CT引导椎间盘造影术在多节段腰椎间盘退变中的临床价值

Clinical value of discography followed by computed tomography for the treatment of multi-level lumbar disc degeneration

[目的]探讨CT引导下椎间盘造影术在治疗多节段腰椎间盘退变疾患中的临床价值。[方法]2005年1月～2008年1月对28例多节段腰椎间盘退变疾患行CT引导下椎间盘造影术，其中男12例，女16例；年龄30～56岁，平均38．2岁。腰椎间盘退变节段：L3,4和L4，5突出9例，L4，5和L5S1突出15例，L3,4、L4，5和L5S1三节段突出4例。造影节段：28例共计92个椎间盘，L2、3间隙10例，L3,4间隙28例，L4，5间隙28例，L5S1间隙26例。按照阳性椎间盘造影的诊断标准，筛选出致痛性椎间盘（责任间盘），对这些病变间隙行相应的椎间融合术治疗。[结果]28例患者92个间隙共筛选出32个责任间盘。VAS≥6分组中Ⅱ＋Ⅲ级间盘（Dallas分级）和退变间盘（Pearce分级）所占的百分比明显高于VAS〈6分组（P〈0．05）。手术前后ODI指数评分比较有显著性差异（P〈0．05）。随访12—36个月，平均25．2个月。Charles疗效评定，术后优22例（78．6％），良5例（17．9％），一般1例（3．6％），差0例。所有病例均未发生与椎间盘造影有关的并发症。1例椎间融合器下沉，1例植骨融合不良，1例术后病变侧伸足母肌力减退，再次手术行椎弓根螺钉调整术，术后2个月肌力恢复。[结论]CT引导下椎间盘造影术对于多节段腰椎间盘退变疾患中责任间盘的选择具有重要的临床意义。

[ Objective ] To explore the clinical value of discography followed by computed tomography for the treatment of multi - level lumbar disc degeneration. [ Methods ] Twenty - eight cases were enrolled from January 2005 to January 2008. There were 12 males and 16 females with average age of 38. 2 years, ranging from 30 to 56 years. The level of degenerated disc included L3,4 and L4,5 （9 cases） , L4,5 and L5S1（ 15 cases） , L3,4, L4,5 and L5S1 （4 cases） . The level of discography ineluded L2,3 （10 cases） , L3,4 （28 cases） , L4,5 （28 cases）, and L5S1 （26 cases） with a total of 92 discs. The painful discs （or responsible discs） were screened according to diagnostic criteria of provocative discography and treated with interbody fusion. [ Results] Thirty - two responsible discs were screened in total of 92 discs. ODI scores between pre and post operation were significantly different （ P 〈 0. 05 ） . The percentage of Grade Ⅱ , Ⅲdiscs （ Dallas grade） and degenerated discs （ Pearee grade Ⅲ toⅤ） in VAS≥6 group was significantly higher than that in VAS 〈6 group. All cases were followed up from 12 to 36 months （mean 25.2 months） . The clinical results were excellent in 22 cases （78.6%）, good in 5 （ 17. 9% ） and fair in 1 （3. 6% ） by Charles score. All eases had no complications related to discography. One cage subsidence and one malunion of bone graft were shown in plain X - ray films. One ease suffered from decreased hallux extensor muscle strength because of malpo- sitioned pedicle screw, requested a revision surgery and recovered to normal 2 months after operation. [ Conclusion ] This study shows that discography followed by computed tomography takes an important role in responsible disc selection in multi - level lumbar disc degeneration.