腰椎动态试验在经皮穿刺椎间盘摘除术中的应用价值

The value of the dynamic mechanical spinal test in the management of automated percutaneous lumbar discectomy

目的探讨腰椎动态试验对预测经皮穿刺椎间盘摘除术(PLD)疗效的价值。方法CT、MRI检查证实的“包容性”腰椎间盘突出症109例;PLD前1 d进行腰椎动态试验,根据发生症状向心化现象(CP)、症状部分向心化现象(PCP)、症状非向心化现象(NCP)分为3组,其中CP组46例,PCP组43例, NCP组20例,各组均行PLD治疗并分别进行疗效统计,用x^2检验比较3组间的疗效。结果PLD术后随访3～6个月统计疗效。CP组,优24例、良22例,优良率100%;PCP组PLD疗效,优5例、良29例、可+差9例,优良率79．1%;NCP组PLD优良率0,3组间疗效有显著性差异(x^2=72．59,P＜0．005)。结论腰椎动态试验发生“CP”现象者,PLD疗效显著;发生“NCP”者PLD疗效差,应行外科手术治疗。

Objective To prospectively assess the predictive power of centralization phenomenon in the curative effect of automated PLD. Methods The survey population was consisted of 109 patients with inclusion heraiation demonstrated by CT/MRI, 74 men and 35 women with average age of 43.1 years（17 - 75 years ）. All were complained of low back pain, with varying degrees of lower extremity pain and altered sensation , lasting for more than 2 months; including one symptomatic disc in 99 patients and two symptomatic discs in 10 patients. Patients were undergone dynamic mechanical spinal test and reported whether the test would aggravate their pain. The assessment included forward flexion, extension, rotation of the trunk to the right and left, rotation to the left with right extension, rotation to the right with left extension, and whether straight leg raising in the supine position would aggravate back pain or leg pain. Symptom resposes were categorized into three groups： centralization group （CG）, partial-centralization group （PCG） and noncentralization group （NCG）. Centralization of pain is the progressive retreat of the most distal extent of the referred or radicular pain toward or to the lumbar midline. Noncentralization of pain is the peripheralization of pain in one or more directions, and no change in the distal-most pain location or intensity.All patients received a single therapy with PLD. Results A follow-up of 109 patients for 3 to 6 months, including 46 cases with 24 as exellent and 22 as good reaching 100% of excellent good rate in CG by MacNab standards; 43 cases with 5 as exellent, 29 as good, 9 as fair and poor, with total effective rate of 79.1% in PCG . Twenty cases of NCG symptoms showed no improvement and therefore surgery was considered. Conclusions Centralization phenomenon occurrence during initial mechanical evaluation is a very accurate predictor for successful PLD outcome. Nonoccurrence of centralization would accurately predict poor PLD outcome and thus helpful as early predictor of the need for surgical treatment.