腰椎间盘突出症脊柱定点旋转复位法前后棘间韧带MR影像的意义  

MRI manifestations of interspinous ligament by Feng's spinal manipulation in the treatment of lumbar intervertebral disc herniation

作　　者：冯宇[1] 杨文东[1] 毕永民[2] FENG Yu YANG Wen-dong BI Yong-min(Research Center of Bone Setting, General Hospital of Air Force, Beijing 100142, China MRI Room, General Hospital of Air Force, Beijing 100142, China)

机构地区：[1]空军总医院全军正骨疗法研究中心,北京100142 [2]空军总医院核磁共振室,北京100142

出　　处：《颈腰痛杂志》2017年第4期313-316,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的本文利用磁共振脂肪抑制技术,观察一组腰椎间盘突出症患者经脊柱定点旋转复位法治疗后,突出节段棘间韧带的信号改变,为脊柱定点旋转复位法疗效提供影像依据,并进一步探讨脊柱定点旋转复位法解除神经根压迫的机理。方法选取2015-08-2016-08于空军总医院诊治的单节段腰椎间盘突出症患者46例(男30例,女16例),年龄21~53岁(平均41.29±9.78岁);其中病变部位为L_5-S_1的19例,L_(4-5)的27例。比较患者治疗前后腰椎间盘突出节段(L_5-S_1或L4-5)棘间韧带矢状位T2WI脂肪抑制信号强度区域均值及最高值,以及治疗前后的直腿抬高角度(ASLR)、视觉疼痛量表(VAS)、MRI轴位像突出髓核矢状径指数(SI)。结果 46例腰椎间盘突出症患者经脊柱定点旋转复位法治疗后ASLR明显高于治疗前,VAS评分值明显低于治疗前,与治疗前相比有显著差异(P<0.01);影像学测试指标中:椎间盘突出的SI值在手法治疗前后比较均无显著性差异(P>0.05);棘间韧带矢状位T_2WI脂肪抑制信号强度区域均值及最高值均在治疗后明显减低(P<0.01)。结论腰椎间盘突出症患者经脊柱定点旋转复位法治疗后,坐骨神经痛明显减轻或消失。MR矢状位T2WI脂肪抑制为脊柱定点旋转复位法治疗后腰椎间盘突出症患者棘间韧带炎性水肿消除或减弱提供了量化的影像学依据,与临床疗效一致。Objective To study the key points and possible mechanism to achieve a satisfactory therapeutic effects of Feng＇s spinal manipulation （FSM） by magnetic resonance （NMR） fat suppression technology, which were observed before and after spinal fixed-point rotation reset method of lumbar disc prolapse outstanding stage between spine ligament signal change, and to further verify the theory of imbalance of spine and vertebral displacement. Methods 46 patients with LIDH who were treated by FSM for 3 weeks were collected in our hospital from August 2015 to August 2016. The angle of straight leg raising （ASLR）, visual analogue （VAS） were observed before and after manipulative treat- ment. The MRI was checked before and after manipulative treatment in order to observe the sagittal di- ameter index number （SI） of protruded nucleus pulposus in MRI axial view, sagittal view T2WI of in- terspinous ligament. Results After 3 weeks treatment by FSM, ASLR, VAS of patients were signifi- cantly higher than before treatment （P〈0.01）. MRI showed that the sagittal view T2WI of interspinous ligament was decreased（P〈0.01 ）. But there was no change in SI （P〉0.05）. Conclusion Treatment of LIDH by FSM can achieve satisfactory effect. The examination of MRI can provide quantified imaging proof for therapeutic effects of MSF, which suggested that the key point of gaining effect for FSM may lie in spine biomechanies and related organizational stnacture relationship to return to normal or com- pensatory state before onset, rather than the obvious changes of shape and location of protruded nucle- us pulposus and the nerve root.

关 键 词：腰椎间盘突出症 核磁共振 脊柱定点旋转复位法 

分 类 号：R683[医药卫生—骨科学]