CT与X线平片对老年腰椎退行性病变的诊断价值

The diagnostic value of CT and X-ray plain film in lumbar spinal degenerative disease in the elderly

目的分析老年腰椎退行性病变特点,评价诊断中采取CT、X线平片的检查效果。方法选择90例老年腰椎退行性病变患者,均进行CT、X线平片检查。比较CT检查、X线平片检查的漏诊率、误诊率、准确率以及影像学表现。结果 CT检查老年腰椎退行性病变的准确率98.89%高于X线平片检查的85.56%,误诊率1.11%及漏诊率0低于X线平片检查的8.89%、5.56%,差异有统计学意义(P<0.05)。经CT检查发现,腰椎骨质退变患者的骨松质密度低,腰椎间盘突出患者的腰椎间盘有膨突、椎管变小与窄等表现,腰椎管退变患者的椎体边缘骨质呈花边形增生、间隙狭窄、椎管变形等表现,韧带与小关节退变患者的椎体骨松质呈点状等。经X线平片扫描发现,腰椎骨质退变患者的腰椎上下边缘呈凹陷表现,腰椎间盘突出患者的腰椎间盘呈侧弯、骨质密度降低等表现,腰椎管退变患者的部分腰椎前后缘骨质增生,韧带与小关节退变患者的腰椎上下缘有圆形/卵圆形内凹等表现。结论 CT、X线平片均可诊断老年腰椎退行性病变,其中, CT检查的准确性更高。为了避免疾病误诊、漏诊风险,可以根据患者意愿、情况进行联合诊断,以助于腰椎退行性病变早期治疗工作的开展。

Objective To analyze the characteristics of lumbar spinal degenerative disease in the elderly,and evaluate the effect of CT and X-ray plain films in the diagnosis.Methods All 90 elderly patients with lumbar spinal degenerative disease were selected,and all of them were examined by CT and X-ray plain films.The missed diagnosis rate,misdiagnosis rate,accuracy rate and imaging performance of CT examination and plain X-ray examination were compared.Results The accuracy rate of CT examination was 98.89%,which was higher than 85.56%of X-ray plain film examination,and misdiagnosis rate 1.11%and missed diagnosis rate 0 were lower than 8.89%and 5.56%of X-ray plain film examination.All the difference was statistically significant(P<0.05).The CT examination revealed that patients with lumbar spine degeneration had low bone cancellous density;patients with lumbar disc herniation had manifestations of bulging,narrowing and narrowing of the lumbar intervertebral disc;in patients with lumbar spinal canal degeneration,the marginal bone of the vertebral body showed lace shaped hyperplasia,space stenosis,and spinal canal deformation;in patients with degenerative ligaments and facet joints,the cancellous substance of vertebral body was punctate.X-ray plain film scans revealed that the upper and lower edges of the lumbar spine of patients with lumbar spine degeneration showed depressions;the lumbar discs of patients with lumbar disc herniation showed scoliosis and decreased bone density;patients with lumbar spinal canal degeneration had hyperosteogeny at the anterior and posterior margins of some lumbar spine;patients with degenerative ligaments and facet joints had round/oval concave at the upper and lower edges of the lumbar spine.Conclusion Both CT and X-ray plain film can diagnose lumbar spinal degenerative disease in the elderly.Among them,the accuracy of CT examination is higher.Among them,the sensitivity,specificity and accuracy of CT examination are higher.In order to avoid the risk of misdiagnosis and missed diagnosis of the disease,joint diagnosis can be carried out according to the patient’s wishes and conditions to help the early treatment of lumbar spinal degenerative diseases.