腰椎间盘纤维环膨隆症站立位动态脊髓造影的临床意义

目的:在MRI或CT检查的腰腿痛病人中,通过站立位动态脊髓造影,了解椎间盘纤维环在腰椎中立、过屈、过伸三位置下的变化,并探讨其临床意义,筛选出具有手术指征的LDH病人,决定手术方式.方法:对86例LDH患者,行站立或平卧中立、过屈、过伸脊髓造影,对比分析两组动态变化.鉴别出LDB,选择性行有限椎板减压,或保留其椎间盘.结果:脊髓造影侧位像“拿破仑帽”状影,站立三位置均明显大于平卧位,差异非常显著(P＜0.01),在动态变化中平卧位者改成由中至屈曲位时,硬膜囊受压影较站立位者明显缩小,差异非常显著(P＜0.01),站立由中至伸时,压迫影较平卧位增大,差异显著(P＜0.05).其中28例,行有限椎板切除或保留其椎间盘,效果优良.结论:站立位会使LDB加重、临床症状加重,因站立过伸位使腰椎管狭窄病人症状加重.而平卧位造影时因重力负荷减轻,(拿破仑帽)影像不明显或消失,而出现假阴性.

Clinical Application of Standing Dynamic Myelogram in the Lumbar Disc Bulging

Objective: For the choice of surgical management in patients LDB associate with LDH simultaneously, a comparative obsewation of the difference between standing and supine position dynamic myelogram were performed in somebody cases, after MRI or CT seam. Methods: Standing and supine dynamic myelography were performed in 86 cases with lower back pain after MRI or CT examination. Identify LDB by analyzing the difference between standing and supine dynamic myelogram then treated the LDB patients by limited hemilaminectomy or enestration reserving intervertebral disc. Results: The changes in "Napolenm hat-like", a depth of notch in the anterior interval of dural sac pressing by LDB or LDH were markedly increased from neutral to hyper-exlension position (P < 0. 05). As cases indentified by the examination were performed on fenestion (or hemilaminectomy) or/and reserved the bulging disc. The results were fair. Conclusions: The standing position can enhance LDB gravitational load pseudo-negative results often appear in supine position dynamic myelogram of the gravitational load.