腰椎间盘突出症在重力牵引下CT及介入治疗的临床分析

Clinical Analysis on the CT Imaging under the Gravity Traction and Interventional Therapy for Lumbar Disc Herniation

目的探讨腰椎间盘突出重力牵引下的CT影像和介入治疗中髓核造影表现以及部分腰椎间盘突出症患者牵引治疗疗效差的原因,并指导介入治疗.方法选择牵引治疗效果差,欲行介入治疗的腰椎间盘突出症患者32例,共43节椎间盘,在同一台CT上,先行病变椎间隙的扫描后,用自制的牵引设备,行骨盆牵引,拉力传感器显示牵引重量,再行CT扫描,扫描参数同牵引前,并与介入治疗中髓核造影影像对照分析.结果牵引中病变椎间隙较牵引前平均增宽0.151 cm,但突出物未见明显回缩,6例7个椎间盘内明显积气.髓核造影显示:纤维环破裂23节,髓核退变明显、纤维环松驰14节,纤维环大部分断裂6节.结论牵引下突出物未见回缩的主要因素是纤维环松弛、断裂失去弹性,椎间盘内压力增高,突出椎间盘组织与周围粘连,这也是牵引效果差、容易复发的原因,在介入治疗时需要方法互补,才能显效.

Objective To explore the cause of poor traction therapy in some patients with lumbar disc herniation and guide the interventional treatment by analyzing the CT images of lumbar disc herniation under the gravity traction and the manifestation of discography during the interventional treatment.Methods 32 patients,a total of 43 discs,with poor effect by traction treatment and requiring interventional treatment were enrolled in this study.The pathological-changed intervertebral spaces were performed CT scan at first.The pelvic traction was carried by a self-made traction device and the traction weight was measured by tension sensor.Another CT scan was performed following the scan parameters,and then the contrast study on CT and discography for interventional treatment were undertaken.Results The average width of pathological-changed intervertebral space was 0.151cm larger than that of anterior recess.However,there was no significant atrophy happen to herniated intervertebral disc.7 segments involving 6 cases were found gas in the disc.Nucleus pulposus radiography showed that annular rupture in 23 segments,significant nucleus pulposus degeneration and annulus relaxation in 14 segments and severe annular break in 6 segments.Conclusions The reasons for no retraction happen to herniated intervertebral disc are the annular relaxation,fracture,loss of elasticity and increased pressure in the disc.The herniated disc adhered to surrounding tissue,which is the cause of poor traction and recurrence.In order to obtain effective treatment,the complement methods should be applied in intervention.