腰椎退变性(假性)滑脱的CT诊断与鉴别诊断

The CT diagnosis and differential diagnosis of degenerative lumbar(pseudo) spendylolisthesis

目的研究腰椎退变性滑脱的CT特征,使之与腰椎峡部裂引起的真性滑脱鉴别。方法对80例无腰椎外伤史和腰椎椎弓峡部裂史腰椎退变性滑脱的CT资料作回顾性分析。CT扫描范围从滑脱椎体椎弓开始至下位椎体上缘,所扫层面与椎间盘平行。结果 CT扫描有以下特征:①椎间盘退行性改变。②椎骨和椎小关节退行性改变,腰椎椎体边缘骨质增生及腰椎骨质疏松,椎小关节面增生硬化、关节面下囊变、碎裂、关节间隙变窄或不对称和关节囊钙化;滑脱腰椎椎弓完整,椎体及附件整体向前(后)移位,向前滑脱时,滑脱椎体下关节突向前移位,其前缘几乎与下位椎体上椎小关节突前缘相平或超出下位椎体上椎小关节突前缘,关节方向向矢状方向转化。③椎管、椎间孔和侧隐窝狭窄。④终板双重轮廓。结论腰椎退变性滑脱有其CT特征,能与腰椎峡部裂引起的真性滑脱鉴别。

Objective To study the CT characteristics of degenerative lumbar （pseudo） spondylolistheses, and differentiate from the lumbar spondylolysis （genuine）. Methods The CT datas of 80 cases with lumbar degenerative spondylolisthesis and without the history of injm＇y and lumbar spondylolysis were retrospectively analyzed. The range of CT scan was from the vertebral arch of the spondylolysis to the upper edge of the next vertebral, and paralleled with intervertebral disc. Results The characteristics of CT as follows： ①The degeneration of intervertebral disc. ②The degeneration of vertebrae and intep：ertebral facet joint, bone hypeFplasia of lumbar vertebral edge, and lumbar vertebral osteoporosis, hyperplasia and sclerosis of intervertebral facet joint, the cyst and fragmentation under the joint surface, joint space narrow or asymmetrical and the calcification of joint capsule; the vertebral arch of lumbar spandylolysis was completed, vertebral body and accessories shifted forward （after） as a whole, when forward slippage, the inferior articular process was displaced forward, the leading edge was nearly parallel to or beyond the leading edge of the next intervertebral facet joint, the direction of joint transfered to sagittal.③ The narrow of spinal canal, intervertebral foramen and lateral recess. ④the double outline of cndplate. Conclusion Degenerative spondylolisthesis has its CT characteristics, and can differentiate from the lumbar spondylolysis （genuine）.