破裂型腰椎间盘突出症的影像学和临床研究  

Imaging and clinical research of ruptured lumbar disc herniation

作　　者：谢垒[1] 池永龙[1] 

机构地区：[1]温州医学院附属第二医院

出　　处：《浙江创伤外科》2007年第3期189-193,共5页Zhejiang Journal of Traumatic Surgery

摘　　要：目的通过CT测量、MRI上影像学改变,结合临床症状、体征,来鉴别破裂型腰椎间盘突出症(RLDH)与腰椎间盘突出症(LDH)的区别。方法取98例患者资料,经手术证实为RLDH 57例、LDH 41例,选取CT中椎间盘突出的最大层面作为测量层。测量包括:突出物的最大矢状径(h)、相应层面的椎管矢状径(H)、参照Bernkardt的研究计算髓核脱出率(NPR)、突出物的后突角(a)、椎间盘突出的层距(D)。同时对MRI矢状位上形态学分型,在临床起病方式、疼痛程度和性质、脊柱侧弯、直腿抬高角、肌力感觉改变、反射改变以及大小便改变等方面进行对比,最后作统计学处理。结果CT上RLDH组h值为8．47±0．92mm,平均8．5mm,NPR值为58．62％±5．95％(大于50％),a值为70．47±12．70(小于90°),D值至少3层;LDH组h值为5．61±0．85mm,平均5．6mm,NPR值为40．09％±5．26％(小于50％),a值为105．44±6．12(大于90°),D值不超过3层,两组有显著性差异(P<0．05)。MRI矢状位上的形态学分型,两组有显著性差异(P<0．05)。临床疼痛程度和性质,脊柱侧弯,直腿抬高角以及肌力改变,两组有显著性差异(P<0．05)。结论RLDH术前根据病史、疼痛程度和性质、脊柱侧弯、直腿抬高角改变、肌力下降,并结合影像学中CT测量h>8．5mm,NPR>50％．a<90°,且D在3层以上,可以诊断;MRI示髓核巨大脱出入椎管或向上、下游离者,可以诊断。Objectives To distinguish ruptured lumbar disc hemiation(RLDH) and lumbar disc herniation(LDH) by means of CT measure and change of MRI shape in imaging, combined with clinical symptoms. Methods 98 cases were taken in this measurement, including 57 RLDH cases and 41 LDH cases which were confirmed after operation. The largest layer of intervertebral disc herniation in CT was chosed to measure.The infirmation includes: the largest sagittal diameter of herniation(h), the spinal diameter of the same layer(H), nucleus protrusion rate(NRP) calculated according to Bernkardt's research, posterior angle of herniation (a), Layer distance of the intervertebral disc herniation (D). And the MRI shape in sagittal section are classiflcted into protrusion, extrusion and sequestered. Meanwhile, compare with starting of disease, extent and nature of pain, spinal scoliosis, angle of straight leg raising test (SLRT), change of muscle power and sense, change of reflex and change of rectum and bladder between RLDH and LDH. The results were studied by a statistical analysis. Results There are significant difference between RLDH and LDH in the largest sagittal diameter of herniation (t=15.612,P<0.05), NPR (t=15.947,P<0.05), posterior angle of herniation (t=16.181,P<0.05), layer distance of intervertebral disc herniation(X2=76.244,P<0.05) and MRI Shape Classification of Sagittal section(X2=98.000,P<0.05), extent and nature of pain(X2= 98.00,P<0.05), spinal scoliosis (X2=25.5840,P<0.05), angle of SLRT (X2=47.953,P<0.05)and change of muscle power (X2=25.5840,P<0.05). Conclusion RLDH can be diagnosed correctly before operation, if the largest sagittal diameter exceed 8.5mm, NPR overtake 50%, posterior angle of herniation incline below 90°, layer distance of intervertebral disc herniation exceed three layers in CT and nucleus extrude into spinal canal or sequester up and down in MRI.

关 键 词：破裂 腰椎间盘突出症 影像学 CT测量 MRI矢状位形态 临床研究 

分 类 号：R64[医药卫生—外科学]