腰椎管狭窄症经皮经椎间孔脊柱内镜治疗前后影像学改变与疗效的关系

Relationship between Imaging Changes and Curative Effect of Percutaneous Intervertebral Foramen Spinal Endoscopy for Lumbar Spinal Stenosis before and after Treatment

摘要:

[目的] 探讨腰椎管狭窄症(lumbar spinal stenosis, LSS)经皮经椎间孔脊柱内镜治疗前后影像学改变与疗效的关系。方法 选择2020年1月-2022年8月76例LSS患者，均采用经皮经椎间孔脊柱内镜治疗，术后3个月采用改良Macnab疗效评定标准评价临床疗效，CT测量治疗前后中央椎管横断面积、双侧侧隐窝前后径、双侧椎间孔矢状面积等CT椎管影像参数，MRI测量横断面积、最大矢状径、三分区面积等硬膜囊影像参数,比较不同疗效患者治疗前后影像参数变化值、疼痛视觉模拟评分法(visual analog scales, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)变化值。分析影像参数变化值与VAS评分、ODI指数的相关性。[结果] 76例LSS患者经皮经椎间孔脊柱内镜治疗后疗效优36例，良32例，可8例；不同疗效患者CT、MRI影像参数、VAS评分、ODI指数变化值差异具有统计学意义（P<0.05）；CT、MRI影像参数变化值与VAS评分、ODI指数均呈正相关关系（P<0.05）。[结论] LSS 经皮经椎间孔脊柱内镜治疗前后CT、MRI影像参数改变与疼痛、功能障碍缓解具有显著关联。

Abstract:

Objective To explore the relationship between the imaging changes and the curative effect of percutaneous and trans Intervertebral foramen spinal endoscopy for lumbar spinal stenosis (LSS). Methods Seventy-six LSS patients from January 2020 to August 2022were selected and treated with percutaneous and trans Intervertebral foramen spinal endoscopy. Clinical efficacy were evaluated using modified Macnab efficacy evaluation criteria 3 months after surgery. CT measurement of central vertebral canal cross-sectional area, bilateral lateral recess anteroposterior diameter, bilateral Intervertebral foramen sagittal area and other CT vertebral canal image parameters before and after treatment. The image parameters of Thecal sac, such as cross-sectional area, maximum sagittal diameter, and three zone area were measured by MRI . The changes in imaging parameters, visual analog scales (VAS) for pain, and Oswestry disability index (ODI) for patients with different therapeutic effects before and after treatment were compared. The correlation between changes in image parameters and VAS score and ODI index were analyzed. Results In 76 LSS patients, 36 cases were excellent, 32 cases were good, and 8 cases were fair after percutaneous endoscopic treatment through Intervertebral foramen; There were statistically significant differences in CT and MRI imaging parameters, VAS scores, and ODI index changes among patients with different therapeutic effects (P<0.05). The changes in CT and MRI imaging parameters were positively correlated with VAS score and ODI index (P<0.05). Conclusion The changes of CT and MRI image parameters before and after percutaneous transforaminal endoscopic treatment of LSS are significantly associated with pain and dysfunction relief.