腰椎峡部裂的影像检查研究

Imaging Study of Lumbar Spondyloschisis

目的 研究不同影像检查方法对腰椎峡部裂 (spondyloschisis ,SS)的诊断价值。材料与方法 对 2 7例SS同时作了X线、常规CT和反机架CT扫描 (reversegantryCT ,RGCT) ;另对 8例正常和 10例伴脊柱假性滑脱的腰椎峡部作RGCT扫描 ,在CT片上测量关节突关节 (zygaphysialesjoint,ZJ)和SS裂隙的矢状倾角 (sagittalinclinationangle ,SIA)及后者与脊柱纵轴夹角。结果 18例非SS组于椎弓根层面均显示完整骨性椎管环 ;2 0例滑脱组SS三种方法均显示 ,唯RGCT均显示清晰 ;8例无滑脱组SSX线漏诊 3例 ,未明确 4例 ,常规CT漏诊 3例 ( 5侧 )。RGCT显示全部SS特征表现 :“环裂征”和“双关节征”。SS和ZJ之SIA差异在常规CT和RGCT均具显著性差异。结论 RGCT完整显示峡部结构和SS形态特征 ,诊断SS优于X线和常规CT。

Objective To evaluate different imaging techniques in the diagnosis of spondyloschisis (SS).Materials and Methods Conventional radiography, routine CT scan and reverse gantry CT (RGCT) scan were performed in 27 cases with SS, while, as a comparison, RGCT was performed in another 8 healthy individuals and 10 cases having pseudo lumbar olisthe but without SS. On CT images, the sagittal inclination angles (SIA) of both the zygapophyseal joint (ZJ) and the fissure of SS, and the angle between SS and spinal sagittal axis were measured.Results In 18 cases without SS, complete circle of bony spinal canal was displayed on scans at the level of vertebral pedicle. In 20 cases with lumbar olisthe, SS was demonstrated on images of all three imaging techniques, with the images of RGCT being more distinct. Of 8 cases without lumbar olisthe, missed diagnosis of SS was occurred in 3 on radiographs and in 3 (5 sites) on routine CT scan, while uncertain diagnosis of SS was made in 4 on radiographs. The characteristic signs of SS, i.e. the 'rupture circle sign' and the 'double joint sign', were clearly displayed on RGCT scans. The SIA of SS was significantly bigger than the SIA of ZJ on both routine CT (P<0.01) and RGCT (P<0.001).Conclusion RGCT can completely display the isthmus of vertebral arch and SS features in detail, thus, it is superior to conventional radiography and routine CT in diagnosing SS.