摘要
1.目的:研究不同类型腰椎间盘突出症的临床特点及CT与MRI在诊断腰椎间盘突出症及鉴别不同类型腰椎间盘突出症的价值。
2.方法:从2005年1月1日至2009年12月31日就诊于福建医科大学附属第一医院骨外科40例腰腿痛并均行CT和MRI检查,经手术证实为腰椎间盘突出症患者。其中破裂型17例,非破裂型23例。男16例(占40%),女24例(60%);年龄31～80岁,平均(50.6±6.6)岁,病程最长的35年,最短的2月。通过比较CT与MRI诊断结果,结合临床症状、体征,研究不同类型腰椎间盘突出症的临床特点CT与MRI在诊断腰椎间盘突出症及鉴别不同类型腰椎间盘突出症的价值。
3.结果:LDH的JOA评分11.32±2.11分,RLDH为18.22±3.77分,两者比较有显著性差异(P<0.01)。40例患者42个病变部位, CT检出37个病变部位,诊断率为88.09%;MRI检出38个病变部位,诊断率为90.47%。两者对比差异无统计学意义。对于不同类型腰椎间盘突出症,CT在破裂型中显示髓核异位、巨大突出、边缘模糊及后缘锐角征象发生率明显高于非破裂型,髓核脱出率在50%以上者,非破裂型的发生率为8.6%,而破裂型为47.06%,两组间有统计学意义。MRI在破裂型中显示髓核异位、脱出髓核周围低信号带亦有较高发生率。
4.结论:RLDH较LDH有更明显的症状、体征,CT与MRI在诊断LDH中均有较高的诊断准确率,CT与MRI有机结合检查在鉴别诊断RLDH与LDH有重要意义。
Objective: To study clinical characteristics of different types of lumbar disc herniation and the value of CT and MRI in the diagnosis and identify in different types of lumbar disc herniation
Methods: From January 1, 2005 to December 31, 2009 in the First Affiliated Hospital of Fujian Medical University, 40 patients with low back pain and bone surgery underwent CT and MRI exmination, whom were confirmed by surgery as lumbar intervertebral disc hernia, with 17 cases ruptured and 23 cases of non-ruptured. And 16 males (40 %) and 24 females (60 %); the age form 31 to 80 years, (50.6±6.6) years. the longest course was 35 years, and shortest in 2 months. By comparing the results of CT and MRI diagnosis, combine clinical symptoms and signs, to study clinical characteristics of different types of lumbar disc herniation and the value of CT and MRI in the diagnosis and identify in different types of lumbar disc herniation
Results: The JOA score of LDH was (11.32±2.11)points, wheres RLDH (18.22±3.77)points , there is a significant difference (P<0.01) . 40 patients with 42 lesions, CT detected 37 lesions, the detection rate of 88.09%,MRI detected 38 lesions, the detection rate of 90.47%. No statistically was between the difference significance. For different types of lumbar disc herniation, CT display as the ruptured edge blur, ectopic nucleus, after huge margin prominent and acute signs were significantly higher than the non-ruptured, disc prolapse rate of 50%, non-broken type of occurrence was 8.6%, while the rupture was 47.06%. Between the two groups was statistically significant difference. MRI shows in ectopic nucleus and the ruptured disc prolapse with low signal around the high incidence there.
Conclusion: RLDH has more obvious symptoms and signs than LDH, CT and MRI both have high diagnostic accuracy in the diagnosis of LDH, the combination of CT and MRI examination show a significant value in indentify LDH and RLDH.
引文
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