椎间盘后方高信号区在峡部裂性腰椎滑脱症的临床意义

发布时间：2018-02-01 09:52

本文关键词： 峡部裂性滑脱高信号区经椎间孔椎体间融合　出处：《中国矫形外科杂志》2017年19期 　论文类型：期刊论文

【摘要】：[目的]探讨椎间盘后方高信号区(high-intensity zone,HIZ)峡部裂性腰椎滑脱症影像学特征及对手术疗效的影响。[方法]回顾性分析2010年1月~2015年1月行TLIF术式治疗且随访2年以上的121例峡部裂性腰椎滑脱患者,其中男28例,女93例;年龄31~69岁(平均51.73岁)。根据在MRI T2加权像上是否伴有椎间盘后方HIZ将患者分为HIZ组和非HIZ组。在术前、术后和末次随访时,测量滑脱率、滑脱角、椎间隙高度、腰椎前凸角和L1椎体中心至骶骨垂线间距离。同时采用Oswestry功能障碍指数(Oswestry disability index,ODI)和腰部疼痛数字评价量表(visual analogue scale,VAS)对患者生活质量进行评估。[结果]伴椎间盘后方HIZ 28例(23.14%)。HIZ组患者平均年龄显著低于非HIZ组(47.21岁vs.55.36岁,P0.05)。术前HIZ组滑脱率和L1椎体中心至骶骨垂线间距离显著低于非HIZ组,而滑脱角、椎间隙高度和腰椎前凸角均显著高于非HIZ组(P0.05)。TLIF术后及末次随访时两组患者滑脱率、椎间隙高度和滑脱角较术前均明显改善。但术后和末次随访时HIZ组滑脱率改善显著低于非HIZ组(P0.05),滑脱角、椎间隙高度、腰椎前凸角和L1椎体中心至骶骨垂线间距离比较差异无统计学意义(P0.05)。术前HIZ组ODI和VAS评分显著高于非HIZ组(P0.05),术后ODI和VAS评分均较术前明显改善,但在术后和随访时组间比较差异无统计学意义(P0.05)。[结论]伴有椎间盘后方HIZ的峡部裂性滑脱患者椎间隙和腰椎前凸角未见显著丢失,有利于TLIF术式滑脱椎体复位。
[Abstract]:[Objective] to investigate the imaging features of high-intensity zoneone HIZ isthmic spondylolisthesis and its effect on the surgical outcome of lumbar spondylolisthesis. [Methods: from January 2010 to January 2015, 121 cases of spondylolisthesis with isthmic spondylolisthesis were treated with TLIF and followed up for more than 2 years, including 28 males and 93 females. Age 31 to 69 years (mean 51.73 years old). Patients were divided into HIZ group and non-#en3# group according to the presence of HIZ on MRI T2 weighted images. The rate of slippage, the angle of spondylolisthesis and the height of intervertebral space were measured after operation and at the last follow-up. The distance between Lumbar Lumbar Lumbar kyphosis angle and L1 vertebra center to sacrum perpendicular line. The Oswestry dysfunction index (Oswestry disability index) was used at the same time. ODI) and visual analogue scale (vas) were used to evaluate the quality of life of patients. [Results] the average age of 28 patients with posterior HIZ of intervertebral disc was significantly lower than that of non-#en1# group (47.21 years old), and that of HIZ group was significantly lower than that of non-#en1# group (47.21 years old). The rate of slippage and the distance from the center of L1 vertebra to the vertical line of sacrum in HIZ group were significantly lower than those in non-#en1# group before operation, but the angle of slippage was lower than that in non-#en1# group. The height of intervertebral space and lumbar kyphosis angle were significantly higher than those in non-#en0# group after operation and at the last follow-up. The height of intervertebral space and the angle of spondylolisthesis were significantly improved compared with those before operation, but the improvement of slip rate in HIZ group was significantly lower than that in non-#en1# group (P 0.05), the angle of slippage and the height of intervertebral space. There was no significant difference in the distance between lumbar kyphosis angle and L1 vertebral center to sacral vertical line (P 0.05). The scores of ODI and VAS in HIZ group were significantly higher than those in non-#en3# group (P 0.05). The scores of ODI and VAS were significantly improved after operation, but there was no significant difference between the two groups at postoperative and follow-up (P 0.05). [Conclusion: there is no significant loss of intervertebral space and lumbar kyphosis angle in patients with isthmic spondylolisthesis with posterior HIZ of intervertebral disc, which is beneficial to the reduction of spondylolisthesis by TLIF.
【作者单位】：浙江省湖州市长兴县人民医院;第二军医大学附属长海医院;
【分类号】：R687.3
【正文快照】： 腰椎间盘后方高信号区(high-intensity zone,HIZ)是指矢状位MRI T2加权像显示的腰椎间盘后方小而圆的局限性高信号区[1-2]。HIZ常见于腰背部疼痛的患者,而椎间盘后缘HIZ的发生率可高达31.7%~32.8%,其中以L4/5和L5/S1椎间隙多见[1,3,4]。既往对椎间盘后方HIZ的研究多集中在其形

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