MRI预测椎板开窗髓核摘除术后腰椎间盘突出再复发的可行性  

The feasibility of magnetic resonance imaging in predicting the recurrent lumbar disc herniation after fenestration laminectomy

作　　者：刘磊[1] 宋飞霏 韩猛[1] 刘光普[1] 马超[1] LIU Lei;SONG Fei-fei;HAN Meng;LIU Guang-pu;MA Chao(Dept of Spine Surgery,Xuzhou Central Hospital,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州市中心医院骨脊柱外科,江苏徐州221000

出　　处：《临床骨科杂志》2023年第5期625-628,共4页Journal of Clinical Orthopaedics

基　　金：江苏省卫健委科研项目(编号:H2019023);江苏省卫健委中医药科技发展计划项目(面上项目)(编号:MS2022068);江苏省徐州市中医学会中医药科技发展计划项目(编号:XZYB2021040);江苏省徐州市卫健委科技项目(面上项目)(编号:XWKYHT20220122)。

摘　　要：目的探讨MRI预测椎板开窗髓核摘除术后腰椎间盘突出再复发(RLDH)的可行性。方法根据是否在5年内发生RLDH将椎板开窗髓核摘除术后的114例患者分为未复发组(97例)与复发组(17例),分析人口学特征、MRI影像学指标、手术情况以及手术前后功能评分等资料,采用logistic单因素及多因素回归分析RLDH的危险因素。结果性别、体重指数、住院时间、手术节段、术前及术后1周疼痛VAS评分、术前及术后1周JOA评分、ODI两组比较差异均无统计学意义(P>0.05),年龄、术后1年疼痛VAS评分及JOA评分两组比较差异均有统计学意义(P<0.05)。椎间盘突出类型、髓核移位方向、椎间盘退变Pfirrmann分级两组比较差异均无统计学意义(P>0.05)。椎间盘突出解剖位置、终板Modic改变两组比较差异均有统计学意义(P<0.05)。单因素logistic回归分析显示,性别、L 4~5手术节段、外侧型椎间盘突出、有终板Modic改变是RLDH的危险因素(P<0.05);多因素logistic回归分析显示,有终板Modic改变是RLDH的高危因素(P<0.05)。结论有终板Modic改变是椎板开窗髓核摘除术后RLDH的高危因素,术前MRI检查显示伴有终板Modic改变的腰椎间盘突出症患者应预防RLDH,谨慎选择手术方案。Objective To investigate the feasibility of magnetic resonance imaging(MRI)in predicting the recurrent lumbar disc herniation(RLDH)after fenestration laminectomy.Methods According to whether RLDH occurred within 5 years,114 patients after fenestration laminectomy were divided into the non-recurrence group(97 cases)and the recurrence group(17 cases).Demographic characteristics,MRI imaging indicators,surgical conditions and pre-and post-operative functional scores were analyzed,and logistic univariate and multivariate regression were used to analyze the risk factors of RLDH.Results There were no statistical differences between the two groups in gender,BMI,length of hospital stay,surgical segment,and pain VAS,JOA scores,ODI before operation and 1 week postoperation(P>0.05).There were statistical differences in age,pain VAS,JOA scores at 1 year after surgery between the two groups(P<0.05).The disc herniation type,displacement direction of nucleus pulposus,and Pfirrmann grade of disc degeneration had no statistical differences between the two groups(P>0.05).There were statistical differences in anatomical location of disc herniation and endplate Modic change between two groups(P<0.05).Univariate logistic regression analysis showed that gender,L 4~5 operation segments,lateral type of disc herniation and endplate Modic change were risk factors for RLDH(P<0.05).Multivariate logistic regression analysis showed that accompanied by Modic change was the risk factor for RLDH(P<0.05).Conclusions Endplate Modic is a high risk factor for RLDH after fenestration laminectomy.RLDH should be prevented in the patients who suffer from lumbar disc herniation accompanied by endplate Modic change on preoperative MRI examination,and the surgical plan should be carefully selected.

关 键 词：椎板开窗 髓核摘除术 腰椎间盘突出复发 磁共振 

分 类 号：R681.57[医药卫生—骨科学] R687.3[医药卫生—外科学] R445.2[医药卫生—临床医学]