基于MRI成像三维平衡正脊技术治疗LDH髓核重吸收的预测因素分析

MRI-based analysis of predictive factors for nucleus pulposus resorption in patients with lumbar disc herniation treated with three-dimensional balanced chiropractic technique

目的通过MRI成像观察三维平衡正脊技术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效并分析突出后髓核(nucleus pulposus,NP)重吸收的预测因素。方法2015年6月—2021年6月期间,在我院接受三维平衡正脊技术治疗的95例LDH患者进行临床资料及MRI回访,根据髓核吸收率分为重吸收组和未重吸收组。采用多因素二元Logistic回归分析法,对患者性别、年龄、病程等共12项因素进行分析,推断预测因素与重吸收的相关性。结果经随访,共发现32例髓核重吸收(吸收率≥30%),占33.7%。其中病程<1年(P=0.000)、MSU分型3型(P=0.014)、有腿麻症状的患者(P=0.006)、突出物节段L4/5或L5/S1(P=0.000)最容易发生重吸收。结论MRI可以作为观察LDH髓核重吸收的重要工具。其中病程<1年、MSU分型3型、有腿麻症状、突出物节段L4/5或L5/S1的患者最容易发生重吸收,可作为三维平衡正脊技术治疗LDH转归的预测因素参考。

Objective To observe the effectiveness of the three-dimensional balanced chiropractic technique in the treatment of lumbar disc herniation(LDH)and analyze predictive factors for resorption of the herniated nucleus pulposus based on magnetic resonance imaging(MRI).Methods From June 2015 to June 2021,95 patients with LDH treated with the three-dimensional balanced chiropractic techniquein our hospital were followed up for clinical and MRI data.They were divided into resorption group and non-resorption group based on the nucleus pulposus resorption rate.Multivariable binary logistic regression analysis was performed to determine the association of 12 factors(sex,age,course of disease,etc.)with nucleus pulposus resorption.Results Thirty-two cases(33.7%)were found at follow-up to have nucleus pulposus resorption(resorption rate≥30%).Resorption was most likely to occur in patients with a disease course of less than a year(P<0.001),type 3 LDH accoding to the Michigan State University(MSU)classification(P=0.014),leg numbness(P=0.006),and a L4/5 or L5/S1 disc herniation(P<0.001).Conclusion MRI can be used as an important tool to observe nucleus pulposus resorption in LDH.A disease course of less than a year,MSU type 3,leg numbness,a L4/5 or L5/S1 disc herniation are associated with a higher possibility of nucleus pulposus resorption,which can be used as indicators predicting the outcome of patients with LDH treated with the three-dimensional balanced chiropractic technique.