MR引导经中后与侧后方入路腰椎间盘穿刺方法对照

目的与经侧后方入路比较,探讨MR引导下经中后方入路腰椎间盘穿刺的可行性及优势。方法在配有iPath200光学导航系统的0.23T开放式介入磁共振系统实时引导下,对需要介入治疗的73例腰椎间盘突出患者、共计116个椎间盘分别经侧后方和中后方入路进行穿刺。由2名MR诊断医师使用术中预扫描图像对拟穿刺椎间盘的退变程度共同进行评价。根据穿刺成功所需穿刺次数、操作时间及并发症出现的例数,对两种穿刺方法进行综合评价。结果 31例患者的49个腰椎间盘经侧后方入路穿刺,42例患者的67个腰椎间盘经中后方入路穿刺,所有病例经两种方法均成功穿刺。两组患者椎间盘退变程度差异无统计学意义。两种入路成功穿刺L3-4、L4-5椎间盘所需穿刺次数、操作时间差异无统计学意义（P均〉0.05）;经中后方入路成功穿刺L5-S1椎间盘所需穿刺次数（1.43±0.68）次vs（2.14±0.77）次]和时间（9.02±2.50）min vs（14.61±3.93）min]均显著低于经侧后方入路（P均〈0.05）;两种穿刺入路短期并发症差异无统计学意义（P〉0.05）。结论 MR引导下经中后方入路穿刺腰椎间盘较与侧后方入路同样安全、可行。对于L5-S1椎间盘,经中后方入路穿刺较侧后方入路可明显减少穿刺次数,缩短操作时间。

Comparison on lumbar disk puncture between posteromedial approach and posterolateral approach under MR guidance

Objective To explore the feasibility of the posteromedial approach（PMA） for lumber disk puncture under MR guidance and its advantages over the posterolateral approach（PLA）.Methods Seventy-three patients with 116 lumbar disk herniation（LDH） were punctured via PMA or PLA under the real-time guidance and monitoring of optical instrument integrated to 0.23T open MR scanner.Lumber disk degeneration was evaluated by 2 MRI radiologists according to pre-scan images.The effect of two different approaches were compared according to times of puncture,procedure time and complications.Results Forty-nine intervertebral disks in 31 patients were punctured by PLA and the others 67 in 42 patients were punctured by PMA successfully.There was no difference for lumber disk degeneration between two groups.Puncture times and procedure time for L₃-4 and L₄-5 intervertebral disk had no significant difference（all P>0.05）.Both puncture times（1.43±0.68） and procedure time（9.02±2.50]min） of PMA for L₅-S₁ intervertebral disk were significantly less than those of PLA（2.14±0.77,14.61±3.93]min,both P<0.05）.There was no significant difference in short-term complications between PMA and PLA（P>0.05）.Conclusion MR guided percutaneous lumbar disk puncture by PMA is safe and feasible.The puncture times and procedure time for L₅-S₁ intervertebral disk are significantly less than those of PLA.