腰椎间盘突出症患者行硬膜外阻滞治疗的临床效果与CT、MRI等影像学区域定位的相关性分析  

The Correlation between the Clinical Effect of Epidural Block in the Treatment of Lumbar Disc Herniation and the Imaging Localization of CT and MRI

作　　者：叶泳均 粱智维 YE Yongjun;LIANG Zhiwei(Dongguan No.5 People’s Hospital,Dongguan 523900,Chin)

机构地区：[1]广东省东莞市第五人民医院,广东东莞523900

出　　处：《中国医学创新》2018年第20期113-116,共4页Medical Innovation of China

摘　　要：目的:分析腰椎间盘突出症患者行硬膜外阻滞治疗的临床效果与CT、MRI等影像学区域定位的相关性。方法:将2017年2月-2018年3月因腰椎间盘突出症于本院进行治疗的237例患者作为研究对象。所有研究对象均采用硬膜外阻滞治疗,后采用CT、MRI对存在突出情况的椎间盘在椎管内所处位置按矢状位、额状位及水平位进行三维定位诊断。其中矢状位主要分为3个层面,水平位则主要分为4个区,额状位分为4个域。评价硬膜外阻滞治疗效果,并将具体疗效与影像学区域定位诊断的相关性进行综合分析。结果:硬膜外阻滞治疗单个椎间盘突出总有效率显著高于2、3个椎间盘突出(P<0.05);2个椎间盘突出与3个椎间盘突出患者的总有效率比较,差异无统计学意义(P>0.05)。各层面对比,Ⅰ层面疗效最好,Ⅲ层面疗效最差(Hc=65.15,q=59.13~4 873.25,P<0.01);区间疗效对比,1~2区疗效显著,且越邻近3区,治疗效果降低程度越为明显(Hc=264.23,q=19.87~511.32,P<0.001);各域间疗效对比,a域疗效显著,b域疗效较差,c域基本呈现无效(Hc=467.26,q=146.74~207.29,P<0.01)。结论:针对行硬膜外阻滞治疗腰椎间盘突出症患者,采用影像学区域定位诊断,可对不同区域的治疗效果进行一定程度预测,对患者后续治疗方案的制定及改善提供了数据支持,有临床推广应用价值。Objective：To analyze the correlation between the clinical effect of epidural blockade in patients with lumbar disc herniation and the imaging localization of CT and MRI.Method：237 patients who were treated with lumbar disc herniation in our hospital from February 2017 to March 2018 were studied.All subjects were treated with epidural anesthesia,CT and MRI were used to diagnose the presence of prominent intervertebral discs in the sagittal,frontal,and horizontal positions in the spinal canal.The sagittal position was mainly divided into three levels;the horizontal position was mainly divided into four regions;the frontal position was divided into four domains.The effect of epidural block therapy was evaluated and the correlation between the specific curative effect and the imaging region location diagnosis was analyzed.Result：The total effective rate of epidural block in treatment of single disc herniation was significantly higher than those of 2,3 intervertebral discs（P〈0.05）;the total effective rate of 2 intervertebral disc herniation patients and 3 intervertebral disc herniation patients was not significantly different（P〈0.05）.Compared with each other,level Ⅰ was the best and level Ⅲ was the worst（Hc=65.15,q=59.13-4 873.25,P〈0.01）;the interval effect was significantly higher than that in the 1 to 2 area,and the closer it was to the third area,the more obvious was the reduction of the therapeutic effect（Hc=264.23,q=19.87-511.32,P0.001）;comparison of curative effect among different domains,significant curative effect in a domain,poor curative effect in domain b,ineffective in domain c on the whole（Hc=467.26,q=146.74-207.29,P〈0.01）.Conclusion：For patients with lumbar disc herniation treated with epidural anesthesia,regional imaging diagnosis can be used to predict the effect of treatment in different regions,it provides data support for the formulation and improvement of follow-up treatment plan for patients,with clinical application value.

关 键 词：腰椎间盘突出症 硬膜外阻滞治疗 CT MRI 影像学区域定位 

分 类 号：R681.53[医药卫生—骨科学]