影像学区域定位在腰椎间盘突出症中的应用

Clinical Study of the Tree-dimensional Localization of the Herniation of Lumbar Disc

目的 :依据 CT或 MRI显示的腰椎间盘的影像 ,探讨区域定位方法在中医药治疗腰椎间盘突出症中的应用价值。方法 :运用胡有谷提出的区域定位方法对 46例腰椎间盘突出症病例进行分析。结果 :(1 )本组5 8例病例中 ,单纯膨出者 1 2例 ,46例 (5 4节段 )腰椎间盘突出 (3 1例伴有膨出 )患者中 ,涉及 层节段数占68.5 % , ～ 层占 1 1 .1 % , ～ 层占 2 0 .4% ;涉及 区节段数占 2 9.6% ,2区占 3 3 .3 % ,1～ 2区占 2 5 .9% ;涉及 a域节段数占 3 3 .3 % ,b域占 5 9.3 % ,c域占 7.4%。(2 )本组 5 8例病例 ,采用改良日本骨科学会下腰痛评分法 ,总有效率 98.3 % ,优良率为 87.9%。结论 :(1 )腰椎间盘突出症好发于 L4～ 5、L5S1 节段 ,并且常常伴有椎间盘膨出。(2 )区域定位方法可以很好的判断出腰椎间盘突出的病理类型 ,方向和严重程度。(3 )中医药综合治疗方法是有效的、痛苦少、适用范围较广的治疗措施 。

Objective:To explore the clinical significance on the tree-dimensional localization of the herniation of lumbar disc according to the morphology of the herniation of lumbar disc showed by CT or MRI.Method:Using the tree-dimensional localization established by Profession Hu yougu,46cases in all 58 cases were statistically analysed.Results:(1)In this series,12 cases were diagnosied of lumbar disc expansion,and 31 cases combined with the expansion of lumbar disc in 46 cases of lumbar disc herniation.The three-dimensional localization was carried out as follow:Sagittal plane:Ⅰlevel of 68.5%,Ⅰ-Ⅱlevel of 11.1%,Ⅰ-Ⅲ of 20.4%;Horizontal plane:1 zone of 29.6%,2zone of 33.3%,1-2zone of 25.9%;Frontal plane:a area of 33.3%,b area of 59.3%,c area of 7.4%.(2)Assessed by modified JOA low back pain scores,57(98.3%) in this 58 cases obtained excellent result.Conclusion:(1)Both L 4～5 and L 5S 1 segments were easy to result in LDH.(2)The tree-dimensional localization is useful for the establishment of an accurate disgnosis,for the prediction of the severity of the disc herniation,as well as for the evaluation of treatment resulty.(3) The manipulation and chinese herb of traditional chinese medicine are effective,low pain and convenience managenment,and should become a major non-operation management.