摘要
目的 探讨腰椎间盘突出症硬膜外封闭治疗无效与影像学 (包括CT、MRI)区域定位的相关因素。方法对 90例硬膜外封闭治疗无效的腰椎间盘突出症患者 ,按照胡有谷的影像学区域定位法进行分类 ,并与手术结果进行对比分析。结果 影像学区域定位与手术探查结果比较显示 :(1)区域定位见位于Ⅲ或Ⅱ层面为主的椎间盘突出 30例中 ,手术证实属脱出型或游离型共 2 6例 (占 86 .7% ) ,4例为突出型 ;(2 )区域定位见c～d区域突出 34例 ,手术均见间盘突出巨大、硬脊膜及神经根压迫严重 ;(3)影像学见突出并有黄韧带增厚或小关节内聚增生、椎板增厚或椎体后缘骨赘增生或腰椎不稳 31例 ,全部与手术所见基本相符。本组 90例影像学除见椎间盘突出外 ,并可见上述之一项影像学征者共 76例 ,占84.4 %。结论 腰椎间盘突出症硬膜外封闭治疗无效与下列影像学征有关 :(1)位于Ⅲ或Ⅱ层面为主的突出 ;(2 )突出超过b域 ;(3)突出在 3区 ;(4)突出并有黄韧带增厚、钙化 ;(5)突出并有椎体后缘或小关节内聚骨质增生、椎板增厚 ;(6)突出并腰椎不稳。
Objective To investigate the relevant factors of ineffective epidural blocking injections for the treatment of herniation of lumbar intervertebral disc and to study its imaging localization. Methods A comparative analysis was performed for the ineffective epidural blocking injections and the operative findings in 90 cases of herniation of lumbar disc according to the classification of three dimensional image localization by Hu Yougu. Results A comparison between the three dimensional image localization and operative results reveals that:1) in the 30 cases at Ⅲor Ⅱplane (86.7%),26 were of the prolapsed type or free type and 4 were of the protruded type;2) 34 cases showed huge protruded disc and severe compression on the dura and nerve roots at c-d area by three dimensional image localization;3) the images of 31 cases of protruded disc with thickening of the ligamentum flavum, osteophytes at facet or at the posterion vertebral body, thickening of the lamina, or lumbar instability were similar to the operative findings. Besides the hernation, 76 out of 90 cases (84%) in this group had one of the above image changes. Conclusion An ineffective epidural blocking injection is related to the following image signs in the herniation of lumbar disc: 1)the main level at Ⅲor Ⅱplane; 2) the extent beyond b-area; 3) lesion at the zone No.3; 4) thickening and calcification of the ligamentum flavum; 5) esteophytes at posterior edge of vertebral body or at facet and thickening of the lamina; 6) lumbar instability.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2000年第2期79-81,共3页
Chinese Journal of Orthopaedics
关键词
腰椎
椎间盘突出
硬膜外封闭疗法
影像学
lntervertebral disc displacement
Injections, epidural
Tomography,X-ray computed
Magnetic resonance imaging
