腰椎滑脱X线诊断测量方法的比较研究

Comparative Study of Various Measurements in X Ray Diagnosis of Lumbar Spondylolisthesis

目的探讨腰椎滑脱X线诊断的最佳测量方法。方法研究组为55例第5腰椎(the 5th lumbar verte-bra,L5)双侧峡部裂的男性招飞学生,对照组为127例无滑脱的同龄男性招飞学生,拍摄站立的侧位X线片,采用Gar-land、Meyerding、Taillard及作者提出的椎间隙中线垂线测量法(Mid-Intervertebral Perpendicular,MIP)测量并发滑脱的程度。对4种测量方法的阳性率进行统计比较。结果研究组中,Garland、Meyerding、Taillard和MIP法对L5滑脱的阳性率分别为81.8%(45/55)、58.2%(32/55)、87.3%(48/55)和94.5%(52/55),有统计学差异(P<0.01)。Garland测量法对轻度的L5滑脱有较高假阳性率,Meyerding、Taillard、MIP 3种测量法诊断腰椎滑脱无假阳性结果。Garland、Meyerding、Taillard 3种测量方法均存在不同程度的假阴性结果,用MIP测量法均得以纠正。结论在腰椎峡部裂并脊柱滑脱的X线测量中,MIP法对腰椎滑脱的检出率高且无假阳性结果。

Objective To find an optimal measurement method in X ray diagnosis of spondylolisthesis.Methods The study group included 55 male aviation students with the 5th lumbar bilateral isthmus spondyloliesis,and the control group included 127 male aviation students of similar ages without spondyloliesis.Lateral radiography was taken in the erect position.Measurements on the spondylolisthesis were performed using Garland,Meyerding,Taillard and Mid-Intervertebral-Perpendical（MIP） method presented by the author.The positive detection rate of these methods were statistically compared.Results The positive rate for L5 spondylolisthesis in the study group was 81.8%（45/55） by Garland method,58.2（32/55） by Meyerding method,87.3%（48/55） by Taillard method and 94.5%（52/55） by MIP method respectively,with significant difference among the 4 methods（P0.01）.Garland method had higher false positive rate of mild degree of L5 spondylolisthesis,and Meyerding,Taillard or MIP methods had no false positive measurements.Different degrees of false negative results existed in Garland,Meyerding and Taillard measurements,which could be corrected by MIP method.Conclusion MIP method has higher positives detection rate of spondylolisthesis in X ray diagnosis of lumbar isthmus spondylolisis associated with spondylolisthesis and has no false positive results.