中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (21): 3390-3394.doi: 10.3969/j.issn.2095-4344.3858

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

二维距离法和三维体积法对内镜下微创颈椎管成形后突出椎间盘再吸收的定量测量

吴彦禹，张春霖，邵成龙，严  旭，刘小康，王永魁，李东哲   

  1. 郑州大学第一附属医院骨科，河南省郑州市   450000
  • 收稿日期:2020-06-18 修回日期:2020-06-24 接受日期:2020-08-29 出版日期:2021-07-28 发布日期:2021-01-23
  • 通讯作者: 张春霖，博士，主任医师，教授，郑州大学第一附属医院骨科，河南省郑州市 450000
  • 作者简介:吴彦禹，男，1996年生，湖北省通城县人，汉族，郑州大学在读硕士，主要从事脊柱微创及植入物方面的研究。

Quantitative measurement of resorption of cervical herniated disc after cervical microendoscopic laminoplasty by two-dimensional distance method and three-dimensional volume method

Wu Yanyu, Zhang Chunlin, Shao Chenglong, Yan Xu, Liu Xiaokang, Wang Yongkui, Li Dongzhe   

  1. Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • Received:2020-06-18 Revised:2020-06-24 Accepted:2020-08-29 Online:2021-07-28 Published:2021-01-23
  • Contact: Zhang Chunlin, MD, Chief physician, Professor, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • About author:Wu Yanyu, Master candidate, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China

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摘要：

文题释义：
二维距离法：选取颈椎MRI矢状面椎间盘突出最明显层面，运用PACS系统测量技术从上下椎体后缘连线至椎间盘突出最明显处的垂直距离即为突出椎间盘的大小。
三维体积法：即应用PACS软件在MRI矢状位T2图像上，以上位椎体后下缘及下位椎体后上缘连线为内边界，突出物边缘作为外边界，得到当前层面突出椎间盘的面积，逐一测量每个层面的面积，利用以下公式计算突出颈椎间盘体积：突出颈椎间盘体积=(层间距+层厚)×∑每一层突出颈椎间盘面积。
突出椎间盘再吸收：指椎间盘突出后再次回缩吸收的现象，即resorption of herniated nucleus pulposus(RHNP)。

背景：文献报道内镜下微创颈椎管成形后出现不同程度的突出椎间盘再吸收现象，但目前尚未有统一的突出颈椎间盘测量方法。
目的：运用二维距离法和三维体积法分别测量内镜下微创颈椎管成形后突出椎间盘体积，并对比观察其突出椎间盘再吸收现象，选出更准确可靠的测量方法。
方法：回顾性分析郑州大学第一附属医院骨科2013年6月至2019年11月行内镜下微创颈椎管成形治疗的患者20例，其中男11例，女9例；年龄31-63岁，平均51岁；病程1-11个月，平均4个月。分别应用二维距离法和三维体积法测量突出颈椎间盘的突出程度，采用吸收比、吸收率、吸收度、再突出比及再突出率等指标评估测量结果。
结果与结论：①患者随访时间为6-34个月，20例病例共67个突出椎间盘，二维距离组中有56个突出椎间盘术后发生突出椎间盘再吸收，三维体积组有61个突出椎间盘术后发生突出椎间盘再吸收，二者吸收比分别为84%和91%，差异无显著性意义(P > 0.05)；二维距离组和三维体积组测算吸收度分别为12.30%-71.24%和7.71%-87.80%；②二维距离组及三维体积组少量吸收比、中量吸收比、大量吸收比分别为49%(33/67)、34%(23/67)、0(0/67)和36%(24/67)、49%(33/67)、6%(4/67)，两组各吸收度之间差异有显著性意义(P < 0.05)；③二维距离组平均吸收率为31%，三维体积组平均吸收率为42%，二者差异有显著性意义(P < 0.05)；④二维距离组及三维体积组再突出比分别为1.49%(1/67)和0，二维距离组该椎间盘再突出率为12.18%；⑤内镜下微创颈椎管成形患者术后优良率为85%(17/20)，无一例加重或死亡；⑥提示三维体积法是一种较二维距离法精度更高、更适合定量观察突出颈椎间盘体积的方法，可为脊髓型颈椎病诊疗提供可靠依据。
https://orcid.org/0000-0002-6160-3118 (吴彦禹) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 微创颈椎管成形, 内镜, 颈椎间盘, 微创, 二维距离, 三维体积, 椎间盘再突出

Abstract: BACKGROUND: Recent literature reported that patients with cervical herniated disc after cervical microendoscopic laminoplasty had extensive natural resorption of herniated nucleus pulposus, but there was still no unified measurement method for cervical herniated disc.  
OBJECTIVE: The methods by two-dimensional distance and three-dimensional volume were used to respectively measure and observe the resorption of herniated nucleus pulposus phenomenon after cervical microendoscopic laminoplasty, so as to evaluate and select a more accurate and reliable method. 
METHODS: Retrospective analysis was performed in 20 patients who underwent cervical microendoscopic laminoplasty in the Department of Orthopedics, First Affiliated Hospital of Zhengzhou University from June 2013 to November 2019, including 11 males and 9 females, aged 31 to 63 years old (averagely 51 years old), with a course of 1 to 11 months (averagely 4 months). Two-dimensional distance method and three-dimensional volume method were used to measure the degree of cervical herniated disc, and the absorption ratio, absorptivity, absorbancy, re-herniation ratio and re-herniation rate were used to evaluate the measurement results. 
RESULTS AND CONCLUSION: (1) The patients were followed up for 6 to 34 months, with 67 cervical herniated discs in 20 cases. In the two-dimensional distance group, resorption of cervical herniated discs after surgery occurred in 56 patients. In the three-dimensional volume group, resorption of cervical herniated discs after surgery occurred in 61 patients. The absorption ratios of the two were 84% and 91%, respectively, and the difference was not significant (P > 0.05). The absorptivities of the two groups respectively were 12.30%-71.24% and 7.71%-87.80% in the two-dimensional distance group and three-dimensional volume group, respectively. (2) In the two-dimensional distance group and the three-dimensional volume group, the small absorption ratio, the medium absorption ratio and the large absorption ratio respectively were 49% (33/67), 34% (23/67), 0 (0/67) and 36% (24/67), 49% (33/67) and 6% (4/67),  and the differences in absorbancy between the two groups were statistically significant (P < 0.05). (3) The average absorptivity of the two-dimensional distance group and the three-dimensional volume group was 31% and 42% respectively. However, there was significant difference in the absorptivity between the two-dimensional distance group and the three-dimensional volume group (P < 0.05). (4) In the two-dimensional distance group and the three-dimensional volume group, the re-protrusion ratios respectively were 1.49% (1/67) and 0. The re-herniation rate was 12.18% in the two-dimensional distance group. (5) The excellent and good rate of cervical microendoscopic laminoplasty patients was 85% (17/20). No aggravation or death occurred. (6) It is indicated that the three-dimensional volume method is more accurate and more suitable for quantitative observation of cervical herniated disc volume than the two-dimensional distance method, which can provide reliable basis for the diagnosis and treatment of cervical spondylotic myelopathy.

Key words: cervical microendoscopic laminoplasty, endoscope, cervical disc, minimally invasive, two-dimensional distance, three-dimensional volume, disc herniation

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