腰椎超声图像特征分析及椎体节段定位研究

Analysis of ultrasonic image features of lumbar spine and research on vertebral body segment positioning

目的应用超声观察腰椎骨性结构移行规律,以及腰椎横突数目正常及异常时腰椎节段的识别方法。方法对我科收治的200例腰痛患者均行超声扫查,重点观察并总结腰椎纵切面、横切面的声像图特点和骨性结构移行规律,当腰椎横突数目异常时参考第12肋骨、腰椎棘突、椎板、横突或髂嵴,采取联合应用多种节段确定的方法对腰椎节段进行定位,并与X线检查结果进行对比。结果总结本研究患者腰椎骨性结构的声像图特点和移行规律:(1)纵切面上大致分为5个切面,包括棘突切面、椎板切面、椎板与下关节突切面、上关节突与横突根部切面、横突切面;当连续动态扫查腰椎时可发现棘突向外移行为椎板,椎板向外移行为上下关节突及横突根部,横突根部向外移行为横突。(2)横切面上可分为3个切面,包括横突上关节突关节切面、横突间切面、横突下椎板切面;当连续动态扫查腰椎时可发现关节突关节向下移行为横突,横突向下移行为椎板,椎板向下移行为下一个关节突关节。本研究共12例患者出现腰椎横突数目异常,其中10出现双侧6个横突声影,考虑为胸椎、骶椎腰化(8例、2例);1例左侧出现6个横突声影、右侧出现5个横突声影,考虑为左侧胸12肋骨变短;1例左侧出现5个横突声影、右侧出现4个横突声影,考虑为右侧L1横突变长所致。12例患者经脊柱X线全长片证实,与超声结果一致。结论腰椎骨性结构在横切面及纵切面上均有一定的移行规律,超声是确定腰椎节段的理想方法。

Objective To observe the migration rules of lumbar bony structure,and to inrestigate the identification method of lumbar segments when the number of lumbar transverse processes was normal or abnormal by ultrasound.Methods A total of 200 patients with low back pain in our department were examined by ultrasound,and the ultrasonographic features of longitudinal and transverse sections of lumbar spine and the migration rules of bone structure were observed and summarized.When the number of transverse processes of lumbar spine was abnormal,the 12 th rib,lumbar spine process,vertebral plate,transverse process or iliac crest were referred,and various methods were used to determine the segments of lumbar spine,and the results were compared with those of X-ray.Results The ultrasonographic features and migration rules of lumbar bony structures in this study were summarized:(1)The longitudinal section was divided into five sections,including spinous process section,lamina section,lamina and inferior articular process section,superior articular process and transverse process root section,transverse process section.When the lumbar vertebrae scanned continuously and dynamically,it showed that the spinous process moves outward as lamina,the lamina moves outward as upper and lower articular process and transverse process root,and the transverse process root moves outward as transverse process.(2)The transverse section was divided into three sections,including the articular section on the transverse process,the intertransverse section and the lamina section under the transverse process.When the lumbar vertebrae scanned continuously and dynamically,it showed that the facet joint moves downward as transverse process,the transverse process moves downward as lamina,and the lamina moves downward as the next facet joint.In this study.There were 12 patients with abnormal number of lumbar transverse processes,of which 10 had 6 bilateral transverse processes,which were considered as lumbar vertebrae and sacral vertebrae(8 cases,2 cases).There were 6 transverse process sounds on the left side and 5 transverse process sounds on the right side in 1 case,which was considered as the shortening of the left chest 12 ribs.One case had 5 transverse process sounds on the left side and 4 transverse process sounds on the right side,which was considered to be caused by the long transverse mutation of L1 on the right side.12 patients were confirmed by full-length spine X-ray film,which was consistent with ultrasound results.Conclusion Lumbar bony structures have certain migration rules in both transverse and longitudinal sections,and ultrasound is an ideal method to determine lumbar segments.