椎间盘源性下腰痛的影像诊断与微创治疗

摘要

目的：探讨椎间盘源性下腰痛的影像诊断、微创治疗的疗效。方法回顾性分析2003年4月～2011年5月82例椎间盘源性下腰痛 MRI 表现、CT 引导下椎间盘造影及微创治疗的临床资料。术前后采用视觉模拟评分（visual analogue scale，VAS）和改良 Macnab 进行疗效评价。结果16例腰部 MRI 表现为椎间盘后缘点状高信号（high intensity zone，HIZ）。CT 引导下椎间盘造影48例有一致性腰痛复制，根据达拉斯 CT 椎间盘造影评价纤维环破裂程度，14例Ⅱ级纤维环破裂，行经皮椎间盘内电热纤维环成形术（intradiscal electrothermal anuloplasty therapy，IDET），34例Ⅲ级以上纤维环破裂行椎间盘镜腰椎间盘切除（microendoscopic discectomy，MED）联合椎体间融合器（Cage）植入椎间融合术。10例 IDET 随访72个月，术前 VAS （9．1±0．3）分，术后72个月（0．9±0．1）分，明显降低（F ＝1904．77，P ＝0．000）；26例 MED 联合 Cage 植入椎间融合随访72个月，术前 VAS（9．2±0．1）分，术后72个月（1．0±0．1）分，明显降低（F ＝4134．17，P ＝0．000）。结论腰椎间盘后缘 MRI 表现 HIZ 提示椎间盘破裂，CT 引导下椎间盘造影显示椎间盘破裂程度及对椎间盘源性下腰痛具有定性诊断价值，根据椎间盘破裂程度选择合适的微创治疗可取得满意的疗效。%Objective To study the imaging diagnosis and effect of minimally invasive treatment for lower back pain. Methods Data of MRI findings,CT discography (CTD) and minimally invasive interventional treatment methods in 82 cases of discogenic low back pain between April 2003 and May 201 1 were retrospectively analyzed.The curative effect was evaluated with the VAS scores and the improved Macnab criteria. Results The MRI findings of lower back showed high intensity zone (HIZ)at the posterior border of lumbar intervertebral disc in 16 cases.The lower back pain was replicated and inducted by CT-guided discography in 48 cases.According to the Dallas discogram description (DDD),the degree of annular disruption was classified as Ⅱ degree in 14 cases who were given intradiscal electrothermal anuloplasty (IDET),and Ⅲ degree in 34 cases who underwent lumbar herniotomy and embedding Cage vertebra fusion with microendoscopic discectomy (MED ).In 10 cases of IDET,the scores of VAS after 72 postoperative months were (0.9 ±0.1 )points,which was significantly lower than the pre-operation [(9.1 ±0.3 )points,F =1904.77,P =0.000].Among the 34 cases who were given lumbar herniotomy and embedding Cage vertebra fusion,26 cases had obviously reduced VAS scores,from pre-operation (9.2 ±0.1 ) points to 72 months after-operation [(1 .0 ±0.1 )points,F =4134.17,P =0.000 ]. Conclusions MRI findings of high intensity zone at the posterior border of lumbar intervertebral disc indicates annular disruption.CT-guided discography shows the degree of disruption and has determinal diagnosis value for lower back pain.The minimally invasive treatment methods should be selected according to the degree of annular disruption.