椎间孔镜TESSYS技术治疗腰椎间盘突出症的疗效与术后MRI变化的关系
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摘要
目的探讨椎间孔镜TESSYS技术治疗腰椎间盘突出症的疗效与MRI变化的关系。方法 2016年3月～2017年10月应用椎间孔镜TESSYS技术治疗腰椎间盘突出症63例。采用局麻加强化,行椎间孔扩大成形,突出髓核摘除,神经根松解和减压。术后采用改良MacNab进行疗效评价,比较术前后视觉模拟评分(Visual Analogue Scale,VAS)、MRI椎管横截面积、椎间孔中部矢状径(椎间盘后缘中点到椎间孔后缘的矢状距离)、椎间孔面积、神经根Pfirrmann分级变化。结果63例均顺利完成手术。术中出血量5～10 ml。手术时间84～134 min,平均107 min。术后住院时间4～14 d,平均7. 3 d。63例术后随访6～24个月,平均8. 8月。改良MacNab疗效:优24例,良34例,可2例,差3例,优良率92. 1%。术后VAS评分与术前比较明显改善(P <0. 05),MRI椎管横截面积、椎间孔中部矢状径、椎间孔面积、神经根Pfirrmann分级与术前比较均明显改善(P <0. 05)。术后VAS评分变化与MRI椎管横截面积变化呈负相关(r=-0. 268,P=0. 034),与椎间孔中部矢状径、椎间孔面积变化无相关性; VAS分级变化和改良MacNab分级与神经根Pfirrmann分级变化无相关性。结论椎间孔镜TESSYS技术治疗腰椎间盘突出症的疗效与术后MRI椎管横截面积改善有关,与椎间孔中部矢状径和椎间孔面积的增加以及神经根在椎管内受压情况变化无明显关系。
Objective To observe the relationship between clinical effects of TESSYS technigue in the treatment of lumbar disc herniation and the changes of magnetic resonance imaging( MRI). Methods From March 2016 to October 2017,63 cases of lumbar disc herniation were treated with TESSYS technique. The operation was performed under local anesthesia and intensified anesthesia,and enlarged foraminoplasty,nucleus pulposus resection,and neurolysis and decompression of nerve root were performed.The modified MacNab evaluation was used after operation. The preoperative and postoperative Visual Analogue Scale( VAS) scores,the cross-sectional area of spinal canal,sagittal diameter in the middle of intervertebral foramen( sagittal distance from the midpoint of intervertebral disc to posterior margin of intervertebral foramen),area of intervertebral foramen,and Pfirrmann grading changes of nerve root were compared. Results The operations were successfully completed in the 63 cases. The intraoperative blood loss was5-10 ml. The operation time was 84-134 min( mean,107 min),and the postoperative hospitalization time was 4-14 d( mean,7. 3 d). The 63 cases were followed up for 6-24 months( mean,8. 8 months). The modified MacNab evaluation showed excellent in24 cases,good in 34 cases,fair in 2 cases,and poor in 3 cases. The rate of excellent and good was 92. 1%. The postoperative VAS scores were significantly improved as compared with that of preoperation( P < 0. 05). The cross-sectional area of spinal canal,sagittal diameter in the middle of intervertebral foramen,area of intervertebral foramen,and Pfirrmann grading of nerve root were significantly improved as compared with that of preoperation( P < 0. 05). The changes in VAS scores before surgery were negatively correlated with changes of spinal canal cross-sectional area in MRI( r =-0. 268,P = 0. 034). There were no correlations between VAS scores and foraminal sagittal diameter and foraminal area. There were no correlations between VAS changes and modified MacNab evaluation and Pfirrmann grading changes. Conclusion The effects of TESSYS technique in the treatment of lumbar disc herniation are correlated to the improvement of the cross-sectional area of the spinal canal on postoperative MRI,but not to the increase of the sagittal diameter and the area of the intervertebral foramen and the change of compression of the nerve root in the spinal canal.
Objective To observe the relationship between clinical effects of TESSYS technigue in the treatment of lumbar disc herniation and the changes of magnetic resonance imaging( MRI). Methods From March 2016 to October 2017,63 cases of lumbar disc herniation were treated with TESSYS technique. The operation was performed under local anesthesia and intensified anesthesia,and enlarged foraminoplasty,nucleus pulposus resection,and neurolysis and decompression of nerve root were performed.The modified MacNab evaluation was used after operation. The preoperative and postoperative Visual Analogue Scale( VAS) scores,the cross-sectional area of spinal canal,sagittal diameter in the middle of intervertebral foramen( sagittal distance from the midpoint of intervertebral disc to posterior margin of intervertebral foramen),area of intervertebral foramen,and Pfirrmann grading changes of nerve root were compared. Results The operations were successfully completed in the 63 cases. The intraoperative blood loss was5-10 ml. The operation time was 84-134 min( mean,107 min),and the postoperative hospitalization time was 4-14 d( mean,7. 3 d). The 63 cases were followed up for 6-24 months( mean,8. 8 months). The modified MacNab evaluation showed excellent in24 cases,good in 34 cases,fair in 2 cases,and poor in 3 cases. The rate of excellent and good was 92. 1%. The postoperative VAS scores were significantly improved as compared with that of preoperation( P < 0. 05). The cross-sectional area of spinal canal,sagittal diameter in the middle of intervertebral foramen,area of intervertebral foramen,and Pfirrmann grading of nerve root were significantly improved as compared with that of preoperation( P < 0. 05). The changes in VAS scores before surgery were negatively correlated with changes of spinal canal cross-sectional area in MRI( r =-0. 268,P = 0. 034). There were no correlations between VAS scores and foraminal sagittal diameter and foraminal area. There were no correlations between VAS changes and modified MacNab evaluation and Pfirrmann grading changes. Conclusion The effects of TESSYS technique in the treatment of lumbar disc herniation are correlated to the improvement of the cross-sectional area of the spinal canal on postoperative MRI,but not to the increase of the sagittal diameter and the area of the intervertebral foramen and the change of compression of the nerve root in the spinal canal.
引文
1 Schubert M,Hoogland T.Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation.Oper Orthop Traumatol,2005,17(6):641-661.
2格日勒,郭昭庆.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展.中国微创外科杂志,2018,18(3):267-270.
3胡友谷,主编.腰椎间盘突出症.第4版.北京:人民卫生出版社,2011.370.
4 Macnab I.Negative disc exploration.An analysis of t he cause of nerve root involvement in sixty eight patients.J Bone Joint Surg Am,1971,53(5):891-903.
5 Pfirrmann CW,Dora C,Schmid MR,et al.MR image-based grading of lumbar nerve root compromise due to disk herniation:reliability study with surgical correlation.Radiology,2004,230(2):583-588.
6姜辉,孙百胜,纪丙军,等.CT导向椎间孔镜技术治疗腰椎间盘突出症术后MR评价.医学影像学杂志,2014,24(3):429-432.
7刘宝平,孙义忠,王峰宝,等.椎间孔镜与开窗治疗椎间盘突出症术后影像学分析.中国骨与关节损伤杂志,2012,27(9):826-827.
8王洪伟,李长青,周跃.腰椎间盘突出症疼痛发生机制的研究进展.中国矫形外科杂志,2011,19(7):568-570.
9胡星新,刘立岷.临床症状体征与影像学检查分离的腰椎间盘突出症的发生机制研究进展.中国骨伤,2015,28(10):970-974.
10胡琦,刘国民,张宇晨,等.腰椎椎间孔韧带的解剖及临床意义.中国老年学杂志,2015,35(20):5988-5989.
11姜宏,施杞,郑清波.腰椎间盘突出后的自然吸收及其临床意义.中华骨科杂志,1998,18(12):755-756.
12梁博伟,唐福兴,彭远媚,等.腰神经根管狭窄分区及程度与经皮椎间孔镜手术疗效的相关性.中国骨与关节损伤杂志,2018,33(11):1184-1186.
2格日勒,郭昭庆.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展.中国微创外科杂志,2018,18(3):267-270.
3胡友谷,主编.腰椎间盘突出症.第4版.北京:人民卫生出版社,2011.370.
4 Macnab I.Negative disc exploration.An analysis of t he cause of nerve root involvement in sixty eight patients.J Bone Joint Surg Am,1971,53(5):891-903.
5 Pfirrmann CW,Dora C,Schmid MR,et al.MR image-based grading of lumbar nerve root compromise due to disk herniation:reliability study with surgical correlation.Radiology,2004,230(2):583-588.
6姜辉,孙百胜,纪丙军,等.CT导向椎间孔镜技术治疗腰椎间盘突出症术后MR评价.医学影像学杂志,2014,24(3):429-432.
7刘宝平,孙义忠,王峰宝,等.椎间孔镜与开窗治疗椎间盘突出症术后影像学分析.中国骨与关节损伤杂志,2012,27(9):826-827.
8王洪伟,李长青,周跃.腰椎间盘突出症疼痛发生机制的研究进展.中国矫形外科杂志,2011,19(7):568-570.
9胡星新,刘立岷.临床症状体征与影像学检查分离的腰椎间盘突出症的发生机制研究进展.中国骨伤,2015,28(10):970-974.
10胡琦,刘国民,张宇晨,等.腰椎椎间孔韧带的解剖及临床意义.中国老年学杂志,2015,35(20):5988-5989.
11姜宏,施杞,郑清波.腰椎间盘突出后的自然吸收及其临床意义.中华骨科杂志,1998,18(12):755-756.
12梁博伟,唐福兴,彭远媚,等.腰神经根管狭窄分区及程度与经皮椎间孔镜手术疗效的相关性.中国骨与关节损伤杂志,2018,33(11):1184-1186.