目的 探究CT和MRI在腰椎间盘突 出及不同类型腰椎间盘突出的诊断及应 用价值，为临床治疗提供指导。方法 回 顾收集来我院诊断为腰椎间盘突出患者65 例，手术前进行CT和MRI检查，证实破裂 型腰椎间盘突出症者28例，证实腰椎间盘 突出症者37例，对照手术结果，对比两种 方法检出准确率，比较CT和MRI对腰椎间 盘突出征象诊断阳性诊断，分析两者对不 同类型腰椎间盘突出鉴别价值。结果 在 椎间盘膨出、脱出、影出、游离及结节 上，MRI和CT检出率无差异(P＞0.05)，在 椎间盘突出及合计上，MRI检测结果显著 高于CT(P＜0.05)；CT在钙化、积气的诊 断上显著优于MRI（P＜0.01)，MRI在椎间 盘变性、硬脊膜受压、脊髓变性的阳性率 优于CT(P＜0.05)，两者在神经根受压的 诊断上无差异(P＞0.05)；在髓核异位、 巨大突出、后缘锐角、边界模糊上，CT 在RLDH的阳性率分别为78%、82%、42%、 75%，在LDH的阳性率分别为8%、13%、 10%、32%，存在显著差异(P＜0.01)；在 髓核异位、低信号带、后缘不规则、椎 间盘变性上，MRI在RLDH的阳性率分别为 89%、21%、85%、82%，在LDH的阳性率 分别为5%、0%、21%、56%，存在差异(P ＜0.05)。结论 两者在腰椎间盘突出的诊 断中有各自的优点，CT观察突出的腰椎间 盘位置、形态、密度有优势，MRI清晰显 示出椎管内构造。

Objective To explore the value of CT and MRI in the diagnosis of lumbar disc herniation and different types of lumbar disc herniation, and provide guidance for clinical surgical treatment. Methods 65 patients with lumbar disc herniation were retrospectively collected in our hospital. CT and MRI examination were used before surgery, 28 cases were confirmed RLDH and 37 cases were confirmed lumbar disc herniation. Compare the detection accuracy and discriminating value on different kind of lumbar disc herniation according to operation result. Results In the intervertebral disc bulge and disc image, protrusion of intervertebral disc, intervertebral disc free, intervertebral disc nodules, MRI and CT detection rate had no difference (P>0.05), on the protrusion of intervertebral disc and total, MRI detection results were significantly higher than those in CT (P<0.05). CT was superior to MRI (P＜0.01) in the diagnosis of calcification and product gas. The positive rate of MRI was superior to CT (P<0.05) in the diagnosis of lumbar disc degeneration, spinal cord degeneration, and the diagnosis of nerve root compression (P>0.05). On ectopic nucleus, enormous prominent, sharp posterior angle, fuzzy boundary, CT positive rate in the RLDH were 78% and 82%, 42%, 75%, the positive rate in the LDH respectively 8%, 13%, 10%, 32%, there is a significant difference (P<0.01). The positive rates of MRI were 5%, 21%, 56%, 0%, 21% and 82% respectively (P<0.05) in RLDH positive rate of85% and 89%, respectively. Conclusion MRI and CT have different advantages in the diagnosis and treatment of lumbar disc herniation. CT has its advantages in observing lumbar intervertebral disc location、shape、density. MRI clearly shows the structure of the spinal canal.