单、双侧椎板开窗髓核摘除术髓核取出容积量比较的实验研究

目的:通过建立猪腰椎间盘退行性病变模型,明确经单侧椎板开窗术及双侧椎板开窗术取出髓核的容积量、质量及造影剂充盈面积的大小,评价两种术式对髓核容积量的影响。方法:对40具猪脊柱分别编号"1、2、3、4…",随机数字表法分为空白1组、空白2组、单侧组、双侧组;空白1组椎骨行MRI检查,明确正常猪T12-S1共计6个椎骨中每个椎间盘各自的体积;空白2组椎骨逐一行横断剖开,取出各椎骨间髓核组织分别称重并逐一记录;单侧组行单侧椎板开窗术,双侧组行双侧椎板开窗术,术后均对髓核行摘除量称重、残余空间造影及CT检查,以明确质量及容积。结果:各椎间盘容积量组间比较差异有统计学意义(P<0.05),各椎间盘髓核量组间比较差异有统计学意义(P<0.05),各椎间盘造影剂充盈面积组间比较差异有统计学意义(P<0.05)。结论:双侧组手术方式较单侧组可明显减少椎间盘髓核残留量并扩大椎间盘造影剂充盈面积,但单侧或双侧椎板开窗术均。未能彻底取出髓核组织。

An Experimental Study on Nucleus Pulposus Volume Removed by the Removal of Unilateral Lamina Fenestration and Bilateral Lamina Fenestration

Objective： To measure the volume, quality and contrast agent filling area size of nucleus pulposus removed by the removal of unilateral and bilateral lamina fenestration through establishing the model of intervertebral disc degeneration in porcine lumbar, and to evaluate the effect of the two surgical approaches on the nucleus pulposus volume. Methods： During July 2011 - September 2012, 40 porcine spine were numbered ＂ 1, 2, 3, 4... ＂ and randomly divided into blank group 1, blank group 2, the unilateral group and the bilateral group. In blank group 1, the vertebrae were treated with MRI, with the volume of each intervertebral disc measured in the pig T12 - S1 vertebrae. In blank group 2, each of the vertebrae was traversed, with each intervertebral nucleus pulposus removed and weighed respectively, and the related data recorded. The unilateral group was treated with unilateral lamina fenestration and the bilateral group with bilateral lamina fenestration. Volume weighing, residual space my- elography and CT of removed nucleus pulposus were performed after the operation so as to define the quality and volume. Re- sults： There was significant difference in intervertebral disc volume （ P 〈 0.05 ）, in the nucleus pulposus volume （ P 〈 0.05 ） and in the discography agent filling area （ P 〈 0.05） among the four groups. Conclusion ： Compared with the unilateral surgical approach, the bilateral surgical approach can significantly reduce the amount of residual nucleus pulposus and expand discography agent filling area.