腰椎真性滑脱CT诊断思路.docVIP

腰椎真性滑脱CT诊断思路[摘要] 目的 寻找一种诊断思路来提高腰椎真性滑脱CT诊断的准确性。方法 随机将54例腰椎真性滑脱的CT片分为两组,每组27例。第1组由2名CT室高年住院医师共同阅读,根据自己的经验进行讨论,并作出诊断;第2组由2名CT室低年住院医师共同阅读,根据自己的观察,并用逆向追踪法进行诊断。阅片结果采用χ2检验。逆向追踪法是指观察滑脱腰椎下方小关节有无异常和从下向上查看滑脱腰椎的椎板前端有无骨质断裂。结果 第1组2名医师讨论后诊断准确率为77.8%(21/27),第2组2名医师诊断准确率为100%(27/27)。经统计学处理,表明两组间存在着差异(P0.05),有显著性意义。结论 用逆向追踪法可提高腰椎真性滑脱的CT诊断水平,对非螺旋CT容积扫描检查腰椎真性滑脱的医院有实用价值。 [关键词] 腰椎; 脊椎滑脱; 椎弓崩裂; 断层摄影; X线计算机 [中图分类号] R816.8 [文献标识码] A [文章编号] 1673-9701(2009)27-153-02 A Diagnosis Mentality on CT in Lumbar Spondylolysis and Spondylolisthesis LI Shiguang Department of Medical Imaging,Zunyi Hospital,Zunyi 563002,China [Abstract] ObjectiveTo seek for a diagnosis mentality to enhance accuracy on CT in lumbar spondylolysis and spondylolisthesis. MethodsThe diagnosis mentality was looking for the spondyloschisis from the bottom up. There were two groups with 54 CT films of lumbar spondylolysis and spondylolisthesis. The first group consisted of 2 senior radiologists without applying the mentality and the second consisted of 2 junior radiologists assisted with using the mentality. Statistical method was χ2 test. ResultsStatistics analysis indicated that there were significant difference(P0.05) between two groups. ConclusionThe diagnostic accuracy of CT imaging in lumbar spondylolysis and spondylolisthesis could be improved markedly by the diagnosis mentality. It is valuable to the hospital which is not using spiral CT to evaluate lumbar spondylolysis and spondylolisthesis. [Key words]Lumbar vertebra; Spondylolysis; Spondyloschisis; Tomography; X-ray 腰椎滑脱是腰腿痛的常见病因之一,分为真性滑脱和假性滑脱两种。由椎弓崩裂所导致的椎体向前移位称为真性滑脱,而由退行性改变所引起的滑脱称为假性滑脱。本文搜集我院54例明确诊断为腰椎真性滑脱的CT图像进行回顾性分析,以找出一种简单可行的诊断思路来提高腰椎真性滑脱CT诊断的准确性。 1 材料与方法 1.1 病例资料 本组54例腰椎真性滑脱患者中男33例,女21例;年龄25～68岁。均用Siemens Emotion due CT机扫描非螺旋平扫,扫描层面与椎间隙平行,层厚4mm,层距4mm,每个椎间隙扫描6层,分别摄软组织窗和骨窗片。 1.2 方法 逆向追踪法:定位相发现腰椎滑脱后,先用Meyerding氏法判断滑脱程度,再于横断面内观察滑脱腰椎下方椎小关节有无退行性变及半脱位;若小关节无相对正常、特别是滑脱较重时,可能提示为真性滑脱;最后从下向上追踪滑脱腰椎之椎板前端、横突附着处后缘有无骨质断裂及缺损,有即可诊断为真性滑脱。以L5椎