L_5椎体后缘连线与棘突上缘连线交角对腰椎峡部裂诊断的价值

Diagnostic value of intersecting angle formed by line aligning L_5 vertebral posterior margin and that aligning L_5 superior margin of spinous process in lumbar spondylolysis

目的探讨在招收飞行员腰椎峡部裂的X线诊断中,椎体后缘连线与棘突上缘连线夹角的诊断价值。方法选择33例诊断L5双侧峡部裂患者,采用CR或DR立位拍摄腰椎正、侧及双斜位X线片,8例加做腰椎CT扫描并二、三维重建,重点对侧位片L5椎体后缘连线与棘突上缘连线的夹角进行测量,其角度与L4同法测量的角度进行比较。结果观察组18例L5<L4型,占54.55%(18/33);15例呈L5>L4型。正常对照组1例L5<L4型,占2.13%(1/47);46例呈L5>L4型,两组L5<L4型的发生率差异有显著的统计学意义(P<0.01)。结论在腰椎峡部裂的X线诊断中,椎体后缘连线与棘突上缘连线交角的L5<L4变化是诊断L5峡部裂的重要间接征象,尤其是在侧位片没有任何峡部裂诊断的直接征象时,更具有独特的提示诊断意义。

Objective To investigate the diagnostic value of intersecting angle formed by the line aligning posterior vertebral margin and that aligning the superior margin of spinous process（∠θ）in lumbar spondylolysis.Methods 33 young male candidates diagnosed as bilateral L5 spondylolysis in health examination for pilot recruitment were selected as observation group,and other 47 ones without this lesion were selected as control group.Anteroposterior,lateral and double oblique views of lumbar spine X-ray were taken in the erect position using CR or DR;8 subjects additionally underwent CT with 2D/3D reconstruction.∠θ of L5 on lateral view as a major parameter was measured and compared with that of L4.Results In observation group,∠θ of L5 less than that of L4（L5L4） accounted for 54.55%（18/33）and ∠θ of L5 greater than that of L4（L5L4）occurred in 15 cases.In control group,L5L4 only occurred in 1 cases and accounted for 2.13%（1/47）,and other 46 cases were L5L4.There was a significant difference in the incidence of L5L4 between the two groups（P0.01）.Conclusion The intersecting angle formed by the line aligning the posterior vertebral margin and that aligning superior margin of spinous process is a useful X ray sign.When the angle of L5 is less than that of L4,it provides a indirect clue for the diagnosis of lumbar spondylolysis especially in the absence of direct sign on lateral view.