■为了验证经皮内窥镜腰椎间盘切除术(PELD)后早期MR显示的残余肿块是否确实为术中保留的纤维环,探讨残余肿块影像学改变与患者临床预后的相关性。
■纳入了118例患者的前瞻性研究。手术期间,造影剂,GadopentetateDimeglumine,在破裂的纤维环周围注射。T2信号的强度,剩余质量(SR)的大小,和椎管的横截面积(SCSA),VAS,术前评估ODI,1小时(7天),6个月,术后间隔12个月。基于手术后7天的VAS,患者被分为非缓解组(A组,VAS>3)或缓解组(B组,VAS≤3)。
■排除6例发展为复发性LDH的患者。手术后1小时在MRI上检测到残留肿块,占94.6%(106/112)。在一年的随访中,90.1%(101/112)的患者表现为纤维环重塑,尽管68.7%(77/112)仍表现出疝。手术后一周,A组和B组之间的ODI差异显着(p<0.001)。然而,T2信号强度无显著差异,SR,和SCSA在1小时,两组术后6个月和12个月(p>0.05)。在多元线性回归分析中,术后早期ODI变化与T2信号相关(B=-10.22,sig<0.05),长期改变与SR(B=5.63,sig<0.05)和SCSA(B=-0.13,sig<0.05)的改变相关.
■PELD术后早期MR图像中观察到的残余肿块为术中保留的纤维环。PELD后临床症状的短期变化与T2信号强度有关,而长期变化与SR和SCSA的变化相关。
UNASSIGNED: To validate whether a residual mass demonstrated on early postoperative MR after percutaneous endoscopic lumbar discectomy (PELD) is indeed an intraoperatively retained annulus fibrosus, and explore the correlation between imaging changes in the residual mass and clinical prognosis of patients.
UNASSIGNED: A prospective study of 118 patients were included. During surgery, a contrast medium, Gadopentetate Dimeglumine, was injected around the ruptured annulus fibrosus. The intensity of the T2 signal, the size of the remaining mass (SR), and the cross-sectional area of the spinal canal (SCSA), VAS, and ODI were assessed at preoperative, 1-h (7-day), 6-month, and 12-month postoperative intervals. Based on VAS at 7 days post-surgery, patients were classified into either a non-remission group (Group A, VAS > 3) or a remission group (Group B, VAS ≤ 3).
UNASSIGNED: Six patients who developed recurrent LDH were excluded. A residual mass was detected on MRI 1 h after surgery in 94.6% (106/112). During one year of follow-up, 90.1% (101/112) of the patients displayed fibrous annulus remodeling, although 68.7% (77/112) still exhibited herniation. Significant differences were found in the ODI between Groups A and B one week after surgery (p < 0.001). However, no significant differences were observed in T2 signal intensity, SR, and SCSA at 1-h, 6-month and 12-month post-surgery (p > 0.05) between the two groups. In a multiple linear regression analysis, early postoperative ODI changes were associated with T2 signal (B = -10.22, sig < 0.05), long-term changes were associated with alterations in SR (B = 5.63, sig < 0.05) and SCSA (B = -0.13, sig < 0.05).
UNASSIGNED: The residual mass observed in early postoperative MR images after PELD was the retained annulus fibrosus intraoperatively. Short-term changes in clinical symptoms after PELD were linked to T2 signal intensity, while long-term changes were associated with changes in SR and SCSA.