摘要
[目的]评估3D-MRI技术在诊治不典型腰椎间盘突出症的作用。[方法]2013年10月~2015年6月,收治36例不典型腰椎间盘突出症患者。男14例,女22例;年龄45~74岁,平均61岁。其中传统影像学检查显示压迫不明显但临床表现典型17例、传统影像学检查显示压迫明显但临床表现不典型7例、传统影像学上多节段表现异常而不能确定责任节段12例。病程1~31个月,平均14.4个月。采用传统MRI、神经根封闭、3D-MRI和磁共振水成像技术进行诊断。明确诊断后12例年轻患者接受经皮脊柱内窥镜椎板间开窗入路微创治疗,24例老年患者则接受腰椎后路减压植骨融合内固定术。[结果]传统MRI发现责任节段病7例,3D-MRI发现33例,神经根封闭发现35例（P〈0.001）。所有患者术后均恢复良好,除2例开放手术患者术后1个月再次出现腰痛,行保守治疗后缓解。末次随访VAS与ODI指数较术前评分明显改善（P〈0.01）。术后1年根据改良Mac Nab标准评价疗效,优良率为94.4%（34/36）。[结论]3D-MRI技术在诊治不典型腰椎间盘突出症中具有重要作用,能减少腰椎失败综合征的发生。
[ Objective ] To investigate the value of three - dimensional magnetic resonance imaging （3 D - MRI） in the di- agnosis and treatment of atypical lumbar disc herniation （LDH） . [ Methods] A total of 36 patients with atypical LDH were admitted from October 2013 to June 2015. There were 14 males and 22 females, aged from 45 to 74 years, with a mean age of 61 years. Among the patients, 17 cases showed unobvious compression with traditional imaging, but had typical clinical symp- toms; 7 cases showed obvious compression with traditional imaging, but had atypical clinical symptoms; 12 cases showed multi - level abnormalities with traditional imaging, but the responsible segment could not be confirmed. The courses of disease were 1 -31 months （mean 14. 4 months） . Diagnosis was made using traditional MRI, nerve root block, 3D -MRI, and magnetic resonance hydrography. After confirmation of diagnosis, 12 young patients underwent microendoscopic discectomy, and 24 elder- ly patients underwent lumbar posterior decompression, bone graft fusion, and internal fixation. [ Results ] Traditional MRI found the responsible segment in 7 cases, 3D - MRI in 33 cases and nerve block in 35 cases （P 〈0. 001 ） . All patients had good recovery after surgery, except that 2 patients experienced waist pain at one month after open surgery, and were alleviated after conservative treatment. The VAS and ODI scores in the last follow up were significantly improved compared with those before surgery （P 〈 0. 01 ） . At one year after surgery, modified MacNab standard was used to evaluate the efficacy, and the excel- lence and good outcomes rate was 94. 4% （34/36） . [ Conclusion] 3D- MRI is of great importance in the diagnosis and treatment of atypical lumbar disc herniation, and can reduce the incidence of failed back surgery syndrome.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第23期2134-2138,共5页
Orthopedic Journal of China
