磁共振介入技术导引下腰椎间盘造影术  

Open MRI guidance and monitoring lumbar disc discography

作　　者：李成利[1] 吕玉波[1] 柳明[1] 张传臣[2] 宋吉清[1] 谢国华[2] 李雷[1] 

机构地区：[1]山东省医学影像学研究所,济南250021 [2]山东省聊城市人民医院

出　　处：《中华临床医师杂志（电子版）》2007年第5期22-25,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的评价开放式MR扫描仪结合光学追踪系统行椎间盘造影术操作方法的可行性及安全性。方法对33例患者的39个椎间盘行开放式MR导引下椎间盘造影术。采用小关节内缘进路或安全三角入路,前者确定针尖位于椎管内硬膜囊外后,推注2ml空气推移同侧硬脊膜囊,为针道留出空隙。穿刺髓核成功后,注入2ml混悬液(磁显葡胺与生理盐水1∶8)。记录可能出现的激惹性疼痛程度及髓核的形态。结果在ipath-200光学追踪系统导引下,所有患者均成功完成椎间盘造影术,无明显严重并发症发生。MR介入椎间盘造影可清晰显示髓核的形态;30个椎间盘造影诱发出疼痛症状,9例无疼痛感觉。对于椎间盘突出者诱发相似性疼痛或完全一致的疼痛,同时进行髓核中心、突出物内及神经根周围臭氧注射治疗术;无疼痛感觉的9例患者则只进行硬膜外腔臭氧治疗或神经根阻滞术。结论开放式MR结合光学导引系统用于引导椎间盘造影术是可行的、安全的。可用于MR介入技术导引的臭氧髓核溶解治疗术适应证的选择。Objective To evaluate the feasibility and safety of lumbar disc discography carried out in an open MR scanner with an optical tracking system. Methods MR-guided lumbar disc discography was performed in 39 disks of 33 patients. The needle reaches the disk via a medial border of the articular processes approach or posterolateral approach. During the former approach, 2 ml air was injected to save space for needle trajectory when the needle tip was positioned out of the theca medulla spinalis in the vertebral canal. After successfully target into nucleus pulposus, 2 ml suspension （Gadopentetic Acid and saline = 1 ： 8 ） was injected. The extent of provocative pain and morphous of nucleus pulposus were recorded. Results All patients were successfully performed discography without any serious complication. The morphous of nucleus pulposus were displayed clearly. Provocative pain was found in 30 lumbar disc. For patients with lumbar disk herniation, minimally invasive oxygen-ozone were performed if alike or similar provocative pain was found, during which oxygen-ozone were injected into discs centers, disc herniation, and around nerve roots. Those with disconcordance or without provocative pain performed oxygen-ozone therapy only with nerve root block. Conclusions Open MR scanner with an optical tracking system guidance and monitoring lumbar disc discography is feasible and safety. It can be used to indication selection for MRguided minimally invasive oxygen-ozone therapy.

关 键 词：椎间盘 磁共振成像 放射学 介入性 

分 类 号：R681.5[医药卫生—骨科学] R445.2[医药卫生—外科学]