[1]周爽 杨功旭 黄勇 赵述艳 潘海松 陈丹丹△.经皮椎间孔镜技术治疗腰椎间盘突出症术后影像学评估的价值探讨[J].中国中医骨伤科杂志,2021,29(06):36-40.
　ZHOU Shuang YANG Gongxu HUANG Yong ZHAO ShuyanPAN Haisong CHEN Dandan.The Value of Imaging Evaluation after Percutaneous TransforaminalDiscectomy for Lumbar Disc Herniation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(06):36-40.
点击复制

经皮椎间孔镜技术治疗腰椎间盘突出症术后影像学评估的价值探讨()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年06期
页码:
36-40
栏目:
临床研究
出版日期:
2021-06-15

文章信息/Info

Title:
The Value of Imaging Evaluation after Percutaneous TransforaminalDiscectomy for Lumbar Disc Herniation
文章编号:
1005-0205(2021)06-0036-05
作者:
周爽1 杨功旭1 黄勇1 赵述艳1 潘海松1 陈丹丹1△
1湖北省中医院(湖北省中医药研究院,湖北中医药大学附属医院)(武汉,430070)
Author(s):
ZHOU Shuang1 YANG Gongxu1 HUANG Yong1 ZHAO Shuyan1PAN Haisong1 CHEN Dandan1△
1Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430070, China.
关键词:
经皮椎间孔镜;  腰椎间盘突出症;  影像学;  疗效评估
Keywords:
percutaneous transforaminal endo-scopic discectomy;  lumbar disc herniation;  imaging;  efficacy evaluation
分类号:
R681.5
文献标志码:
A
摘要:
目的:分析影像学技术在经皮椎间孔镜技术治疗腰椎间盘突出症术后疗效评估中的价值。方法:选取2017年10月至2020年7月接受手术治疗的80例腰椎间盘突出症患者作为研究对象,均行经皮椎间孔入路椎间孔镜手术治疗,并于术后采用磁共振成像(MRI)对其临床疗效进行评估,比较患者术前、术后1个月、术后3个月、术后6个月疗效指标(日本骨科协会评估治疗分数(JOA)、Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、跛行距离情况)、影像学评估指标(硬膜外压痕矢径、硬膜外压痕纵轴值、椎间隙后缘高度、棘突顶距),并通过Spearman系数分析两者相关性。结果:患者不同时间段JOA评分、跛行距离比较,术前<术后1个月<术后3个月<术后6个月; ODI、VAS评分比较,术前>术后1个月>术后3个月>术后6个月,差异有统计学意义(P<0.05)。患者不同时间段硬膜外压痕矢径、硬膜外压痕纵轴值、椎间隙后缘高度、棘突顶距比较,术前>术后1个月>术后3个月>术后6个月,差异有统计学意义(P<0.05)。患者术后JOA、跛行距离与硬膜外压痕矢径、硬膜外压痕纵轴值、棘突顶距呈负相关,ODI、VAS与硬膜外压痕矢径、硬膜外压痕纵轴值、棘突顶距呈正相关(P<0.05)。结论:经皮椎间孔镜治疗腰椎间盘突出症术后采用MRI进行评估,其监测的影像学指标与JOA、ODI、VAS等疗效评分存在明显相关性,可以作为疗效参考指标,有一定的临床参考价值。
Abstract:
To study the evaluation of curative efficacy of imaging after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation.Methods:80 patients with lumbar disc herniation who underwent surgical treatment in hospital from October 2017 to July 2020 were selected as the study objects. All patients were treated by percutaneous transforaminal approach, and their clinical efficacy was evaluated by magnetic resonance imaging(MRI)after surgery. The curative effect indexes(JOA, ODI,VAS and claudication distance)were compared before operation, 1 month after operation, 3 months after operation and 6 months after operation. The results of imaging evaluation(sagittal diameter of epidural indentation, longitudinal axis of epidural indentation, maximum height of intervertebral foramen, and apical distance of spinous process)were compared to analyze the correlation between them by Spearman coefficient. Results:JOA score and claudication distance of patients in different time periods were compared, and the differences were statistically significant(P<0.05). There were statistically significant differences in the sagittal diameter, longitudinal axis value, posterior margin height and spinous process distance of epidural indentation at different time points(P<0.05). JOA and claudication distance were negatively correlated with sagittal diameter of epidural indentation, longitudinal axis value of epidural indentation and apical distance of spinous process, while ODI and VAS were positively correlated with sagittal diameter of epidural indentation, longitudinal axis value of epidural indentation and apical distance of spinous process(P<0.05). Conclusion:After percutaneous foraminoscopy for lumbar disc herniation, MRI is used to evaluate, and the monitored imaging indicators shows obvious correlation with the efficacy scores such as JOA, ODI and VAS, which can be used as the efficacy reference index and have a certain clinical value.

参考文献/References:


[1] OHRTNISSEN S, FRITZ B G, WALBOM J,et al.Bacterial biofilms:a possible mechanism for chronic infection in patients with lumbar disc herniation-a prospective proof-of-concept study using fluorescence in situ hybridization[J].Apmis,2018,126(5):440-447.
[2] 格日勒,郭昭庆.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展[J].中国微创外科杂志,2018,18(3):267-270.
[3] 谭响,潘兴臣,周帮健,等.PELD联合硬膜外注射糖皮质激素治疗腰椎间盘突出症的临床疗效观察[J].重庆医学,2020,49(6):918-921.
[4] 向熙,司群超,成伟益,等.不同手术方式治疗腰椎间盘突出症的网状Meta分析[J].中国组织工程研究,2020,24(27):4398-4405.
[5] 刘湘,赵晓东,龙耀武,等.腰椎间盘突出症严重程度与腰椎曲度相关性的影像学研究[J].广东医学,2017,38(24):3824-3826.
[6] 中华医学会骨科学分会脊柱外科学组,中华医学会骨科学分会骨科康复学组.腰椎间盘突出症诊疗指南[J].中华骨科杂志,2020,40(8):477-487.
[7] 顾敦星,孙翾,陈常玉,等.腰大肌肌间沟神经阻滞联合热敏灸治疗腰椎间盘突出症效果观察[J].山东医药,2020,60(11):46-48.
[8] 索利娅,贾建新.腰椎棘突间距和顶距的应用解剖[J].解剖学杂志,2014,37(2):209-211.
[9] FUJIMORI T, OKUDA S, IWASAKI M,et al.Validity of the japanese orthopaedic association scoring system based on patient-reported improvement after posterior lumbar interbody fusion[J].Spine J,2016,16(6):728-736.
[10] MOHAN V, PRASHANTH G S, MERAVANIGI G,et al.Adaptation of the oswestry disability index to kannada language and evaluation of its validity and reliability[J].Spine,2015,41(11):674-680.
[11] 樊春亮,刘永红,郭爱,等.关节镜下微创手术治疗运动性肩袖损伤临床疗效及视觉模拟评分疼痛评分探讨[J].中国药物与临床,2018,18(12):2212-2214.
[12] 王海澎,舒伟,倪兵,等.经皮内镜椎板间入路椎间盘切除术治疗腰椎间盘突出症的疗效分析[J].中华神经外科杂志,2018,34(5):485-489.
[13] 付朝华,蒋雄健,付兆宗,等.经椎板间入路椎间孔镜治疗第5腰椎与第1骶椎椎间盘突出症的长期疗效分析[J].中华显微外科杂志,2020,43(3):300-303.
[14] 唐金祥,齐丽贞,王芳,等.MRI检查在腰椎间盘突出髓核摘除术患者术后椎间隙感染的诊断价值[J].中华医院感染学杂志,2018,28(17):2642-2644.
[15] 李江华,陈磊,戴毅,等.微创手术与开放椎板切除术治疗LSS疗效与安全性的Meta分析[J].重庆医学,2018,47(31):64-68.
[16] 郑淞文,孟仪,龙钰函,等.双侧椎弓根螺钉置入内固定联合椎间融合治疗腰椎间盘突出症:CT影像学的客观评估[J].中国组织工程研究,2019,23(36):5850-5855.
[17] 辛欣,刘新新.腰椎间盘突出症手术治疗的MRI影像学疗效评价[J].中国CT和MRI杂志,2015,13(9):6-8.
[18] 赵兵善,王世东,吕文涛.椎间孔镜TESSYS技术治疗腰椎间盘突出症的疗效与术后MRI变化的关系[J].中国微创外科杂志,2019,19(4):40-43.

备注/Memo

备注/Memo:
△通信作者 E-mail:20287894@qq.com
更新日期/Last Update: 2021-06-15