神经根注射激惹术和椎间盘造影术诊断LDH责任椎间盘及病灶的对比研究

A COMPARATIVE STUDY OF RADICULAR INJECTION PROVACATION AND COMPUTED TOMOGRAPHY DISCOGRAPHY IN THE DIAGNOSIS OF THE RESPONSIBLE INTERVERTEBRAL DISC AND THE LESION OF LUMBAR DISC HERNIATION

摘要:

目的：在CT引导下通过神经根注射激惹术(radicular injection provocation,RIP)和 椎间盘造影术(computed tomography discography,CTD)的对比研究,探讨RIP诊断腰椎间盘突出症(lumbar disc herniation,LDH)责任椎间盘及病灶部位的准确性。方法：选择CT引导下脊柱内镜椎间盘摘除术的LDH患者141例,按突出物分区及手术入路随机分为A、B、C三组,其中Ⅰ、Ⅱ区突出患者按手术入路分为A组(经椎板间入路组)和B组(经椎间孔入路组,为A、C组对照组),Ⅲ、Ⅳ区突出患者分为C组(经椎间孔或椎旁入路组),各组再按手术顺序单双号随机分为甲乙亚组,甲组先行RIP,后行CTD,乙组相反。术中统计两种方法复制LDH患者原有症状的阳性率,比较其对LDH责任椎间盘判定的敏感性,术后核对患者原有症状是否有效缓解,比较其对LDH责任椎间盘判定的特异性。结果：A组RIP(92.7%)较CTD(50.9%)阳性率有显著统计学差异(P<0.01)；B组RIP(62.1%)较CTD(54.5%)阳性率无统计学差异(P>0.05)；C组RIP(95%)较CTD(40%)阳性率有显著统计学差异(P <0.01)；A组、C组与B组RIP阳性率对比均有显著统计学差异(P<0.01)；A组和C组RIP阳性率对比无统计学差异(P>0.05),A、B、C三组组间CTD阳性率对比无统计学差异(P>0.05),甲乙亚组组中RIP、CTD的阳性率对比无统计学差异(P>0.05)。结论：RIP较CTD诊断LDH责任椎间盘及病灶部位的准确性更高,值得进一步研究并临床推广。

Abstract:

Objective: To explore the accuracy of the diagnosis of the responsible intervertebral disc and the lesion of lumbar disc herniation (LDH), by comparing radicular injection provocation (RIP) and computed tomography discography(CTD). Methods: According to the Lee classification and percutaneous endoscopic surgical approach, 141 patients with LDH were randomly divided into A, B, C three groups. The patients with zoneⅠand zoneⅡherniation were divided into group A (through the interlaminar approach ) and group B (through the transforaminal approach, the control group for group A and group C), the patients with zone Ⅲ and zone Ⅳ herniation were divided into group C (through the transforaminal or paravertebral approach ). Each group was randomly divided into two subgroups according to the operation sequence,RIP and CTD were performed successively.During the operation, the positive rates of the two methods to duplicate the radicular pain of patients were counted, and the sensitivity of them to determine responsible intervertebral disc was compared. After the operation, we checked whether the radicular pain of patients was effectively relieved or not, and the specificity of them was compared. Results: In group A, the positive rate of RIP (92.7%) was significantly higher than CTD (50.9%) (P< 0.01); In group B, the positive rate of RIP (62.1%) was not significantly different from CTD(54.5%) (P> 0.05); In group C, the positive rate of RIP (95%) was significantly higher than CTD (40%) (P< 0.01).The positive rate of RIP was significantly different between group A and group B (P<0.01); The positive rate of RIP was significantly different between group B and group C(P<0.01); There was no significant difference in the positive rate of RIP between group A and group C (P> 0.05).There was no significant difference in the positive rate of CTD among each groups (P>0.05). There was no significant difference in the proportion of RIP and CTD between each subgroups (P>0.05). Conclusions: Rip is more accurate than CTD in the diagnosis of the responsible intervertebral disc and the lesion of LDH, which is worth further study and clinical promotion.