脊髓造影斜位片诊断腰椎间盘突出症价值的探讨  

The Value of Different Angle Myelography on the Diagnosis of Disc Herniation

作　　者：锡林宝勒日 陈刚[2] 白靖平[2] 刘应祯[1] 陈慰民[1] 武忠炎 冯成堂[4] 

机构地区：[1]新疆医科大学第二附属医院骨科 [2]新疆医科大学第一附属医院骨科 [3]乌鲁木齐铁路中心医院骨科 [4]新疆医科大学第二附属医院放射科

出　　处：《现代医用影像学》2003年第5期198-203,共6页Modern Medical Imageology

摘　　要：目的 :探讨脊髓造影斜位片的最佳投照角度范围 ,细化脊髓造影的诊断征象 ,提高脊髓造影诊断的符合率。材料与方法 :(1)回顾 10 6例患者脊髓造影正、侧、斜位像X线病理变化征象 ,并与手术所见进行比较。 (2 )按预先设计的角度(30°、 4 0°、 4 5°、 5 0°和 6 0°)对 30例诊断为腰椎间盘突出症的患者拍摄不同角度脊髓造影斜位片 ,计算诸角度斜位像诊断符合率 ,测量不同角度斜位像神经根长度和根囊角大小 ,并用盲法与手术结果进行统计学比较。结果 :(1)回顾性资料 :定性诊断中 ,脊髓造影正、侧、斜位像灵敏度分别为 :86 4 %、 83 3%和 91 2 % ,特异度分别为 :6 6 7% ,17 2 %和 80 0 %。对 73例手术证实为旁侧型椎间盘突出症患者的定位诊断中 ,正位像符合率为 30例 (4 1% ) ,斜位像 6 2例 (84 9% )。 (2 )前瞻性资料 :与手术结果比较 ,30°～ 5 0°斜位像诊断腰4～ 5、腰5骶1椎间盘突出症的符合率未见明显差别。经配伍组方差分析 ,Newman -Keuls检验 ,30°～ 5 0°斜位像神经根长度、根囊角大小无显著性差异 ,与 6 0°比较均有显著性差异。结论 :(1)与正侧位像相比较斜位像对诊断旁侧型腰椎间盘突出症具有明显优势。 (2 )脊髓造影斜位片应在 30°～ 4 5°范围内投照 ,在腰4～ 5水平首选出 4 0°为中?Purpose:The purpose of this study was using different angle myelogrphy (DAM) observation to explore the insignificance on the diagnosis of disc herniation and to evaluate the best angle's scope of DAM oblique projection.Materials and Methods:The image materials of 106 cases in recent 6 years were viewed and compared with their operative findings individually.30 cases of DAM,including 30°,40°,45°,50°and 60° oblique projection,had been performed before operation in advance.At L 4～5 and L 5～S 1 level,length of never root and degrees of root-sac angle were measured and analyzed by statistical method.Results:In retrospective materials,the sensitivities of right,lateral and oblique position had achieved 86.4%,83.3% and 91.2% and the specificities were 66.7%,17.24% and 80% respectively.According to localizing herniation direction in the middle of 73 lateral protrusion cases,the accuracy of right positoon was 41% and oblique position was 84.9%.In prospective materials,there is not obvious difference on diagnosing disc herniation of L 4～5 and L 5～S 1 level during the scope from 30°to 45° oblique.The oblique from 30° to 45° do not have obvious difference at the length of never root and degrees of root-sac angle.Conclusion:(1) oblique projection may be the most valuable index on the diagnosis of lateral protrusion for myelography.(2)The oblique of myelography should be performed at the scope from 30° to 45°.

关 键 词：诊断 脊髓造影 斜位片 投照 腰椎间盘突出症 患者 神经根 细化 大小 角度 

分 类 号：R816.8[医药卫生—放射医学]