腰椎滑脱的影像学特征和手术治疗  

The radiographic features of spondylolisthesis and outcomes of surgical treatment

作　　者：丁文元[1] 张为[1] 高石军[1] 申勇[1] 董玉昌[1] 张标[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄0580051

出　　处：《中国骨肿瘤骨病》2003年第6期360-362,共3页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的 分析腰椎滑脱的影像病理特征,评估腰椎滑脱减压植骨内固定术的疗效。方法 对41名(男21例,女20例,41～63岁)腰椎滑脱患者进行至少为期1年的随访评估。结合影像学检查,分析腰椎滑脱的影像学病理特征,据此选择不同的手术方法治疗,应用侯树勋等人提出的疗效评价标准评估术后临床疗效。结果 特征性的影像学表现:X线片上的峡部断裂、CT扫描可见关节突间部骨质缺损、脊髓造影的“台阶”现象或脊髓造影的不完全梗阻或完全梗阻,以及MRI检查的双叶征等,可显示神经受压情况,用来指导神经减压术。本组患者术后取得满意疗效,Ⅰ度滑脱的21例患者完全解剖复位,Ⅱ度滑脱18例中17例完全复位,Ⅲ度滑脱1例完全解剖复位,1例复位至Ⅰ度。30例达到优的标准,6例达到良,4例可,1例效果差。结论 术前仔细分析患者的影像学检查,了解影像学特征,制定合理的手术方案是获得满意临床疗效的关键。Objective To study the pathological imaging features of spondylolisthesis and evaluate the clinical outcomes of surgical treatment of this disease. Methods A retrospective study of 41 patients (21 men, 20 women) ranging in age from 41 to 63 years with a follow - up of at least 12 months was conducted. The pathological imaging fea- tures of the slip segments were analyzed based on these imaging findings. Different surgical approaches were selected according to the different pathological imaging features of the patients. The clinical outcomes of surgical treatment were assessed using the evaluation criteria proposed by HOU, Shuxun, et al. Results The characteristic imaging appearances such as‘boken pars' in radiography,‘incomplete ring' in CT scan or‘double leaf sign' in MRI were demonstrated. In this situation, neurological compromise could be seen in the most imaging findings and could be used as an indicator for decompression. The results of surgical treatment were satisfying. All the 21 patients with grade Ⅰlesion got anatomical reduction while 17 of the 18 patients with grade Ⅱ lesion got anatomical reduction. In the 2 patients with grade Ⅲ le- sion, 1 patient got full reduction while the other got reduction to grade Ⅰlesion. The postoperative clinical outcomes showed excellent in 30 patients, good in 6 patients, fair in 4 patients and poor 1 patient. Conclusion If surgical inter- vention is considered, imaging examinations should he studied carefully to get clear understand of the pathological chang- es and thus chose proper surgical approach, this is essential to achieve good clinical results.

关 键 词：腰椎滑脱 影像学 手术治疗 CT 放射摄影术 

分 类 号：R687[医药卫生—骨科学]