磁共振在评估腰椎椎体间融合术后骨性融合中的价值

发布时间：2018-05-19 05:07

本文选题：磁共振 + 影像学评估　；参考：《浙江大学》2015年硕士论文

【摘要】：目的探讨磁共振(MRI)在评估腰椎后路椎体间融合结合椎弓根螺钉内固定术后椎体间融合情况的临床应用价值。方法回顾性分析2008年3月至2012年3月间因腰椎退变性疾病行单节段经椎间孔腰椎椎体间植骨融合内固定术(TLIF)且术后有症状的31例患者的影像学随访资料。分析术后3月、6月、1年、2年的腰椎正侧位X线、CT扫描重建、MRI检查以评估椎体间融合状态。结果术后3月、6月、1年、2年随访时腰椎X线、CT扫描重建及MRI所示椎体间融合率分别为16.1%、6.45%、0%；80.7%、61.3%、58.1%；96.8%、83.8%、87.1%和100%、96.8%、96.8%。术后6月与术后3月的融合率进行比较,X线片(χ2=25.833,P=0.000).CT扫描重建(χ2=20.811,P=0.000)和MRI(χ2=25.364,P=0.000)的融合率差异均有统计学意义。术后1年与术后6月的融合率进行比较,MRI(χ2=6.565,P=0.021)的融合率差异有统计学意义,而CT扫描重建(χ2=3.971,P=0.086)和X线片(χ2=4.026,P=0.104)的差异无统计学意义。术后2年与术后1年融合率相比较,X线片(χ2=1.016,P=1.000).CT扫描重建(χ2=2.952,P=0.195)和MRI(χ2=1.958,P=0.354)的融合率差异均无统计学意义,但后两者仍发现相当数量的病例在融合器内外有新生骨出现。术后3月、6月、1年、2年融合率各评估方法之间的结果虽有差异,但无统计学意义。各时间点CT扫描重建和MRI的融合率评判结果之间具有高度一致性(90.3%-100%)。结论通过融合节段终板下骨信号变化及融合区域的信号连续性,MRI可以较为准确地判定椎体间融合术后骨性融合状态。MRI评估椎体间融合需要2年以上的随访时间。MRI可以作为腰椎椎体间融合术后仍有症状患者的融合状态评估的优选方法。
[Abstract]:Objective to evaluate the clinical value of magnetic resonance imaging (MRI) in the evaluation of posterior lumbar interbody fusion combined with pedicle screw fixation. Methods from March 2008 to March 2012, the imaging data of 31 patients with symptoms of lumbar degenerative disease were analyzed retrospectively. Three months, six months, one year and two years after operation, the anterior and lateral lumbar vertebrae were analyzed with CT scan and MRI to evaluate the status of lumbar interbody fusion. Results at 3 months, 6 months, 1 year and 2 years of follow-up, the rates of lumbar X-ray CT reconstruction and interbody fusion revealed by MRI were 16.1and 6.450.The rate was 87.1% and 96.8%, respectively. There were significant differences in the fusion rate between 6 months after operation and 3 months after operation (蠂 ~ 2 ~ 2 ~ (25. 83) P ~ (0.000) ~ (0.000) and MRI (蠂 ~ (2) ~ (2) ~ (25. 364) P ~ (0.000) with CT scan reconstruction (蠂 ~ 2 ~ 2 ~ (20. 811) P ~ (0.000) and MRI (蠂 ~ 2 ~ 2 ~ (25. 364) P ~ (0.000). The fusion rate of MRI was significantly higher than that of 6 months after operation (蠂 ~ 2 ~ 2 ~ (6.565) P ~ (0.021), but there was no significant difference between CT scan (蠂 ~ (2) ~ (3) 971) and X-ray (蠂 ~ (2) 4.026 ~ (0.104). There was no significant difference in the fusion rate between 2 years after operation and 1 year after operation (蠂 ~ 2 ~ 2 ~ (1.016) P ~ (1.000). Ct scan reconstruction (蠂 ~ (2) 2 ~ (2) 952) P ~ (0.195) and MRI (蠂 ~ (2) ~ (1.958) P ~ (0.354), but a significant number of cases were still found to have new bone in and out of the fusion cage. Three months, six months, one year and two years after surgery, the results of fusion rate were different, but there was no statistical significance. There was a high consistency between CT reconstruction and fusion rate of MRI at different time points (90.3- 100). Conclusion MRI can accurately determine the status of bone fusion after interbody fusion. It takes more than 2 years of follow-up time. MRI to evaluate interbody fusion. It can be used to evaluate the fusion status of patients with symptoms after lumbar interbody fusion.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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