椎间盘压力测定在射频消融髓核成形术中的可行性研究

Feasibility study of discometry in radio frequency nucleuplasty

目的探讨椎间盘压力测定在颈椎、腰椎间盘射频消融髓核成形术中的可行性及椎间盘压力变化的影响因素。方法随机选择2006年7月－2007年7月同组医生施行局麻下经皮射频？肖融髓核成形手术治疗的颈椎、腰椎病例各10例，于术中射频？肖融前后分别测量椎间盘内压力。共测量18个颈椎间盘及17个腰椎间盘，其中5个腰椎间盘术前同时行椎间盘前部测压。另随机选择术中行椎间盘造影检查的椎间盘源性颈腰痛病例10例，10个椎间盘（颈椎、腰椎间盘各5个），于术中椎间盘造影检查前后分别测量椎间盘内压力。分析射频？肖融减压前后椎间盘内压力数据分布的正态性、减压情况、应用造影剂及穿刺部位等相关干预因素对压力的影响。结果全部测压病例术前与术后椎间盘压力的数据均符合正态分布（P〉0．05）。颈椎间盘压力术前为26．56mmHg±3．35mmHg（1mmHg=0．133kPa），术后为22．94mmHg±4．12mmHg；腰椎间盘压力术前为37．18mmHg±4．23mmHg，术后为31．47mmHg±5．95mmHg。射频？肖融术后椎间盘压力均较术前降低，且差异有显著性（P〈0．05）。应用造影剂后，颈椎间盘压力增高21．44mmHg±7．82mmHg，腰椎间盘压力增高30．06mmHg±11．25mmHg，较应用前均有显著性差异（P〈0．05）。腰椎间盘前部压力比中部高2．00mmHg±3．12mmHg，但二者差异无显著性（P〉0．05）。结论椎间盘压力变化与射频？肖融术及造影剂的应用关系密切。初步研究结果表明，椎间盘压力监测在射频？肖融髓核成形术中具有可行性，并有助于量化减压程度，为保证术后疗效提供重要参考。

Objective To study the feasibility of discometry in radio frequency nucleuplasty, and discuss the influential factors of pressure changes in the intervertebral discs. Methods Twenty cases, including 10 cervical （ 18 cervical discs） and 10 lumbar （17 lumbar discs）, were selected, which treated with radio frequency nucleuplasty with local anesthesia by same doctors from July 2006 to July 2007. The pressures of operated intervertebral disc were measured in the operation. And the anterior partial pressures of preoperative intervertebral disc in 5 lumbar discs were measured at the same time. Another 10 cases （ l0 discs, 5 cervical discs and 5 lumbar discs） with disc contrast examine were random selected. The pressure changes from pre-contrast examine to post-contrast examine were calculated. The distribution of the pressure data of interveterbral disc, the pressure change, the relation with contrast medium and the part of puncture were analyzed by statistic methods. Results All pressure data of interveterbral discs were normal distribution （ P 〉 0.05 ）. The pre-operative pressure of cervical was 26.56 ± 3.35 mmHg （ 1 mmHg ± 0. 133 kPa）, and post-operative, 22.94 ± 4.12mmHg. The pre-operative pressure of lumbar was 37.18 ±4.23 mmHg, and post-operative, 31.47 ±5.95 mmHg. There were significant differences between pre-operative and the post-operative on pressure（ P 〈0.05 ）. And there were significant differences on pressure between pre-contrast examine and post-contrast exa-mine（ P 〈 0.05 ）. The pressure of cervical disc increased 21.44 ± 7.82 mmHg post-contrast examines, and the pressure of lumbar disc increased 30.06 ± 11.25 mmHg. The lumbar disc pressure of anterior part was over 2.00 ± 3.12 mmHg than middle part, but there were not significant difference between them（ P 〉 0.05 ）. Conclusion The pressure changes of intervertebral disc had the close relation with radio frequency nucleuplasty and the using of contrast medium. Primary study indicated the feasibility of discometry in radio frequency nucleuplasty. Discometry will help in control of the degree of compression, and provide critical reference to ensure the curative effect.