摘要
目的 探讨多层螺旋CT（MSCT）负荷检查在评估腰椎间孔（LIF）内神经根卡压中的价值。资料与方法 利用自行研制的腰椎应力器对30例腰腿痛患者行MSCT检查，负荷前后各作1次螺旋扫描，范围包括整个LIF，在3个正交的平面上分别调整重建中心线使之与人体正交的3个平面平行，在冠状像上重组LIF的矢状平面，观察LIF内神经根的毗邻关系，将其分成4级：0级：神经根周围或前后下缘环绕脂肪；Ⅰ级：神经根前缘或后缘脂肪消失与LIF壁接触；Ⅱ级：神经根前后缘脂肪消失，与LIF壁接触，神经根可变形；Ⅲ级：神经根周围脂肪消失，神经根变形。以0-Ⅰ级神经根无卡压，Ⅱ级可疑卡压，Ⅲ级神经根受压为标准并结合临床评估LIF内神经根卡压情况。结果 30例中，35个平面无椎间盘膨出／突出（A组），负荷前后神经根分级分别为：0级31个、Ⅰ级39个、Ⅱ，Ⅲ级0个和0级25个、Ⅰ级42个、Ⅱ级3个、Ⅲ级0个。负荷后9个LIF内神经根分级晋级，神经根分级Ⅱ-Ⅲ级3个（χ^2=1．87，P〉0．05）。55个平面椎间盘膨出／突出（B组），负荷前后神经根分级分别为：0级21个、Ⅰ级49个、Ⅱ级36个、Ⅲ级4个和0级15个、Ⅰ级32个、Ⅱ级47个、Ⅲ级16个，负荷后34个LIF内神经根分级晋级，显著高于A组（χ^2=20．42，P〈0．01），神经根分级Ⅱ-Ⅲ级63个显著高于负荷前40个（χ^2=9．66，P〈0．01）。负荷检查时30例均伴不同程度的腰腿痛；常规检查时仅17例伴不同程度的腰腿痛（χ^2=9．29，P〈0．01），且程度较轻。结论 MSCT负荷检查较有效地评估腰椎退变LIF内神经根受压情况，有助于对隐匿性腰椎管狭窄的检出。
Objective To discuss the value of assessing the compression of nerve root （for short： N） in lumbar intervertebral foramen （for short： LIF） by 16 multi-slice spiral CT axial loading examination. Materials and Methods Using the self-developed compression deviee , 30 patients with low back pain, sciatica or neurogenic claudication were examined by 16 multi-slice spiral CT under pscas-relaxed position （PRP） and axial compression in extension （ACE） respectively. The field of scan covered the whole of LIF. The collimiuation uf scan was 0.75mm. In the three cross-corrected plane, the central line of the reconstruction was regulated to parallel to the three cross-corrected human body plane. The sagittal plane of LIF was reconstructed in coronal plane; in which the adjacent relation of the nerve root was observed. The relation were divided into four grade ： zero grade ： the around or except upper edge of N was surround by fat; grade Ⅰ： the front or behind edge of N was in touch with the wall of LIF; grade Ⅱ： both the front and behind edge of N was in touch with the wall of LIF, the form of N was changed; grade Ⅲ： fat in the around of N was disappeared, N was pressed. Combined with the clinic, the condition of the compression of N was assessed by the criterion ： grade zero-Ⅰ： no compression; grade Ⅱ： suspicious compression and grade Ⅲ： compression of N. Results 35 plane was not disc bulge or herniation （group A） in 30 patients, The number of N in grade of zero, Ⅰ, Ⅱ and Ⅲ before and after axial loading were 31 . 39. 0, 0 and 25, 42, 3, 0,respectively, There were only 9 N which the grade of compression was promoted, Ⅱ-Ⅲ grade N was ACE（3） and PRP（χ^2 = 1.87, P 〉 0.05）. 55 disc bulge or herniation （group B） in,30 patients, The number of N in grade of zero Ⅰ,Ⅱ and Ⅲbefore and after axial loading were 21, 49, 36, 4 and 15, 32, 47, 16, respectively. There were 34 N which the grade of compression be promoted ; The number of N in increased grade of compression in group B was more higher than that of group A （χ^2 = 20.42, P 〈 0.01 ） . There were more significant difforenee of number of Ⅱ-Ⅲ grade N in ACE （63） and PRP （40） （χ^2= 9.66, P 〈 0.01 ）at group B. 30 patients had symptoms in some degree during ACE, while only 17 patients had symptoms during PRP （χ^2 = 9.29, P 〈 0.01 ）. Conclusion Axial loading using 16 multi-slice spiral CT can effectively assess the conditions of the compression of N in LIF of degenerated lumbar spine, which is useful to detect occult lumbar canal stenosis.
出处
《临床放射学杂志》
CSCD
北大核心
2007年第1期49-52,共4页
Journal of Clinical Radiology
基金
江苏省南通市社会科技发展计划基金资助项目(S40003)
