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目的:探讨脊髓造影与CT脊髓造影在退行性腰椎侧凸性椎管狭窄(degenerative lumbar stenosis with scoliosis,DLSS)中的诊断价值,并与MRI扫描、手术所见相比较。方法:选择2004-01/2007-06在北京协和医院骨科收治、并经手术证实的DLSS患者97例。所有患者均经脊髓造影和CT脊髓造影观察,其中43例同时行MRI扫描。通过脊髓造影与CT脊髓造影的影像进行分析,确定其椎管狭窄部位、病变范围和病变程度,并与术中所见及MRI比较。结果:①脊髓造影与CT脊髓造影的表现:DLSS对硬膜囊或神经根的压迫较退行性腰椎管狭窄症复杂,除与关节突肥大增生、黄韧带肥厚、椎间盘退变突出有关外,还与关节突关节半脱位、椎弓根移位压迫神经根等因素有关。②与手术所见的符合率:脊髓造影、CT脊髓造影的诊断正确率分别为87.6%和92.8%,二者联合应用的诊断正确率为95.3%;对于不同弯度的DLSS,二者的诊断正确率无明显差异。③与MRI比较:在弯度较大的DLSS中,脊髓造影与CT脊髓造影的诊断正确率高于MRI。结论:脊髓造影和与CT脊髓造影的联合应用于DLSS诊断正确率较高,对于弯度较大的DLSS诊断正确率优于MRI。
Objective: To investigate the diagnostic value of myelography and CT myelography in degenerative lumbar stenosis with scoliosis (DLSS), and to compare with MRI and surgical findings. Methods: A total of 97 patients with DLSS who were admitted to Peking Union Medical College Hospital from January 2004 to June 2007 were selected. All patients were observed by myelography and CT myelography, of which 43 cases were simultaneously scanned by MRI. Myelography and CT myelography images were analyzed to determine the location of spinal stenosis, lesion range and degree of lesions, and compared with intraoperative findings and MRI. Results: ① myelography and CT myelography performance: DLSS on the dural sac or nerve root compression than degenerative lumbar spinal stenosis complicated, in addition to the joint hypertrophy hypertrophy, ligamentum flavum, prominence of disc degeneration With subluxated facet joint subluxation, pedicle root compression nerve root compression and other factors. ② The coincidence rate with the surgery: myelography, CT myelography diagnostic accuracy rates were 87.6% and 92.8%, the combined diagnosis of the two was 95.3%; for different camber DLSS, both diagnosed correctly No significant difference in rates. ③ Compared with MRI: in the larger curvature of the DLSS, myelography and CT myelography diagnosis accuracy rate higher than MRI. Conclusion: The combination of myelography and CT myelography has a higher correct rate of DLSS diagnosis, and the diagnostic accuracy of DLSS with larger curvature is better than that of MRI.