背景:扩散张量成像(DTI),一种描述神经结构的新方法,是一种特殊形式的磁共振成像(MRI)。这种新的成像方法可用于定位腰椎间盘突出症的病变神经根。
目的:本研究的目的是比较单神经根压迫腰椎间盘突出症的单级和双重经皮内镜下腰椎间盘切除术(PELD)的患者结局,其中单侧PELD由磁共振扩散张量成像(DTI)引导。
方法:回顾性总结潍坊医学院附属医院2019年1月至2021年5月收治的腰椎间盘突出症单神经根双重压迫患者的临床资料,分为经DTI定位后的单节段经皮内镜髓核摘除术(PELD)组和双节段PELD组。操作时间,术中出血,比较两组患者的VAS评分和JOA评分,以及DTI组的术前和术后各向异性分数(FA)值。
结果:DTI组患者的手术时间和术中出血量明显低于双节段组,两组VAS评分和JOA评分比较差异无统计学意义。手术后,DTI组患者负责压迫部位的神经根FA值显著升高,但它仍然低于健康的对称部分。
结论:基于DTI的单水平PELD在术后3个月内达到了与双水平PELD相似的效果,可以提高病变神经根的FA值。它的出血量较少,手术时间更短,但这项技术的疗效仍需要大样本的长期随访。
Diffusion tensor imaging (DTI), a novel method of describing nerve structure, is a special form of magnetic resonance imaging (MRI). This new imaging method can be used to locate the diseased nerve roots in lumbar disc
herniation.
The objective of this study is to compare patient outcomes between single-level and doublesection percutaneous endoscopic lumbar discectomy (PELD) in the treatment of lumbar intervertebral disc
herniation with single nerve root compression, where single-sided PELD is guided by magnetic resonance diffusion tensor imaging (DTI).
The clinical data of patients with lumbar intervertebral disc
herniation with double compression of single nerve root symptoms in the Affiliated Hospital of Weifang Medical University from January 2019 to May 2021 were retrospectively summarized and divided into single-level percutaneous endoscopic discectomy (PELD) group after DTI localization and double-section PELD group. The operation time, intraoperative bleeding, VAS score and JOA score of the two groups were compared, as well as the preoperative and postoperative fractional anisotropy (FA) values in the DTI group.
The operation time and intraoperative bleeding volume of patients in the DTI group were significantly lower than those in the double segment group, and there was no significant difference between VAS scores and JOA scores in the two groups. After the operation, the nerve root FA value of the responsible compression site of patients in the DTI group increased significantly, but it was still lower than the healthy symmetrical part.
The single-level PELD based on DTI has achieved a similar effect to that of the doublesegment PELD in 3 months after the operation, which can improve the FA value of the lesion nerve root. Its bleeding amount is less, and the operation time is shorter, but the efficacy of this technology still requires long-term follow-up of large samples.