,5例显示有椎体移位程度的改变,CT扫描5例,确诊5例;假性滑脱12例,其中X线腰椎双斜位摄影7例,确诊4例,腰椎过伸过屈位摄影10例,椎体移位变化均不明显,CT扫描6例,确诊6例,均显示不同程度的椎小关节及间盘退变。结论腰椎双斜位摄影更容易直接显示真、假性滑脱的存在;过伸过屈位摄影对于判定滑脱腰椎的稳定程度有重要意义;CT扫描对显示病变区椎管形态、椎间盘退变、小关节退变及软组织状况更为确切。

Objective To evaluate CT and X-ray findings of spondylolisthesis and to discuss the diagnastic value of X-ray scanning technique. Methods The date of 21 patients with spondylolisthesis were reviewed. All cases taken photograph of normal side, including 17 cases taken photograph of over-flexure posture and over-extending posture, 16 cases taken oblique position, 11 cases scanned with axial CT using 5mm slice thickness and 5 mm slice interval parallel to the intervertebral space. Results In 21 cases, there were 9 cases of true spondylolisthesis, finding 6 cases in 7 patients taken photograph oblique position, 5 cases in 8 patients taken photograph of over-flexure posture and over-extending posture, 5 cases in 5 patients taken CT scans;And there were 12 cases of false spondylolisthesis, finding 4 cases in 7 patients taken photograph of oblique position, no case in patients taken photograph of over-flexure posture and over-extending posture, 6 cases in 6 patients taken CT scans. Conclusion X-ray films of oblique positison is a valuable method for showing the existence of true and false spodylolisthesis： X-ray films of over-flexure posture and over-extending posture is valuable for diagnosis and evaluating the degree of spodylolisthesis; CT scanning is valuable for evaluating bone changes of pyramid or intervertebral facet joints, intervertebral disc degeneration and soft tissues condition.