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目的确定正中矢状径(median sagittal diameter,MSD)在椎间隙层面(DIV)与椎体层面(DV)是否相等,并计算出正常值和正常下限。方法对200例正常成人及183例腰椎管狭窄患者行L2~5椎管CT检查。每个椎间隙层面扫描5层,每个椎体弓根上1/3处扫描1层。均垂直于椎管,层厚层距均为3mm。在软组织窗下测量:椎间隙层面正中矢状径DIV及上方相应椎体弓根上1/3处正中矢状径DV。2组采用同样的扫描和测量方法。结果(1)DIV及DV的平均值分别为(18.38±2.29)mm、(15.40±2.30)mm,正常下限分别为14.6mm及11.6mm;(2)DIV和DV在不同节段间无显著性差异(P>0.05),但DIV与DV在不同节段及同节段间均存在显著性差异(P<0.01);(3)分别用DV和DIV的正常下限值,来判断经手术证实的322个狭窄平面。DV法对先天性骨性椎管狭窄符合率较高(95.6%),但对继发性椎管狭窄符合率很低(17.3%);DIV法对继发性椎管狭窄符合率较DV法明显提高(82.0%);MSD对椎管狭窄的符合率达83.8%,高于DV。结论MSD在椎间隙层面(DIV)与椎体层面(DV)不相等,应分开分别使用,可提高符合率。
Objectives To determine whether the median sagittal diameter (MSD) is equal to the vertebral level (DV) at the intervertebral space level (DIV) and to calculate the normal and normal lower limits. Methods L2 ~ 5 spinal CT was performed in 200 normal adults and 183 patients with lumbar spinal stenosis. Each intervertebral space level scan 5 layers, each vertebra 1/3 on the top of the scan 1 layer. Are perpendicular to the spinal canal, layer thickness layer are 3mm. Measurements were made under a soft tissue window: the median sagittal dimension DIV of the intervertebral space and the median sagittal diameter DV of the upper 1/3 of the corresponding vertebral arch. Group 2 used the same scanning and measurement methods. Results (1) The average values of DIV and DV were (18.38 ± 2.29) mm and (15.40 ± 2.30) mm, respectively, and the normal lower limits were 14.6mm and 11.6mm respectively. (2) There was no significant difference between DIV and DV in different segments (P> 0.05). However, there were significant differences between DIV and DV in different segments and in the same segment (P <0.01). (3) The normal lower limits of DV and DIV The 322 narrow planes. The DV coincidence rate of congenital skeletal spinal canal stenosis was higher (95.6%), but the coincidence rate of secondary spinal stenosis was very low (17.3%). The coincidence rate of DIV and secondary vertebral canal stenosis was lower than that of DV (82.0%). The coincidence rate of MSD to spinal canal stenosis was 83.8%, higher than that of DV. Conclusion The MSD is not equal to the vertebral body level (DV) in the intervertebral space (DIV) and should be used separately to improve the coincidence rate.