症状型腰椎间盘突出症应用腰椎过伸过屈位MRI的诊断价值及手术治疗效果  

Role of lumbar dynamic position MRI in the diagnosis and treatment of symptomatic lumbar disc herniation and the surgical outcome

作　　者：段亮[1] 范亚一[1] 徐洪海[1] 祁洁[1] 弓立群[1] 赵伟 邹泽[2] DUAN Liang;FAN Yayi;XU Honghai;QI Jie;GONG Liqun;ZHAO Wei;ZOU Ze(Department of Orthopedics,Shaanxi People’s Hospital,Xi'an710068,China;Department of MRI,Shaanxi People’s Hospital,Xi'an710068,China)

机构地区：[1]陕西省人民医院骨科,西安710068 [2]陕西省人民医院MRI室,西安710068

出　　处：《中华实用诊断与治疗杂志》2019年第9期911-914,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：陕西省科技统筹创新工程计划项目(2015KTCL-03-02)

摘　　要：目的探讨腰椎过伸过屈位MRI在症状型腰椎间盘突出诊疗中的应用价值,以及后路改良小切口经椎间孔入路腰椎椎间融合术(transforminal lumbar interbody fusion,TLIF)联合对侧经皮椎弓根螺钉固定术治疗症状型腰椎间盘突出症的疗效。方法腰椎MRI平扫未发现明显腰椎间盘突出症表现腰腿痛患者12例,均行过伸过屈位腰椎MRI扫描,发现腰椎间盘突出症征象,并依据过伸过屈位腰椎MRI检查结果制订手术方案。12例于全身麻醉下行后路改良小切口TLIF术联合对侧经皮椎弓根螺钉固定术,比较术前、术后2周及1、6个月视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分、腰椎日本骨科协会(Japanese Orthopadic Association,JOA)评分、直腿抬高试验角度。结果12例手术时间(76.00±16.37)min,术中出血量(46±15)mL,术后住院时间(7±2)d;1例麻醉清醒后12h无症状侧直腿抬高试验约30°阳性,行三维CT检查示1枚螺钉螺纹切割内侧皮质边缘,急诊局部麻醉下取出健侧钉棒,直腿抬高试验即刻转阴;术后2周及1、3个月,VAS[(2.00±0.58)、(0.71±0.50)、(0.75±0.60)分]、ODI评分[(12.08±0.76)、(5.06±0.58)、(5.08±0.64)分]较术前[(7.00±0.71)、(44.83±1.82)分]降低,JOA评分[(23.17±3.31)、(25.67±0.94)、(25.67±0.94)分]较术前[(12.67±1.49)分]增高,直腿抬高试验角度[(67.08±12.65)°、(70.42±5.94)°、(70.50±6.00)°]较术前[(20.33±7.31)°]增大(P<0.05);随访8~50(29±2)个月,均未出现腰椎失稳及内固定失效等并发症。结论过伸过屈位腰椎MRI在症状性腰椎间盘突出症诊断中具有重要价值,并可为手术方案制订提供依据;后路改良小切口TLIF联合对侧经皮椎弓根螺钉固定术治疗症状型腰椎间盘突出症效果满意。Objective To evaluate the value of hyperextension and hyperflexion lumbar MRI to the diagnosis and treatment of symptomatic lumbar disc herniation as well as the effect of transforminal lumbar interbody fusion(TLIF)combined with contralateral percutaneous pedicle screw fixation.Methods Twelve patients with low back and leg pain but no obvious lumbar disc herniation on non-contrast-enhanced MRI were found lumbar disc herniation signs by hyperextension and hyperflexion lumbar MRI scan.The surgical scheme was formulated according to the results of dynamic lumbar MRI.Twelve patients underwent modified posterior mini-incision TLIF combined with contralateral percutaneous pedicle screw fixation under general anesthesia.Visual analogue scale(VAS),Oswestry disability index(ODI),Japanese Orthopadic Association(JOA)score and lumbar spine and straight leg elevation test results were compared before operation,and 2weeks,1 month and 6 months after operation.Results The operation lasted for(76.00±16.37)min,the intraoperative blood loss was(46±15)mL and postoperative stay was(7±2)d.The straight leg elevation test on the asymptomatic leg was positive for about 30°in 1patient 12hafter waking up from general anesthesia,and 3-dimensional CT examination showed that a screw thread cutting the medial cortical edge.After the emergency removal of contralateral nail rod under local anesthesia,the straight leg elevation test turned negative immediately.The VAS scores(2.00±0.58,0.71±0.50,0.75±0.60)and ODI indexes(12.08±0.76,5.06±0.58,5.08±0.64)were significantly lower,and JOA scores(23.17±3.31,25.67±0.94,25.67±0.94)were significantly higher and the straight leg elevation test angle((67.08±12.65)°,(70.42±5.94)°,(70.50±6.00)°)were significantly larger 2weeks,1month and 3months after operation than those before operation(7.00±0.71,44.83±1.82,12.67±1.49,(20.33±7.31)°)(P<0.05).The 8-to 50-month((29±2)months)follow-up showed no lumbar instability and internal fixation failure.Conclusion Hyperextension and hyperflexion lu

关 键 词：症状型腰椎间盘突出症 腰椎过伸过屈位MRI 椎间孔入路腰椎椎间融合术 对侧经皮椎弓根螺钉固定术 

分 类 号：R68[医药卫生—骨科学]