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1、临床医学论文・CT引导椎间盘造影术在多节段腰椎间盘退变中的临床价值作者：薛华明，涂意辉，蔡琨巍，杨安礼【摘要】［目的］探讨CT引导下椎间盘造影术在治疗多节段腰椎间盘退变疾患中的临床价值。［方法］2005年1月〜2008年1月对28例多节段腰椎间盘退变疾患行CT引导下椎间盘造影术，其中男12例，女16例;年龄30-56岁，平均38.2岁。腰椎间盘退变节段：L3、4和L4、5突出9例,L4、5和L5S1突出15例,L3、4、L4、5和L5S1三节段突出4例。造影节段:28例共计92个椎间盘,L2、3间隙10例，L3、4间隙28例,L4、5间隙28例,L5S1间隙26例。按照阳性椎间盘造影的诊断标准
2、，筛选出致痛性椎间盘(责任间盘)，对这些病变间隙行相应的椎间融合术治疗。［结果］28例患者92个间隙共筛选出32个责任间盘。VAS$6分组中II+III级间盘(Dallas分级)和退变间^(Pearce分级)所占的百分比明显高于VAS<6分组(P<0.05)。手术前后ODI指数评分比较有显着性差异(P<0.05)o随访12〜36个月，平均25.2个月。Charles疗效评定，术后优22例(78.6%),良5例(17.9%),-般1例(3.6%),差0例。所有病例均未发生与椎间盘造影有关的并发症。1例椎间融合器下沉，1例植骨融合不良，1例术后病变侧仲足母肌力减退，再次手术行椎弓根螺钉调整术，术后
3、2个月肌力恢复。［结论］CT引导下椎间盘造影术对于多节段腰椎间盘退变疾患中责任间盘的选择具冇重要的临床意义。【关键词】腰椎；椎间盘造影术；多节段；腰椎间盘退变Clinicalvalueofdiscographyfollowedbycomputedtomographyforthetreatmentofmulti-levellumbardiscdegeneration//XUEHua-ming,TUYi-hui,CAIMin-wei,etal・DepartmentofOrthopaedics,YangpuDistrictCentralHospital,Shanghai200090,ChinaAbs
4、tract:[Objective]Toexploretheclinicalvalueofdiscographyfollowedbycomputedtomographyforthetreatmentofmulti-levellumbardiscdegeneration.[Methods]Twenty・eightcaseswereenrolledfromJanuary2005toJanuary2008.Therewere12malesand16femaleswithaverageageof38.2years,rangingfrom30to56years.Thelevelofdegeneratedd
5、iscincludedL3>4andL4>5(9cases),L4>5andL5S1(15cases),L3>4,L4、5andL5S1(4cases).ThelevelofdiscographyincludedL2、3(10cases),L3>4(28cases),L4>5(28cases),andL5S1(26cases)withatotalof92discs・Thepainfuldiscs(orresponsiblediscs)werescreenedaccordingtodiagnosticcriteriaofprovocativediscographyandtreatedwithin
6、terbodyfusion・[Results]Thirty・lworesponsiblediscswerescreenedintotalof92discs.ODIscoresbetweenpreandpostoperationweresignificantlydifferent(P<0.05)・ThepercentageofGradeII,111discs(Dallasgrade)anddegenerateddiscs(PearcegradeIIItoV)inVAS26groupwassignificantlyhigherthanthatinVAS<6group.Al1caseswerefol
7、lowedupfrom12to36months(mean25.2months)・Theclinicalresultswereexcellentin22cases(78.6%),goodin5(17.9%)andfairinl(3.6%)byCharlesscore.Al1caseshadnocomplicationsrelatedtodiscography.Onecagesubsidenceand
