| MRI中椎管及硬膜囊大小与单节段腰椎间盘突出症治疗的相关性研究 |
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Received:October 17, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 唐强 |
TANG Qiang |
汕头大学医学院第二附属医院脊柱关节外科, 广东 汕头 515041 |
Department of Spinal Joint Surgery, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong, China |
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| 袁帅 |
YUAN Shuai |
汕头大学医学院第二附属医院脊柱关节外科, 广东 汕头 515041 |
Department of Spinal Joint Surgery, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong, China |
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| 王伟东 |
WANG Wei-dong |
汕头大学医学院第二附属医院脊柱关节外科, 广东 汕头 515041 |
Department of Spinal Joint Surgery, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong, China |
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| 孔抗美 |
KONG Kang-mei |
汕头大学医学院第二附属医院脊柱关节外科, 广东 汕头 515041 |
Department of Spinal Joint Surgery, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong, China |
kangmeikong@21cn.com |
| 王新家 |
WANG Xin-jia |
汕头大学医学院第二附属医院脊柱关节外科, 广东 汕头 515041 |
Department of Spinal Joint Surgery, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong, China |
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| 期刊信息：《中国骨伤》2015年28卷，第11期，第994-999页 |
| DOI：10.3969/j.issn.1003-0034.2015.11.004 |
| 基金项目:国家自然科学基金项目(编号:81273862) |
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目的:探讨MRI中椎管及硬膜囊大小对椎间盘突出症治疗方法选择的参考价值。
方法:对2010年1月至2012年12月非手术和手术治疗的144例腰椎间盘突出症患者的临床资料进行回顾性分析。其中非手术组91例,男55例,女36例,年龄20～ 68岁,平均(43.37±12.48)岁;手术组53例,男28例,女25例,年龄20～ 64岁,平均(42.98±12.95)岁。采用JOA评分(29 分)对两组患者治疗前后的临床表现(包括症状、体征、日常活动受限度和膀胱功能)及效果进行量化评价。同时在腰椎MRI T2轴位测量椎管和硬膜囊大小的相关参数(包括椎管正中矢径和有效矢径、侧隐窝宽度、椎管和硬膜囊面积),并计算有效矢径/正中矢径、隐窝宽度/正中矢径和膜囊面积/椎管面积的比值。将两组患者的各参数值进行统计学比较,并分析其与治疗前JOA评分的相关性。
结果:(1)144例患者随访1～3年,平均2.1年。治疗前非手术组和手术组的JOA评分分别为16.27±2.96和12.64±3.30,差异有统计学意义(t=6.319,p<0.01).末次随访非手术组与手术组比较,JOA评分(25.41±2.22 vs 25.76±2.29;t=-0.853,p=0.396>0.05),改善率[(72.95±12.54)% vs (76.80±9.45)%;t=-1.855,p=0.065>0.05]和优良率(84.91% vs 78.02%;χ2=3.704,p=0.295>0.05)的差异均无统计学意义;但非手术组的复发率(14.29%)较手术组(5.67%)高。(2)手术组椎管正中矢径和有效矢径、侧隐窝宽度、椎管和硬膜囊面积、有效矢径/正中矢径、隐窝宽度/正中矢径均小于非手术组,硬膜囊面积/椎管面积则大于非手术组,两组比较差异均有统计学意义(p<0.01).(3)治疗前JOA评分与椎管正中矢径和有效矢径、侧隐窝宽度、椎管及硬膜囊面积有正相关性(p<0.01);与有效矢径/正中矢径、侧隐窝宽度/正中矢径也有正相关性(p<0.05);而与硬膜囊面积/椎管面积有负相关性(p<0.01).
结论:非手术和手术治疗腰椎间盘突出症均能获得良好的效果,但非手术治疗复发率较高。术前测量椎管及硬膜囊的MRI参数对椎间盘突出症治疗方法的选择有一定的临床参考价值,但需要进一步完善和临床验证。 |
| [关键词]:椎间盘移位 磁共振成像 临床方案 |
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| Correlation study of spinal canal and dural sac dimensions on MRI with therapy of lumbar disc herniation |
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Abstract:
Objective:To explore the value of spinal canal and dural sac dimensions for the treatment of lumbar disc herniation in MRI.
Methods:The clinical data of 144 patients with single-level lumbar disc herniation underwent nonsurgical or surgical treatment from January 2010 to December 2012 were retrospectively analyzed. There were 91 patients in the nonsurgical group,including 55 males and 36 females,ranging in age from 20 to 68 years old with an average of(43.37±12.48) years;and there were 53 patients in the surgical group,including 28 males and 25 females,ranging in age from 20 to 64 years old with an average of (42.98 ± 12.95) years. JOA scores(29 scores) were used to evaluate clinical manifestation (including subjective symptoms,objective findings,limitation of daily activities and bladder function) and outcomes. The parameters related to spinal canal and dural sac dimensions(including spinal canal midsagittal diameter and available diameter,lateral recess width,spinal canal and dural sac cross-sectional area) in the initial axial T2-weighted MRI were measured,and odds ratio of available diameter to midsagittal diameter,odds ratio of lateral recess width to midsagittal diameter and area ratio of dural sac to spinal canal were calculated. Then,the differences of all parameters between two groups,and the correlations with initial JOA scores were analyzed.
Results:(1)All patients were followed up from 1 to 3 years with an average of 2.1 years. JOA scores before treatment were 16.27±2.96 in nonsurgical group and 12.64±3.30 in surgical group,there was statistically significant differ-ence(t=6.319,p<0.01). At final follow-up time,there was no statistically significant difference in JOA scores(25.41±2.22 vs 25.76±2.29),improvement rate [(72.95±12.54)% vs(76.80±9.45)%],and the excellent and good rate (84.91% vs 78.02%) between two groups (p>0.05). But,the relapse rate of nonsurgical group was higher than surgical group (14.29% vs 5.67% ). (2)Spinal canal midsagittal diameter and available diameter,lateral recess width,spinal canal and dural sac area,the ratio of available diameter to midsagittal diameter,and the ratio of lateral recess width to midsagittal diameter in surgical group were smaller than that of nonsurgical group,but the area ratio of dural sac to spinal canal was larger,and there were statistically significant differences between two groups(p<0.01). (3)The initial JOA scores showed significantly positive correlation with spinal canal midsagittal diameter and available diameter,lateral recess width,and canal and dural sac area(p<0.01);also presented positive correlation with the ratio of available diameter to midsagittal diameter and the ratio of lateral recess width to midsagittal diameter(p<0.05);but there was a significantly negative correlation between initial JOA scores and the area ratio of dural sac to spinal canal.
Conclusion:Both nonsurgical and surgical treatment of lumbar disc herniation can obtain good effect,but the recurrence rate of non-surgical treatment is higher. Preoperative MRI measurement parameters of spinal canal and dural sac dimensions has certain value for the treatment selection of lumbar disc herniation,but further refinement and validation is still required. |
| KEYWORDS:Intervertebral disk displacement Magnetic resonance imaging Clinical protocols |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 唐强,袁帅,王伟东,孔抗美,王新家.MRI中椎管及硬膜囊大小与单节段腰椎间盘突出症治疗的相关性研究[J].中国骨伤,2015,28(11):994~999 |
| 英文格式: | TANG Qiang,YUAN Shuai,WANG Wei-dong,KONG Kang-mei,WANG Xin-jia.Correlation study of spinal canal and dural sac dimensions on MRI with therapy of lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(11):994~999 |
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