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腰椎间盘突出症手术治疗的MRI影像学疗效评价

作者:辛 欣1 刘新新2

所属单位:1.陕西省安康市中心医院骨科医院骨科(陕西 安康 725000) 2.陕西省西安市红会医院核磁共振室(陕西 西安 710000)

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摘要

目的探讨椎间盘突出症手术 治疗的MRI影像学疗效评价。方法 选取 医院收治的腰间盘突出症患者32例作为 研究对象,术前及术后均行磁共振成像 (MRI)检查,评估临床疗效。结果 本组 32例患者手术均成功,治疗优良率为 87.5%。本组患者中2例出现术后并发 症,经针对性处理后均明显好转;治疗 后VAS评分为(3.07±1.06)分较治疗前 低,JOA评分为(23.94±3.27)分较治疗 前高,差异具有统计学意义(P<0.05); 治疗后硬膜外压痕矢径、硬膜外压痕纵 轴、椎间隙高度分别为(3.98±1.85) mm、(9.52±4.06)mm、(9.05±2.61)mm 均较治疗前低,差异具有统计学意义(P <0.05);治疗后软骨退化程度较治疗 前轻,差异显著,具有统计学意义(P <0.05);术后28例椎间组织上T2WI明 显回升;32例神经根增粗、变性明显改 变,T2WI信号减低。结论 MRI可作为评 价椎间盘突出症术后疗效的重要影像学 方式。

Objective To explore the therapeutic evaluation of MRI imaging of surgical therapy for lumbar disc herniation. Methods 32 cases of patients with lumbar disc herniation admitted into the hospital were selected as the research object. Magnetic resonance imaging (MRI) was carried out before and after surgery and the clinical efficacy was evaluated. Results All the 32 patients in the group were operated successfully and the excellent and good rate was 87.5%. There were postoperative complications appearing in 2 cases and after the targeted treatment, they were significantly improved; VAS score after the treatment was (3.07±1.06) which was lower than that before the treatment. JOA score was (23.94±3.27) which was higher than that before the treatment and the differences were statistically significant (P<0.05); after the treatment, the epidural indentation radius vector, epidural indentation longitudinal axis, intervertebral space height respectively were (3.98±1.85)mm, (9.52±4.06)mm and (9.05±2.61) mm which were lower than those before the treatment and the differences were statistically significant (P<0.05); After the treatment, the degree of cartilaginous degradation was lighter than that before the treatment and the difference was statistically significant (P<0.05); There 28 cases of significantly rebounded intervertebral tissue T2WI; 32 cases of nerve root thickening, significantly changes of degeneration and decreasing T2WI signal. Conclusion MRI can be used as an important imaging method to evaluate the efficacy of the treatment of lumbar disc herniation.

【关键词】腰间盘突出症;手术;磁共振成像;椎间隙高度

【中图分类号】R323.3+3

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.09.003

前言

腰椎间盘突出症是临床常见随疾病,具有病程长、复发率高的特 点,严重影响着患者的生活质量。手术是临床治疗的LDH的常用方式, 如:椎板间开窗腰椎间盘摘除术、经皮椎间摘除术、显微镜或椎间孔镜 下腰椎间盘摘除术等,短期手术效果为75%~95%[1]。多项研究表明,部 分患者接受治疗后,疾病相关症状明显改善,但影像表现与术前差异并 不明显。可见,腰椎间盘突出症手术效果与影像学表现存在密切关系。 随着影像学技术的发展,MRI逐渐应用于腰椎间盘突出症诊治中,因其 具有分辨率高、图像质量好、无创的特点,可清楚显示脊髓、神经受压 等情况,在术前诊断和术后评估疗效中具有较高的应用价值[2]。对此, 本文分析了32例腰椎间盘突出症患者经椎间孔镜下腰椎间盘摘除术后临 床体征及MRI表现改善情况,现报道如下。