髓核突出椎管造影、CT、MRI比较研究

Comparative Study of Myelography,CT and MRI on Nuclear Pulposus Herniation

笔者分析了经手术病理证实的34例患者44个部位髓核突出,术前皆行非离子型水溶性造影剂椎管造影、CT和MRI检查,结果三者确诊率分别为84.1％,93.2％和93.2％。结合对冰冻腰段标本的解剖及镜下组织学研究,作者重点讨论:(1)髓核突出三种影像检查的优缺点,(2)髓核突出好发于腰4～5及旁中央型的解剖学基础,(3)髓核突出与腰腿痛的关系。认为MRI为首选方法,既可查出纤维环破裂又能确定后纵韧带是否完整,为选择手术或经皮切吸方法提供关键依据。

34 patients with 44 nuclear pulposus herniations (NPH) were analysed. Iopamiro myelography,CT and MRI were done before operation in each patient. The diagnostic accuracy of myelography ,CT and MRI was 84. 1% ,93. 2% and 93. 2% ,respectively. Compared with anatomic and microscopic study of cadavers,we discussed as follows: (l)advantages and disadvantages of the three methods. (2)anatomic basis of NPH at the side of paracentre and L4-5 level; (3)the relationship between the low-back pain and NPH. The authors made out the conclusion that MRI was the first method of choice for NPH,which confirmed both the rupture of annulus and the transligament herniation,providing the key basis of the choice of operation or nucleotomy.