CT平扫与X线平片检查在腰椎滑脱内固定术前、后中的应用价值探讨

Application Value of CT Plain Scan and X-ray Plain Film in Lumbar Spondylolisthesis before and after Internal Fixation

目的探讨CT平扫与X线平片检查在腰椎滑脱内固定术前、后中的应用价值。方法选取2017年3月至2018年4月我院收治的腰椎滑脱患者47例,患者均进行了CT平扫及椎体X线检查,收集47例腰椎滑脱患者的临床及影像学资料,计算CT平扫与X线平片对腰椎滑脱的诊断正确率,总结腰椎滑脱患者影像学图像变化,分析CT平扫、X线平片检查在腰椎滑脱内固定术前、后的应用价值。结果CT平扫检查对腰椎滑脱诊断正确率明显高于X线平片(100.00%vs90.56%)(χ^2=5.248,P=0.022<0.05);腰椎侧位片中多数患者椎体后缘连续性不完整,滑脱的椎体上下缘较为模糊,密度呈现局限性增高。17例患者呈现新月形密度增高,同时与两侧横突相连,10例峡部性椎体滑脱者中,6例移位距离较小,出现“狗戴项圈征”,3例峡部性椎体滑脱移位不明显出现漏诊。CT平扫横断位可清晰显示峡部裂细微变化情况,下位椎体可见膨隆移位的椎间盘影,椎管、侧隐窝狭窄均出现不同程度的狭窄,硬膜囊变形,椎体后缘呈现双边征。峡部性椎体滑脱者峡部裂表面均出现不规则锯齿状,滑脱水平的椎管前后径增宽。退行性椎体滑脱者可见椎间隙变窄,终板侵蚀、骨质出现增生,少数患者可见骨赘形成。结论CT平扫较X线平片对腰椎滑脱内固定术前诊断正确率较高,术后采用X线平片检查较为经济、快捷。

Objective To explore the application value of CT and X-ray plain film examination before and after internal fixation for lumbar spondylolisthesis.Methods 47 patients with lumbar spondylolisthesis admitted to our hospital from March 2017 to April 2018 were selected.All patients underwent CT plain scan and vertebral X-ray examination.The clinical and imaging data of 47 patients with lumbar spondylolisthesis were collected,and the diagnostic accuracy of CT and X-ray plain films for lumbar spondylolisthesis was calculated.The image changes of patients with lumbar spondylolisthesis were summarized,and the application value of CT and X-ray examination before and after internal fixation of lumbar spondylolisthesis was analyzed.Results The diagnostic accuracy of CT plain scan for lumbar spondylolisthesis was significantly higher than that of X-ray plain film(100.00%vs 90.56%)(χ^2=5.248,P=0.022<0.05).In the lateral radiographs of lumbar spine,the continuity of the posterior edge of the vertebral body is incomplete in most patients,the upper and lower edges of the spondylolisthesis are blurred,and the density of the spondylolisthesis is limited.17 patients showed increased crescent density and connected with bilateral transverse processes.Of the 10 patients with isthmic spondylolisthesis,6 had smaller displacement distance,and had"dog wearing collar sign",while 3 had no obvious isthmic spondylolisthesis and missed diagnosis.The slight changes of isthmus fissure can be clearly shown in the transverse position of CT plain scan.The disks with dislocation and swelling can be seen in the lower vertebral body.Stenosis of spinal canal and lateral recess appeared in varying degrees,dural sac deformed,and posterior edge of vertebral body showed bilateral signs.In isthmic spondylolisthesis,the surface of isthmic fissure was irregular serrated,and the anterior and posterior diameters of the spinal canal with smooth dehydration were widened.In degenerative spondylolisthesis,the intervertebral space was narrowed,the endplate was eroded,the bone was proliferated,and osteophytes were found in a few patients.Conclusion CT plain scan is more accurate than X-ray plain film in the diagnosis of lumbar spondylolisthesis before internal fixation,and X-ray plain film examination after operation is more economical and fast.