三维体积法定量评价单开门颈椎管成形与保守治疗突出椎间盘的体积变化  

Volume changes of cervical herniated discs after open-door laminoplasty and conservative treatment as assessed by three-dimensional volume method

作　　者：鲁攀 张春霖[1] 王永魁 严旭[1] 董超 岳义森 李龙[1] 朱安迪 Lu Pan;Zhang Chunlin;Wang Yongkui;Yan Xu;Dong Chao;Yue Yisen;Li Long;Zhu Andi(Department of Orthopedics,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China;School of Nursing,Henan University of Science and Technology,Luoyang 471003,Henan Province,China)

机构地区：[1]郑州大学第一附属医院骨科,河南省郑州市450000 [2]河南科技大学护理学院,河南省洛阳市471003

出　　处：《中国组织工程研究》2022年第9期1395-1401,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(81802128),项目负责人:王永魁。

摘　　要：背景:单开门颈椎管成形治疗是目前最为常用的一种颈椎后路减压手术,其术后突出颈椎间盘体积变化一直是人们关注的热点问题。有个案报道治疗后突出颈椎间盘会发生再吸收现象,但这些观察多为定性研究,尚未见三维体积法定量观察治疗后突出颈椎间盘体积变化的报道。目的:对比分析单开门颈椎管成形和保守治疗后突出颈椎间盘体积变化。方法:回顾性研究收集2014-2020年在郑州大学第一附属医院骨科接受单开门颈椎管成形治疗61例患者和接受保守治疗63例患者的病历资料。使用三维体积法测量两组患者治疗前首次及治疗后末次随访时突出颈椎间盘体积,对测量结果进行一致性检验,并分析其变化。所有患者2次测量至少间隔3个月以上,使用突出颈椎间盘的吸收比和吸收率、再突出比和再突出率等指标作为测量结果。当突出颈椎间盘吸收率大于5.00%(或再突出率小于-5.00%)认为发生吸收(或再突出)。结果与结论:①单开门颈椎管成形治疗组患者突出颈椎间盘体积变化:61例患者共有176个突出颈椎间盘,其中96个突出颈椎间盘出现吸收,吸收比54.6%(96/176),吸收率5.0%-55.2%;另有46个椎间盘再突出,再突出比26.1%(46/176),再突出率-5.9%至-77.9%;其他34个椎间盘体积无变化;按Odom评价标准:优17例,良28例,优良率为73.8%(45/61)。②保守治疗组患者突出颈椎间盘体积变化:63例患者共有171个突出颈椎间盘,其中55个突出颈椎间盘出现吸收,吸收比32.2%(55/171),吸收率5.3%-50.7%;另有83个椎间盘再突出,再突出比48.5%(83/171),再突出率-5.4%至-219.8%;其他33个椎间盘体积无变化;按Odom评价标准:优12例,良21例,优良率为52.4%(33/63)。③三维体积法测量突出颈椎间盘的可靠性高(ICC=0.818)。单开门颈椎管成形治疗组有6例患者所有突出颈椎间盘均表现为不同程度再突出;有13例患者均表现为突出颈椎间盘再吸收BACKGROUND:Open-door laminoplasty is the most commonly used posterior cervical decompression surgery.The volume change of cervical herniated disc has always been a hot topic.It has been reported the phenomenon of resorption of herniated nucleus pulposus after open-door laminoplasty.However,most of these observations are qualitative studies.There is no literature on the quantitative observation of postoperative cervical herniated disc volume by threedimensional volume method.OBJECTIVE:To compare and analyze the changes of cervical herniated disc volume after open-door laminoplasty and conservative treatment.METHODS:The data of 61 patients who underwent open-door laminoplasty and 63 patients who received conservative treatment in the Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from 2014 to 2020 were collected retrospectively.Three-dimensional volume method was used to measure the cervical herniated disc volume of the two groups at the first time before treatment and the last follow-up after treatment.The consistency of the measurement results was tested and the changes were analyzed.The interval between two measurements of all patients was at least 3 months.The absorption ratio and absorption rate,re-protrusion ratio and re-protrusion rate of cervical herniated disc were used as the measurement results.When the absorption rate of herniated cervical intervertebral disc was greater than 5.00%(or the re-protrusion rate was less than-5.00%),it is considered that the cervical herniated disc experienced absorption(or re-herniation).RESULTS AND CONCLUSION:(1)Changes in cervical herniated disc volume in the open-door group:There were 176 cervical herniated discs in 61 patients.Among them,96 cervical herniated discs were absorbed;the absorption ratio was 54.6%(96/176),and the absorption rate was 5.0%-55.2%.In addition,46 cervical herniated discs were re-protruded;the ratio of re-protrusion was 26.1%(46/176),and the re-protrusion rate was-5.9%to-77.9%.There was no change in the volume of the o

关 键 词：三维体积法 突出椎间盘再吸收 单开门颈椎管成形术 保守治疗 定量观察 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]