规范手法治疗腰椎间盘突出症的CT三维重建观察

摘要

Objective:To observe the morphological change of prominence through CT three-dimensional reconstruction before and after manipulative treatment and in order to investigate biomechanical effect of manipulation in treating lumbar in-tervertebral disc herniation(IJDH). MethodS:From December 2009 to May 2010,24 patients with LIDH(32 herniated discs) with the unilateral typing,which were treated with manipulation (on alternate day one time and every time about 20 min,3 weeks as a course of treatment). There were 10 males and 14 females,ranging in age from 25 to 54 years with an average of 36.2 years, in course of disease from 2 days to 10 years with an average of 6.9 years. Protrusible 12 discs were in L(,5 and 20 discs were in L5S1. According to typing of distance between prominence and zygapophysial joint or vertebral plate (ligamentum flavum) ,5 cases were type I ,13 cases were type II and 6 cases were type HI. After a course of treatment, the morphological changes of prominences were analyzed in the same level of CT three - dimensional reconstruction, including contour map of nerve root sheath side distance (TD) ,the distance between prominence and zygapophysial joint or vertebral plate (ligamentum flavum), the deviated angle of prominence (AN value) and the sagittal index (SI value). Results: From the contour map of TD, 19 patients (79.2% of the total) can be identified morphological changes after the treatment; from the distance between prominence and zygapophysial joint or vertebral plate (ligamentum flavum) ,7 cases with type II turned into type I and 2 cases with type III turned into type II after treatment; AN value increased after treatment (f<0.05),it showed prominence occurred morphological change toward deviated direction of intervertebral foramina; there was no significant difference in SI value between before and after treatment (ft>0.05). Conclusion: Standard manipulation can make prominence change, the prominence and nerve roots release,and mutual position improve,which can provide imaging evidence for the study in biomechanical effects.%目的:通过对规范手法治疗前后腰椎间盘突出症三维重建CT突出物形态学的定性定量观测,探讨手法的生物力学效应.方法:自2009年12月至2010年5月,采用规范的手法操作技术治疗偏侧型腰椎间盘突出症患者24例(32个突出椎间盘),隔日治疗1次,每次20 min,3周为1个疗程.其中男10例,女14例;年龄25～54岁,平均36.2岁;病程2d～10年,平均6.9年;突出部位:L4,5 12个,L5S1 20个.突出髓核和关节突关节及椎板(黄韧带)间距:Ⅰ型5例、Ⅱ型13例、Ⅲ型6例.制订观测CT重建图像的操作规程,3周治疗后通过对治疗前后同一层面神经根鞘膜间距(TD)重构神经根鞘膜侧轮廓图、突出髓核和关节突关节及椎板间距、突出物偏向角(AN值)、矢状径指数(SI值)的观测,进行突出物形态学的分析评价.结果:神经根鞘膜间距(TD)重构神经根鞘膜侧轮廓图的观察中,可以确定19例患者(79.2%)治疗前后神经根走行形态发生变化;突出髓核和关节突关节及椎板间距Ⅱ型患者中有7例治疗后变为Ⅰ型,Ⅲ型患者中有2例治疗后变为Ⅱ型;AN值治疗后比治疗前增大(P<0.05),说明突出物朝偏离椎间孔的方向形变;SI值治疗前后无差别(P>0.05).结论:规范手法可以使偏侧型的突出髓核或膨出物发生形变,突出物与神经根之间发生松解,相互位置改善,为研究手法的生物力学效应提供了影像学依据.