旁侧型腰椎间盘脱出术前MR神经成像与手术分型的对比研究

Comparison Between MR Neurography and Surgical Classification for Lateral Prolapse of Lumbar Intervertebral Disc

目的应用磁共振三维短恢复时间反转恢复（3D-STIR）序列磁共振神经成像（MRN）诊断旁侧型腰椎间盘脱出,并与手术分型对比观察。方法回顾性分析24例旁侧型腰椎间盘脱出病例的影像学资料和临床资料,将术前MRN所示按脱出髓核组织与受累神经根的位置关系分为肩型、腋型和根型,总结MRN所示不同水平各型椎间盘脱出卡压神经根的情况,并将术前MRN表现与手术所见的3种分型进行比较。结果 24例患者共25处椎间盘脱出,集中在L_3~S_1椎间盘水平。3D-STIR增强扫描示肩型、腋型及根型脱出分别为3处、7处和15处,80%（20/25）的脱出累及下一椎体神经根,其中腋型脱出多累及两根神经根（71.4%,5/7）。术前MRN与手术分型有较好的一致性（Kappa值=0.865,P〈0.01）。结论 3D-STIR MRN可对腰椎间盘脱出卡压的神经根进行具体且全面的评估,与术中手术分型一致性较高,对患者的术前评估、手术方案制定、术后并发症的预防具有重要的指导意义。

Objective To apply 3D-STIR MR Neurography for diagnosing lateral prolapse of lumbar intervertebral disc,and comparing it with the surgical classification.Methods MR Imaging data of 24 patients who were diagnosed with lum-bar lateral disc extrusion were analyzed retrospectively.The lateral prolapse of lumber discs were divided into three types;-shoulder type,axillar type and root type according to the position relations between prolapsed nucleus pulposus and affected nerve root on 3D MR Neurography.Summary of the involvement of nerve roots on different types and levels in MRN and comparison of the two classifications between MRN and surgery was done.Results There were 25 disc herniation in 24 patients,and disc herniation often occured on L_3~ S_1 levels.On 3D-STIR MRN;the number of the three types（shoulder type,axillar type and root type） was 3,7 and 15 respectively.We found 80%（20/25） of disc herniation affected the nerve root of the next vertebra,and the axillar type usually involved 2 nerve roots（71.4%,5/7）.MRN classification had good compatibility with the surgical classification（Kappa = 0.865,P 0.01）.Conclusion 3D-STIR MRN can provide a definite and comprehensive evaluation of the affected nerve roots in patients with lumbar disc extrusion.We found a strong consistency of the MRN classification with the surgical findings.3D-STIR sequence has a guiding significance for the preoperative assessment,surgical planning and prevention of postoperative complications to these patients.