腰椎间盘突出症的区域定位

The Three-dimensional Localization of the Herniation of Lumber Disc

目的：依据腰椎间盘突出在ＣＴ或ＭＲＩ显示的影像，提出腰椎间盘的区域定位，为腰椎间盘突出症做出更精确的诊断。方法：（１）将突出椎间盘在椎管内所处的位置从矢状位、水平位和额状位予以定位。矢状位分为椎间盘层面（Ｉ层面）、椎间盘上层面（Ⅱ层面）、椎间盘下平面（Ⅲ层面）。水平位分为正中区（１区）、旁正中区（２区）、外侧区（３区）和极外侧区（４区）。额状位分为ａ、ｂ、ｃ、ｄ域。（２）随机统计腰椎间盘突出症手术组与非手术组５０例ＣＴ区域定位。结果：（１）病变所在层面和区，两组比较差异无显著性意义（Ｐ＞０．０５）。（２）病变所在域，两组比较差异有非常显著性意义：手术组无１例为ａ域，非手术组ａ域为２３例（Ｐ＜０．００５）；手术组ｃ域１５例，非手术组２例（Ｐ＜０．００５）。结论：区域定位可反映出不同病理类型、不同严重程度的椎间盘突出以及精确的定位诊断，为治疗的选择和手术方法的实施提供了重要的参考依据，也为评定术后效果提供了客观的标准。

bjective:According to the morphology of the herniation of the lumbar disc showed by CT or MRI, a concept of threedimensional localization was considered for the establishment of an accurate diagnosis. Methods:(1)Threedimensional localization could be carried out as follows: Sagittal plane: I (disc level), II(supradiscal level), III(infradiscal level), Horizontal plane: 1(medial zone), 2( paramedial zone,L&R) , 3(lateral zone, L&R), 4(extraforamen zone, L&R) and Frontal plane: a,b, c and d areas.(2) Using the threedimensional localization, all 50 cases in this series were respectively treated operatively and conservatively and were statistically analysed. Results:There was no significant difference in the level and zone of disc herniation, but significant difference was seen in the area distribution (P<0.005). Conclusion:The authors consider that the threediminsional localization is useful for the establishment of an accurate diagnosis, for the prediction of the severity of the disc herniation,as well as for the selection of management and evaluation of treatment results.