椎间隙中线-垂线的新测量方法及对脊柱滑脱的诊断价值

New measurement method of mid-intervertebral perpendicular and its value in diagnosis of spondylolysis

目的探讨椎间隙中线-垂线X线测量诊断脊柱滑脱的新方法,研究其临床应用的价值和意义。方法研究组为88例腰5(L5)双侧峡部裂的招飞学生,对照组为157例无滑脱的同龄学生,取拍摄的站立侧位X线片,采用Meyerding、Garland、Taillard及笔者提出的椎间隙中分线三垂线测量方法(MIP);以椎间隙中线作通过下位椎体后上缘的垂线,以此界定上位椎体后下缘的位点,对两组进行脊柱滑脱的测量,比较分析两组的阳性检出率。结果研究组:Meyerding法检出L5峡部裂并脊柱向前滑脱的阳性率为48.9%(43/88),Garland法为77.3%(68/88),Taillard法为81.8%(72/88),MIP法为92.1%(81/88),4种测量方法阳性率比较有显著差异(P<0.05),说明Meyerding、Garland和Taillard测量方法均存在不同程度的假阴性结果。对照组:只有Garlland法检出L5脊柱向前滑脱12例(7.6%),其他3种方法测量均无向前滑脱,因此证实Garland法有较高假阳性率,后3种测量方法诊断脊柱滑脱无假阳性结果。结论笔者提出的MIP法划线测量简单、应用范围广、诊断准确,且方法简便、准确、实用,为目前脊柱滑脱的各种测量方法中检出率最高、确定滑脱的距离数值更为精细的测量方法。

Objective To discuss a new measurement method of mid - intervertebral perpendicular（ MIP） in the diagnosis of spondylolysis,and to investigate its value and significance in clinical application. Methods Research group included 88 students for pilot recruitment with bilateral isthmus spondylolysis in the 5th lumbar（ L5 ）. Control group comprised 157 normal students of the same age without spondylolysis. Lateral radiographs in erect position were selected. Measurement methods included Meyerding, Garland, TaiUard and the new method （ MIP, a perpendicular line was drawn from the center line of the intervertebral space via the posterior upper margin of the lower vertebra, which was used to define the sites of posterior lower margin of the upper vertebra）. The degrees of spondylolysis in the two groups were detected,and their positive detection rates were compared and analyzed. Results In the research group, the detection rate of L5 isthmus spondylolysis complicated with spondylolisthesis by the methods of Meyerding, GarUand, Taillard, and MIP were respectively 48.9% （43/88）, 77.3% （68/88）, 81.8% （72/88）, and 92. 1% （81/88）. There were significantly differences among the detection rates detected by these four methods（ P 〈 0.05） ,which indicated there were various degrees of false negative results detected by Meyerding, Garlland, and Taillard methods. In the control group, the Garlland method detected 12 cases of L5 spondylolisthesis（7.6% ）, and other three methods showed no spondylolisthesis, which indicated there was a relatively high false positive rate detected by Garlland method and no false positive result of spendylolishesis diagnosed by the other three methods. Conclusion This new measurement method has the advantages of easy line - drawing and detection,wide range of application,accurate diagnosis, and convenient, accurate, and practical manipulation. Compared with other measurement methods, it is the measurement with the highest detection rate and more accurate figures of spondyMysis distance.