腰椎峡部裂X线诊断的新征象—腰椎峡部上下缘连续性中断

Evaluation of discontinuity of the superior and inferior margins of laminar isthmus in imaging diagnosis of spondylolysis of the lumbar spine in screening of aviation students.

目的探讨飞行学员招收工作中腰椎峡部上下缘连续性对腰椎峡部裂诊断的价值。方法将38例诊断L5双侧峡部裂者作为研究对象,采用CR或DR机行立位拍摄腰椎正、侧、双斜位X线片,8例加做腰椎CT。重点研究侧位片和斜位片腰椎峡部上下缘的连续性,其显示率两者间、与同体位峡部裂隙的显示率之间的比较采用配对χ2检验。结果侧位片X线征象:L5峡部上下缘连续性中断的显示率为:81.6%。L5峡部裂隙的显示率为76.3%。两者比较差异无统计学意义(P>0.05)。斜位片X线征象:L5峡部上下缘连续性中断的单和双侧总显示率为92.1%。L5峡部裂隙的单和双侧总显示率为71.1%。两者比较差异有统计学意义(P<0.05)。8例腰椎CT检查均证实了L5峡部裂的诊断。结论腰椎峡部裂的X线诊断中,峡部上下缘连续性中断与峡部裂隙的诊断价值相同,检出率高于后者,是X线诊断的直接征象,可单独作为峡部裂的诊断依据。

Objective To investigate on the significance of discontinuity of the superior and inferior margins of the laminar isthmus in imaging diagnosis of spondylolysis of lumbar spine in screening of aviation students.Methods Front,lateral and double oblique views of the lumbar spine in 38 candidates for aviation students with spondylolysis were taken in the erect position using CR or DR.8 subjects underwent CT scan.The results were studied and analyzed with emphasis on visualization rate of discontinuity of superior and inferior margins of laminar isthmus on lateral and oblique views as compared with the visualization rate of isthmus cleft on corresponding views using matched χ2 test.Results On lateral view,visualization rate of discontinuity of the upper or lower margin of the L5 laminar isthmus was 81.6%,while that of L5 isthmus cleft was76.3%,and no statistical significance was found（P〉0.05）.On oblique views,visualization rate of discontinuity of the upper and lower margin of L5 isthmus both bilateral and unilateral was 92.1%,while that of L5 isthmus cleft both bilateral and unilateral was 71.1%,and statistical significance was found（P〈0.05）,indicating that the former had higher detectability than the latter.CT scan confirmed the diagnosis in all 8 cases.Conclusion In imaging diagnosis of lumbar spondylolysis,discontinuity of superior or inferior marginal lines of lumbar laminar isthmus has the same diagnostic value as the isthmus cleft,both are direct signs,the former is also a direct sign with has even higher detectability.The diagnosis of lumbar spondylolysis can be established on this sign alone.