腰椎管狭窄症的影像学诊断

Imaging diagnosis of lumbar spinal stenosis

目的:探讨腰椎管狭窄症的X线、CT及MRI诊断价值。方法:分析130例临床诊断和影像学检查征象典型的腰椎管狭窄症的病例资料。男83例,女47例;年龄27～75岁,平均43.5岁。所有病例均行CT检查,其中23例行X线检查,57例行MRI扫描。结果:腰椎管狭窄位于L3,4水平25例,L4,5水平48例,L5S1水平57例。CT显示椎体后缘、椎板、下关节突骨质增生46例,椎板上下关节突肥大7例,黄韧带钙化、骨化13例,椎体向前滑脱5例,侧隐窝狭窄24例,椎间孔狭窄35例。MRI显示椎间盘突出伴黄韧带肥厚23例,黄韧带对称性肥厚18例,广泛多节段增生肥厚9例,局限性黄韧带肥厚7例。结论:继发性腰椎管狭窄症的最常见原因是退变。传统X线检查有很大的局限性,CT和MRI具有多方位成像和分辨率高的优点,但在韧带骨化上MRI难于显示,而CT能很好的显示韧带钙化与骨化及骨质改变,腰椎管狭窄症检查应该首选CT。

Objective：To investigate value of X ray,CT and MRI for the diagnosis of lumbar spinal stenosis. Methods： The data of 130 patients with clinical diagnosis and typical imaging signs of lumbar spinal stenosis were analyzed. The present study included 83 males and 47 females with an average age of 43.5 years （range from 27 to 75 years）. CT examination was performed in all patients,routine X ray examination in 23 patients and routine MRI in 57 patients. Results：The lumbar spinal stenosis showed at L3,4 plane in 25 patients,L4,5 in 48 patients and L5S1in 57 patients. CT showed hyperostosis of lumbar posterior marginal,vertebral lamina,inferior articular process in 46 patients,hypertrophy of superior and inferior articular processsus in 7 patients,calcification or ossification of ligamentum flavum in 13 patients,vertebral body spondylolisthesis in 5 patients, lateral recess stenosis in 24 patients,and intervertebral foramen stenosis in 35 patients. MRI showed intervertebral disk hernia with disc associated with ligamentum flavum hypertrophy in 23 patients,ligamentum flavum symmetrical hypertrophy in 18 patients,extensive multi segmental ligamentum flavum hypertrophy in 9 patients,and local ligamentum flavum hypertrophy in 7 patients. Conclusion：The main cause of secondary lumbar spinal stenosis is degeneration. Traditional X ray examination has great limitations in diagnosis of lumbar spinal stenosis. CT and MRI have advantages of multi directional imaging and the high resolution. CT can show well ligament calcification and ossification and other bone change which are showed not well on MRI, so CT is recommended to lumbar spinal stenosis.