MRI检查在腰椎间盘突出髓核摘除术后椎间隙感染病人中的诊断价值分析
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摘要
目的探究MRI检查在腰椎间盘突出症髓核摘除术后椎间隙感染上的临床诊断价值。方法选择86例腰椎间盘突出症术后椎间隙感染病人的临床资料进行研究,所有病人行MRI检查,确诊后给予积极治疗,分析其MRI诊断结果,观察治疗前后所有病人的白细胞计数、血沉及C反应蛋白水平变化。结果 86例椎间盘感染病人的感染部位多数集中在L4～L5或L5～S1椎间隙,病变椎间表现为不同程度的椎间盘碎裂、变小、消失、边缘不齐。MRI检查结果显示病变椎间盘间隙失去正常形态和信号。其中长T1低信号77例,T1等信号9例;长T2高信号82例,短T2低信号4例。86例椎间盘感染病人的病变椎间盘间隙上下的椎体软骨终板以及周围邻近的椎体松质骨均表现有不同程度的损坏,周围邻近椎体部分出现信号异常(75例),整个椎体信号异常(11例)。多数表现为长T1信号、长T2信号,少部分病变部位表现处以T2为主的混杂信号。椎体旁软组织表现出肿胀增厚,T1表现为等信号、稍高信号或混杂信号,T2表现为高信号。21例行MRI增强扫描,病变椎间盘及邻近椎体、椎旁软组织明显强化。随访6个月后,临床症状完全消失的病人共计63例,占73. 26%,所有病人在治疗后的白细胞计数、血沉以及C反应蛋白水平均显著低于治疗前(P <0. 05)。结论在诊断腰椎间盘突出症髓核摘除术后椎间隙感染上,MRI检查能够对其病变感染部位进行充分显示,对于椎间隙感染的早期诊断鉴别及治疗具有重要意义。
Objective To research the MRI examination and diagnostic value of intervertebral space infection after nucleus pulposus extraction in patients with lumbar disc herniation. Methods 86 cases of intervertebral space infection after lumbar disc herniation in our hospital were selected as the research objects. All patients were given MRI examination,and gave positive treatment after diagnosis. Analyzed the MRI diagnostic results,and observed the changes of WBC count,ESR and C reactive protein levels before and after treatment. Result The location of infection in 86 cases of intervertebral disc infection was mostly located in L4 ～ L5 or L5 ～ S1 intervertebral space. The intervertebral disc showed varying degrees of intervertebral disc fragmentation,smaller,disappeared,and uneven edge. MRI examination showed that the intervertebral disc space of lesion lost normal shape and signal,a 77 cases with long and low T1 signal,9 cases with equal T1 signal,82 cases with long and high T2 signal,4 cases with short and short T2 signal. The lesions in 86 cases of intervertebral disc infection showed different degrees of damage to the vertebral endplate and the adjacent vertebral spongy bone around the intervertebral disc. The surrounding part of adjacent vertebral bodies had abnormal signal appears(75 cases),the whole vertebral body signal was abnormal(11 cases). Most of them were characterized by long T1 signal and long T2 signal,while a few of the lesions showed mixed signals dominated T2 signal. The soft tissue adjacent to the vertebral body showed swelling and thickening,and T1 showed equal signal,slightly higher signal or mixed signal,and T2 showed high signal. MRI enhanced scan was performed in 21 cases,the pathological changes of intervertebral disc,adjacent vertebral body and paravertebral soft tissue were obviously enhanced. After 6 months of follow-up,A total of 63 patients with complete disappearance of clinical symptoms,accounting for 73.26%. All the patients had significantly lower WBC counts,ESR and C reactive protein levels than before treatment( P < 0. 05). Conclusion In the diagnosis of lumbar disc herniation discectomy intervertebral space infection after MRI,check to fully display the lesion site of infection,it is important for early diagnosis and treatment of intervertebral space infection.
Objective To research the MRI examination and diagnostic value of intervertebral space infection after nucleus pulposus extraction in patients with lumbar disc herniation. Methods 86 cases of intervertebral space infection after lumbar disc herniation in our hospital were selected as the research objects. All patients were given MRI examination,and gave positive treatment after diagnosis. Analyzed the MRI diagnostic results,and observed the changes of WBC count,ESR and C reactive protein levels before and after treatment. Result The location of infection in 86 cases of intervertebral disc infection was mostly located in L4 ～ L5 or L5 ～ S1 intervertebral space. The intervertebral disc showed varying degrees of intervertebral disc fragmentation,smaller,disappeared,and uneven edge. MRI examination showed that the intervertebral disc space of lesion lost normal shape and signal,a 77 cases with long and low T1 signal,9 cases with equal T1 signal,82 cases with long and high T2 signal,4 cases with short and short T2 signal. The lesions in 86 cases of intervertebral disc infection showed different degrees of damage to the vertebral endplate and the adjacent vertebral spongy bone around the intervertebral disc. The surrounding part of adjacent vertebral bodies had abnormal signal appears(75 cases),the whole vertebral body signal was abnormal(11 cases). Most of them were characterized by long T1 signal and long T2 signal,while a few of the lesions showed mixed signals dominated T2 signal. The soft tissue adjacent to the vertebral body showed swelling and thickening,and T1 showed equal signal,slightly higher signal or mixed signal,and T2 showed high signal. MRI enhanced scan was performed in 21 cases,the pathological changes of intervertebral disc,adjacent vertebral body and paravertebral soft tissue were obviously enhanced. After 6 months of follow-up,A total of 63 patients with complete disappearance of clinical symptoms,accounting for 73.26%. All the patients had significantly lower WBC counts,ESR and C reactive protein levels than before treatment( P < 0. 05). Conclusion In the diagnosis of lumbar disc herniation discectomy intervertebral space infection after MRI,check to fully display the lesion site of infection,it is important for early diagnosis and treatment of intervertebral space infection.
引文
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[10] Messner A,Stelzeneder D,Trattnig S,et al. Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3. 0 Tesla magnetic resonance study[J]. Eur Spine J,2017,26(3):877-883.
[11]潘刚明,钟润泉,王非.腰椎间盘术后椎间隙感染的后路手术治疗[J].中国中医骨伤科杂志,2013,21(6):42-43,45.
[12]张鹏,杨军妍,丁世斌,等.布氏杆菌性脊柱炎的MRI、CT表现[J].中国临床医学影像杂志,2016,27(4):278-281.
[13] Jamaludin A,Lootus M,Kadir T,et al. ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017:Automation of reading of radiological features from magnetic resonance images(MRIs)of the lumbar spine without human intervention is comparable with an expert radiologist[J]. Eur Spine J,2017,26(5):1374-1383.
[14]菅振,傅一山.腰椎术后椎间隙感染诊断与治疗[J].国际骨科学杂志,2014,35(4):226-227,234.
[15]樊渊,成文,高跃翔,等.腰椎术后椎间隙感染的治疗探讨[J].中华医院感染学杂志,2014,24(19):4847-4849.
[16] Rapp M,Ley CJ,Hansson K,et al. Postoperative computed tomography and low-field magnetic resonance imaging findings in dogs with degenerative lumbosacral stenosis treated by dorsal laminectomy[J]. Vet Comp Orthop Traumatol,2017,30(2):143-152.
[17]朱小龙,徐卫星,刘杰,等.椎间隙感染的诊断与治疗进展[J].中国骨伤,2016,29(9):870-874.
[2] Sun D,Liu P,Cheng J,et al. Correlation between intervertebral disc degeneration,paraspinal muscle atrophy,and lumbar facet joints degeneration in patients with lumbar disc herniation[J]. BMC Musculoskelet Disord,2017,18(1):167.
[3]程清平,王东福,焦朋,等.腰椎间盘突出症术后椎间隙感染的治疗及危险因素分析[J].中国骨与关节损伤杂志,2017,32(1):32-35.
[4]王福兵,彭庆辉,马大年,等.椎间孔镜辅助腰椎间盘突出症髓核摘除术的疗效[J].江苏医药,2014,40(4):482-483.
[5]孟宪勇,杨新明,胡长波,等. MRI影像学分型对胸腰椎布鲁杆菌病性脊椎炎手术策略的效果分析[J].中国矫形外科杂志,2017,25(5):416-421.
[6]浦智韬,金中高,陈松平,等.磁共振成像对腰椎间盘突出症术后椎间隙感染的早期诊断评价[J].中华医院感染学杂志,2017,27(4):853-856.
[7] Zhou Z,Chen Z,Zheng Y,et al. Relationship between annular tear and presence of Propionibacterium acnes in lumbar intervertebral disc[J].Eur Spine J,2015,24(11):2496-502.
[8]刘志昂,张陆,高军胜,等.椎间盘镜下病灶清除结合置管冲洗治疗腰椎椎间隙感染[J].医药论坛杂志,2014,35(2):110-111.
[9]解仿,熊龙. 14例腰椎内固定术后感染的诊疗体会[J].中国医学创新,2014,11(33):125-128.
[10] Messner A,Stelzeneder D,Trattnig S,et al. Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3. 0 Tesla magnetic resonance study[J]. Eur Spine J,2017,26(3):877-883.
[11]潘刚明,钟润泉,王非.腰椎间盘术后椎间隙感染的后路手术治疗[J].中国中医骨伤科杂志,2013,21(6):42-43,45.
[12]张鹏,杨军妍,丁世斌,等.布氏杆菌性脊柱炎的MRI、CT表现[J].中国临床医学影像杂志,2016,27(4):278-281.
[13] Jamaludin A,Lootus M,Kadir T,et al. ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017:Automation of reading of radiological features from magnetic resonance images(MRIs)of the lumbar spine without human intervention is comparable with an expert radiologist[J]. Eur Spine J,2017,26(5):1374-1383.
[14]菅振,傅一山.腰椎术后椎间隙感染诊断与治疗[J].国际骨科学杂志,2014,35(4):226-227,234.
[15]樊渊,成文,高跃翔,等.腰椎术后椎间隙感染的治疗探讨[J].中华医院感染学杂志,2014,24(19):4847-4849.
[16] Rapp M,Ley CJ,Hansson K,et al. Postoperative computed tomography and low-field magnetic resonance imaging findings in dogs with degenerative lumbosacral stenosis treated by dorsal laminectomy[J]. Vet Comp Orthop Traumatol,2017,30(2):143-152.
[17]朱小龙,徐卫星,刘杰,等.椎间隙感染的诊断与治疗进展[J].中国骨伤,2016,29(9):870-874.