腰椎间盘突出与有无临床症状的影像对照研究

Imaging study of lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation

目的:探讨应用区域定位评分法研究腰椎间盘突出(膨出、突出、脱出)有临床症状与无临床症状的相关性及原因分析。方法:将符合要求的CT病理分型为膨出、突出、脱出的体检或住院或门诊患者120例,按有临床症状与无临床症状分为2组,每组按CT病理分型分3组,年龄20～59岁,平均38.5岁,有临床症状与无临床症状两组间在性别、年龄、病程及椎间盘分布节段差异均无统计学意义;应用区域定位评分法对各组评分;用游标卡尺分别测量矢状径指数(SI)、盘黄韧带前间隙、侧隐窝上口宽度、硬膜囊前后径。CT值由X线断层扫描测定,分别测量3次,取平均值。结果:①腰椎间盘突出有临床症状与无临床症状两组在SI、CT值、CT评分、硬膜囊前后径之间差异无统计学意义(P>0.05);在侧隐窝上口宽度、盘黄韧带前间隙之间差异有统计学意义(P<0.05)。②腰椎间盘突出有临床症状与无临床症状两组突出类型比较,差异有统计学意义(P<0.05);腰椎间盘脱出有临床症状与无临床症状两组突出节段比较,差异有统计学意义(P<0.05)。结论:①腰椎间盘突出大小、部位、类型不一定与临床症状存在必然关系,腰椎间盘突出症与压迫程度无正比关系;②椎管内突出髓核是否导致相应的临床症状存在着诸多或必然因素,可能与椎间盘突出物可代偿的椎管储备容量、受累神经根对机械压迫的逃逸避让与弹性延长功能,以及受累神经根低氧消耗与抗缺血性损伤代偿作用等因素有关。

Using regional assignment to forked method to study lumbar intervertebral disc herniation （bugle, hernia, prolapse） dependablity and reason of lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation. Methods： From March 2005 to October 2006,120 patients of match condition from orthopaedics dept and rehabilitative dept of the Boai hospital of Longyan were studied. All patients were equally divided into two groups according to whether or not accompany with symptom of lumbar intervertebral disc herniation. There was not statistical difference in sex, age, course of disease, segment of intervertebral disc between two groups. Sixty patients of symptomatic lumbar intervertebral disc herniation were equally divided into three groups according to （bugle, hernia, prolapse ） image on CT. Sixty patients of asymptomatic lumbar intervertebral disc herniation were equally divided into three groups according to （bugle, hernia, prolapse ） image on CT. The age was 20-59 years old with an average of 38.5 years. Using regional assignment to give a mark respectively for every group. The sa- gittal diameter index （SI）, anterior diastema of flaval ligaments, the width of superior outlet of latero-crypt, anteroposterior diameter of dura sac were respectively measured by sliding caliper. CT value and protrusible areas were respectively evaluated by computer tomography. Adopting mean value to measure three times. Results： ①There were not statistical difference in SI, CT value, hernia areas, anteroposterior diameter of dura sac between two groups （symptomatic lumbar intervertebral disc herniation and asy- mptomatic lumbar intervertebral disc herniation）. There were statistical difference in the width of superior outlet of latero-crypt, anterior diastema of flaval ligaments between two groups （symptomatic lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation）. ②There were statistical difference in protrusible type, protrusible segment between two groups （symptomatic lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation）. Conclusion： There were not necessary relationship between in protrusible size, location, type, compression degree and clinical symptom. This paper may support the mechanism of lumbar intervertebral disc herniation that associated with the following the three aspects： ①spinal reserve capacity （SRC） ; ②involved nerve roots escaping from herniated disc compression and its elastic lengthening function ; ③hypoxia symptosis and anti-ischemia injury compensation of involved nerve roots.