Pfirrmann分级对髓核成形术治疗包容性腰椎间盘突出症临床疗效分析

THE CLINICAL VALUE OF PFIRRMANN GRADES IN THE TREATMENT OF CONTAINED LUMBER DISC HERNIATION BY NUCLEOPLASTY

目的:探讨MRI Pfirrmann分级在等离子消融髓核成形术治疗包容性腰椎间盘突出症中的临床意义。方法:32例经X线片、MRI影像学检查,并结合临床表现明确诊断为包容性椎间盘突出症患者,在C型臂或CT引导下采用等离子髓核成形术治疗。记录术前责任间盘MRI Pfirrmann分级,观察术前及术后7 d、1个月、3个月、6个月、12个月疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、改良Macnab疗效标准评价的疗效。结果:髓核成形术后1月疼痛缓解率平均为63.5%,优良率为76.6%;12月疼痛缓解率平均为60%,优良率为63.3%。术前与术后VAS和ODI比较有统计学差异。PfirrmannⅢ级组12月疼痛缓解率为64%,优良率为87.5%;PfirrmannⅣ级组12月疼痛缓解率为41%,优良率为45.5%。两组组间疗效有统计学差异。结论:回顾性分析显示等离子髓核成形术的临床疗效与椎间盘退化程度有关,Pfirrmann分级系统对等离子消融髓核成形术治疗椎间盘突出症术前合理选择患者,术后疗效的评价具有重要的临床价值。

Objective： To investigate the clinical value of Pfirrmann grades in the treatment of contained lumbar disc herniation by nucleoplasty. Methods： 32 Cases of contained lumbar disc herniation which were diagnosed by physical examination of X-ray and/or MRI. The cases were treated with nucleoplasty guided by CT. MRI Pfirrmann grades of herniation discs were recorded before treatment. The visual analogue scale （VAS）, Oswestry disability index （ODI） were recorded before the operation, and 7 d, 1 month, 3 months, 6 months, 12 months after operation. The improved Macnab criterion was useded to evaluate the clinical efficacy. Results： The pain relief rate of 1 month and 12 months was 63.5% and 60%, respectively. The efficacy rate of 1 month and 12 months was 76.6% and 63.3%, respectively. There were statistical differences in the VAS and ODI between before and after operation. The pain relief rate of Pfirrmann Ⅲ and Pfirrmann Ⅳ grade groups at 12 months was 64% and 41%, respectively. The efficacy rate of Pfirr- mann Ⅲ and Pfirrmann Ⅳ grade groups at 12 months was 87.5% and 45.5%, respectively. There were statistical differences in the pain relief rate and efficacy rate between Pfirrmann Ⅲ and Pfirrmann Ⅳ gra- des. Conclusion： Nucleoplasty is a safe, minimally invasive, simple, effective treatment for contained lum- bar disc herniation. Efficacy in Pfirrmann Ⅲ grade patients is better than that in the Pfirrmann Ⅳ grade patients. Pfirrmann grade is valuable for selecting the appropriate case before nucleoplasty and evaluating efficacy after nucleoplasty.