MRI在椎间孔镜腰椎间盘切除术治疗腰椎间盘突出症疗效评价中的应用

doi:10.3760/cma.j.cn101202-20210917-00264

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摘要目的探讨MRI在椎间孔镜腰椎间盘切除术治疗腰椎间盘突出症疗效评价中的应用价值。方法回顾性研究。纳入2018年2月—2020年9月北京积水潭医院收治的500例腰椎间盘突出症患者的临床资料。其中男343例,女157例;年龄25~70（50.6±10.4）岁;均为单节段椎间盘突出,L_4/5273例、L₅/S₁227例。患者均行椎间孔镜术治疗。分别于手术前和手术后1、6个月行MR检查。观察指标：（1）评估手术疗效,比较术前和术后1、6个月患者的疼痛视觉模拟评分法（VAS）评分、日本骨科协会（JOA）评分;（2）测量术前和术后不同时间的椎间盘还纳值、硬膜外压痕纵轴值;（3）观察术前和术后不同时间椎间孔、侧隐窝的狭窄发生率,计算手术后不同时间患者椎间隙高度率的变化;（4）分析术后1个月硬膜外压痕纵轴值与患者疼痛VAS评分、JOA评分的相关性。结果 500例患者均顺利完成手术,术后随访1~6个月。患者术后症状均得到缓解。（1）患者术后1、6个月的VAS评分分别为（4.81±0.94）和（2.50±0.65）分,均低于手术前的（7.14±1.48）分;JOA评分分别为（20.64±3.26）和（27.03±2.45）分,均高于术前的（16.06±2.31）分,差异均有统计学意义（F=4.62、P=0.010;F=4.15、P=0.016）。（2）患者术后1、6个月的硬膜外压痕纵轴值分别为（6.37±2.47）、（6.37±2.65）mm,均低于术前的（8.45±3.21）mm,差异有统计学意义（F=92.34,P<0.001）;术后1、6个月的椎间盘还纳值分别为（5.25±2.06）、（5.30±2.34）mm,差异无统计学意义（t=0.36,P=0.720）。（3）术后1、6个月患者的椎间孔狭窄发生率分别为11.2%（56/500）、3%（15/500）,侧隐窝狭窄发生率分别为6.2%（31/500）、1%（5/500）,均低于术前的48.2%（241/500）和20.4%（102/500）,差异均有统计学意义（χ²=352.01、120.71,P值均<0.001）。术后1、6个月患者的椎间隙高度比较,差异无统计学意义（t=1.57、P=0.116）。（4）术后1个月硬膜外压痕纵轴值与患者VAS评分呈正相关（r=0.73,P=0.015）,与JOA评分呈负相关（r=-0.68,P=0.023）。结论 MRI可作为评估椎间孔镜治疗腰椎间盘突出症疗效的有效影像学方式。

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关键词 ：磁共振成像, 椎间孔镜, 腰椎间盘突出症, 疗效比较研究

Key words： Magnetic resonance imaging Lumbar disc herniation Foraminal endoscope Comparative effectiveness research

收稿日期: 2021-09-17

通讯作者: 吴昕峰,Email：wxftsf@163.com

引用本文:

吴昕峰, 安岩, 曾成. MRI在椎间孔镜腰椎间盘切除术治疗腰椎间盘突出症疗效评价中的应用[J]. 中华解剖与临床杂志, 2022, 27(6): 426-430.
Wu Xinfeng, An Yan, Zeng Cheng. Application of MRI in evaluating the curative effect of foraminal endoscope on lumbar disc herniation. Chinese Journal of Anatomy and Clinics, 2022, 27(6): 426-430.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210917-00264 或 http://www.cjac.com.cn/CN/Y2022/V27/I6/426

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