摘要
目的分析滑脱前期腰椎弓峡部裂(slipping prophase lumbar spondylolysis,SPLS)常规影像检查表现,探讨其诊断策略。方法收集经影像诊断明确的SPLS患者69例,均因腰腿痛首诊,分别做了不同种类的常规影像学检查,检查前均无临床提示。分析SPLS常规影像学表现,计算X线、多层螺旋CT(MSCT)和MRI首诊率并做统计分析。结果 69例患者中,31例摄X线正侧位片,其中5例同时加摄双斜位片;33例行腰椎间盘MSCT扫描,其中24例及时做了补充扫描;5例行MRI常规扫描。X线、MSCT和MRI首诊率依次为:61.3%(19/31)、72.7%(24/33)和20.0%(1/5)。SPLS常规影像表现为:椎弓峡部变细,X线可见透亮线影;MSCT下位椎体上关节突附近发现碎骨块和椎管矢状径增大;MRI峡部皮髓质信号欠连续。结论 SPLS常规影像检查表现隐匿,敏感而及时地发现其蛛丝马迹并进一步做MSCT容积扫描多方位重组或反机架层面扫描是防止SPLS漏诊的关键;后者因其低耗、低辐射和高诊断率,可以作为SPLS筛选和确诊的首选检查方法。
Objective To analyze the imaging manifestations of slipping prophase lumbar spondylolysis（SPLS） in conventional examinations and to discuss its diagnosis strategies.Methods Data of 69 cases of confirmed SPLS were collected.All patients underwent different kinds of routine imaging examinations with backleg pain as the initial symptoms.Findings of routine imaging examinations were analysis and first visit rates of X-ray,multislice computed tomography（MSCT）,and Magnetic Resonance Imaging（MRI） were calculated and analyzed statistically.Results Of the 69 cases,31 underwent X-ray examinations in anteroposterior and lateral positions,5 with additional double oblique positions at the same time;33 underwent MSCT scan of the lumbar disks,of which 24 underwent supplementary scanning timely;5 underwent routine MRI scans.First visit rates of X-ray,MSCT,and MRI were 61.3%（19/31）,72.7%（24/33）,and 20.0%（1/5）respectively.Imaging manifestations of SPLS in conventional examinations include：slimmer isthmus of vertebral arch,bright thread shadows in X-ray imaging,fractured bone graft near the upper spine and enlargement of the vertebral canal in MSCT findings,poor continuity for signals of cortex and medulla in the isthmus from MRI findings.Conclusion The imaging manifestations of SPLS in conventional examinations were occult.Further MSCT volume scanning for multi-planar reconstruction and counter-angle plane scanning are crutial to avoid misdiagnosis,the later of which is the first choice for SPLS screening and diagnosis because of the low cost,low radiation and high diagnosis rate.
出处
《中国全科医学》
CAS
CSCD
北大核心
2011年第21期2467-2470,共4页
Chinese General Practice
