一种鉴别腰椎真性滑脱和假性滑脱的临床诊断方法

A clinical diagnostic method for differentiating true spondylolisthesis from pseudospondylolisthesis of the lumbar spine

目的介绍运用腰椎X线侧位片快速鉴别诊断腰椎真、假性滑脱的方法,并明确腰椎滑脱的部位及其程度。方法通过测量腰椎侧位片上滑脱椎体的椎骨前后径和观察滑脱椎骨棘突与相邻棘突的位置关系,同时结合手法触诊进一步明确诊断。结果在腰椎侧位片上,腰椎真性滑脱时滑脱椎体的椎骨前后径增大,并且滑脱椎体椎骨的棘突与上位棘突形成阶梯状改变;腰椎假性滑脱时滑脱椎体的椎骨前后径不变,并且滑脱椎体椎骨的棘突与下位棘突形成阶梯状改变。结论通过在腰椎侧位片上观测滑脱腰椎椎骨前后径的改变以及其棘突与相邻棘突的位置关系即可快速鉴别腰椎真性滑脱和假性滑脱以及诊断腰椎滑脱的部位和程度,大大提高了腰椎滑脱的临床诊断效率,避免医务人员因阅片经验不足或投照技术等问题造成误诊或漏诊的可能性。

Objective To introduce a method of quickly differentiating true spondylolisthesis from pseudo spondylolisthesis of the lumbar spine by using lumbar lateral X-ray films,and clarify the location and degree of lumbar spondylolisthesis.Methods The anterior and posterior diameter of the vertebral body with spondylolisthesis was measured on lumbar lateral film,and the positional relationship between spondylolisthesis spinous process and adjacent spinous process was observed.Combined with palpation,the diagnosis was further clarified.Results On lumbar lateral X-ray film,when true spondylolisthesis occurred,there was an enlargement of anterior and posterior vertebral diameter in spondylolisthesis,and spondylolisthesis spinous process and superior spinous process form a stepped change.When pseudospondylolisthesis occurred,the anterior and posterior vertebral diameter in spondylolisthesis remained unchanged,and spondylolisthesis spinous process and inferior spinous process form a stepped change.Conclusion Measuring the anterior and posterior diameter of the vertebral body with spondylolisthesis on lumbar lateral film and observing the positional relationship between spondylolisthesis spinous process and adjacent spinous process can quickly differentiate true spondylolisthesis from pseudospondylolisthesis of the lumbar spine and diagnose the location and degree of lumbar spondylolisthesis.This greatly improves the clinical diagnostic efficiency of lumbar spondylolisthesis and avoids the possibility of misdiagnosis or missed diagnosis by medical personnel due to the lack of experience in film reading or photography technology.