MRI检查在腰椎间盘突出髓核摘除术患者术后椎间隙感染的诊断价值

Diagnostic value of MRI examination in patients with intervertebral space infection after nucleus pulposus removal for treatment of lumbar disc herniation

目的探讨磁共振成像(MRI)检查在腰椎间盘突出髓核摘除术患者术后椎间隙感染的诊断价值。方法选取医院2013年4月-2016年4月收治的腰椎间盘突出髓核摘除术后椎间隙感染患者19例为研究对象,均通过磁共振成像技术开展MRI检测,明确诊断后给予针对性干预治疗,重点观察该病症MRI检查影像学特征,随访12~15个月,分析患者白细胞、血沉、C-反应蛋白指标变化。结果 MRI扫描T1加权,信号呈持续对称性低信号,T2信号则表现为明显高信号;扫描征象可见椎体软骨终板异常分离缺损,椎间盘破损。MRI征象中病变椎体与邻近正常椎体分界较为模糊;邻近受累椎体与椎间隙软组织均发生肿胀或增厚迹象,较病灶点椎间盘更为明显;治疗12~15个月,17例椎间隙感染者体征症状均完全消失,治愈率达到89.47%,1例治疗后依旧存在轻度间歇性腰痛,1例则伴有明显腰椎活动受限。治疗后,患者白细胞计数、血沉、C-反应蛋白分别为(10.35±2.17)×109/L、(78.69±8.34)mm/h、(51.97±4.07)mg/L均低于治疗前(P<0.05)。结论 MRI技术对于腰椎间盘突出髓核摘除术后椎间隙感染诊断效果良好,能对感染病灶椎体、边缘、间隙及软组织做准确显像,明确患者病理变化特征,有助于准确鉴别诊断早期椎间隙感染。

OBJECTIVE To evaluate the value of magnetic resonance imaging（MRI）in the diagnosis of intervertebral space infections after nucleus pulposus removal for treatment of lumbar disc herniation.METHODS A total of19 patients with lumbar intervertebral disc herniation who underwent nucleus pulposus removal treatment for lumbar disc herniation from Apr.2013 to Apr.2016 were enrolled in this study.All patients received magnetic resonance imaging（MRI）examination and were given targeted intervention after examination.The MRI features were observed and followed up for 12-15 months,the changes of white blood cells,erythrocyte sedimentation rate and C-reactive protein were analyzed.RESULTSIn MRI scanning,the weighted T1 signal showed low signal of continuous symmetry,whereas T2 signal showed obvious high signal.The scanning signs showed abnormal separation and defect in vertebral plate endplate,and intervertebral disc breakage.In MRI images,the boundary between vertebral body lesions and adjacent normal vertebral body was fuzzy.Swelling or thickening occurred in vertebral body and intervertebral space adjacent soft tissue,which was more obvious than the lesions in intervertebral disc.After12 months of follow-up,the symptoms and signs of 17 patients with intervertebral space infection disappeared completely,and the cure rate was 89.47%.1 case still had mild intermittent low back pain,and 1 case had obvious lumbar spine movement limitation.After treatment,the WBC count,ESR,C-reactive protein were（10.35 ±2.17）×10 - 9/L,（78.69 ±8.34）mm/h,（51.97 ±4.07）mg/L,lower than those before treatment（P〈0.05）.CONCLUSION MRI technique can be used to diagnose intervertebral space infection after nucleus pulposus removal treatment for lumbar disc herniation.It can clearly display the images for the vertebral body,edge,gap and soft tissue of the infected lesions.It can identify the characteristics of pathological changes in the patients and help the doctors to differentiate and diagnose early intervertebral infection accurately.