保留并缝合黄韧带对腰椎间盘突出术后椎管内瘢痕形成的MRI评估  

The evaluation of epidural scar in patients underwent microendoscopic discectomy( MED) with the preservation and suture of the ligamentum flavum using magnetic resonance imaging

作　　者：刘绍伟[1] 丁秋[1] 陈晓[1] 李志伟[1] 

机构地区：[1]南京中医药大学附属江苏省中医院放射科,江苏南京210029

出　　处：《医学影像学杂志》2016年第7期1284-1287,共4页Journal of Medical Imaging

基　　金：江苏省中医药管理局课题(编号:LZ13038)

摘　　要：目的探讨保留并缝合深层黄韧带对腰椎间盘突出症术后椎管内瘢痕形成的MRI评估的临床价值。方法对35例行椎间盘镜椎间盘切除术治疗的腰椎间盘突出症患者,其中18例采用保留并缝合黄韧带,17例采用常规部分切除术,术后6个月复查腰椎平扫MRI。应用面积测量结合分级评分法计算硬膜外瘢痕面积及瘢痕指数。通过VAS(视觉疼痛模拟评分法)评分及ODI(腰椎功能障碍指数)评分,评估临床效果。采用秩和检验及Spearman Rank相关分析进行数据统计。结果保留并缝合黄韧带组患者平均瘢痕面积及瘢痕指数均显著低于传统部分切除法(P<0.01),疼痛及腰椎功能也较传统部分切除组有明显改善(P<0.05);相关分析显示平均瘢痕面积及瘢痕指数与VAS及ODI评分有显著负相关(P<0.01)。结论保留并缝合深层黄韧带可减轻腰椎间盘突出症术后瘢痕形成、改善疼痛及功能障碍。Objective To evaluate the epidural scar in patients underwent microendoscopic discectomy （MED） with or without the preservation of the ligamentum flavum using magnetic resonance imaging （MRI） and to investigate the clinical value of preservation of the ligamentum flavum. Methods A total of 35 patients underwent MED between Aug 2014 and Aug 2015 were included in this study. 18 patients underwent MED with the preservation and suture of the ligamentum flavum （LF）, the other 17 patients underwent MED without the preservation of the LF. The MRI scans of lumber spine were performed at the 6th month postoperatively using a standard protocol. Epidural scar area and epidural fibrosis index were obtained from MR images. Clinical efficiency was evaluated by Visual analogy scale （VAS） and oswestry disability index （ODI）. Rank sum test and Spearman Rank analysis were used for statistical analysis. Results Epidural scar area and epidural fibrosis in patients underwent MED with the preservation and suture of the LF were significantly less than those patients underwent MED without the preservation of the LF （ P 〈 0. 01 ）. VAS and ODI in patients underwent MED with the preservation and suture of the LF were significantly lower than those patients underwent MED without the preservation of the LF （ P 〈 0.05 ）. Correlation analysis showed that epidural scar area and epidural fibrosis were negatively correlated with VAS and ODI （ P 〈 0.01 ）. Conclusion The preservation and suture of the LF is helpful for the reduction of epidural fibrosis and sear formation and improves the back pain and functional disability.

关 键 词：硬膜外瘢痕 椎间盘镜椎间盘切除术 腰椎间盘突出症 黄韧带 缝合 

分 类 号：R681[医药卫生—骨科学] R445.2[医药卫生—外科学]