老年脊柱畸形影像学检查应注意的问题（中英文对照）

在评估老年脊柱畸形时，放射学测量要求拍摄患者独立站立位影像。这样的体位对有效评估畸形的主要特征和患者可能恢复平衡的潜在代偿机制是必不可少的。如果患者不处于负重位，那么就有可能低估畸形全貌、躯干倾斜以及代偿机制，导致对患者不准确的评估和治疗。理想的站立位X线照片体位包括自然足位，肩关节前屈，肘关节屈曲至指尖置于颧骨或锁骨中点。

Radiographic measures in the context of adult spinal deformity evaluation require images obtained in a freestanding patient position.This patient positioning is essential to effectively evaluate key aspects of a deformity and potential compensatory mechanisms that a patient may be recruiting.If a patient is not in a weight-bearing position,global deformity,truncal inclination,or compensatory mechanisms can be underestimated and lead to improper patient evaluation and treatment.Ideal standing radiograph position involves natural foot position,forward shoulder flexion,and elbow flexion to bring fingertips onto the cheekbones or midclavicles.

CT和MRI研究表明，可以量化腰段脊柱对旋转力矩的反应，并发现退变椎间盘轴向旋转的增加与椎间盘造影激发的疼痛有一定联系。另外，轴性腰痛患者的X线平片显示出与退变性椎间盘疾病相一致的特征。虽然X线照片不能区分软性椎间盘组织，但可以显示椎间盘高度降低，即提示椎间盘塌陷或脱水。终板硬化或骨在骨上的现象常见于严重的椎间盘退变，且这就是疼痛源的标志。

CT and MRI studies have quantified the response of the lumbar spine to rotatory torque and have correlated increased axial rotation in degenerated discs with pain provocation on discography.Additionally plain radiographic fi ndings in patients with axial low back pain may demonstrate characteristics consistent with degenerative disc disease.While radiography does not demarcate soft tissue disc,film may reveal decreased disc height consistent with a collapsed or dehydrated disc.Sclerotic end plates or bone-on-bone appearance are commonly seen with severely degenerated discs and may indicate pain origin.

参见《微创脊柱畸形外科学（第三章）》