摘要目的 探讨患者术前腰椎MRI预测腰椎间盘突出症术后复发的意义并评价其临床应用价值.方法 选取2009年1月至2011年4月诊断为单纯L4～5椎间盘突出症复发并随访2.5年的患者25例作为复发组,选取同一时间段因相同节段腰椎间盘突出症行同种手术方式且术后随访2.5年结果为优或良的患者25例作为对照组.两组患者在性别构成、年龄和体重指数之间的差异无统计学意义(P＞0.05).收集两组患者首次手术前腰椎MRI检查资料,对椎间盘退变程度进行分级.采用x2检验分析两组患者术前腰椎退变程度情况差异,使用秩相关检验分析椎间盘退变程度与术后复发距首次手术时间间距之间的联系.结果 复发组患者L4～5椎间盘轻度退变22例,重度椎间盘退变3例;对照组患者L4～5椎间盘轻度退变5例,重度椎间盘退变20例.复发组轻度椎间盘退变患者所占比例高于对照组(x2 =23.27,P ＜0.05).经相关性分析发现患者术后复发与椎间盘的退变程度相关,即轻度椎间盘退变患者术后复发可能性明显高于重度退变患者,为后者的4.4倍(r=0.564,OR =4.4,95％ CI:1.983～9.765,P ＜0.05).在复发组中,复发距首次手术的时间与椎间盘的退变程度之间存在正性相关(r =0.733,P ＜0.05).结论 患者首次术前腰椎MRI评价轻度椎间盘退变可能与椎间盘术后复发有关,且首次手术距复发的时间与椎间盘退变的严重程度呈正相关.

abstractsObjective To retrospectively evaluate the clinical evaluation of preoperative lumbar T2 sagittal MRI image in predicting the recurrent lumbar disc herniation (RLDH).Methods Between January 2009 and April 2011,28 patients were diagnosed as recurrent L4-5 disc herniation within 2.5 years after surgery,and 25 of them were included in the study as relapse group.At the same time,selected 25 patients implemented the same surgical methods in the same level as a control group randomly,they were all with good to excellent result and the follow-up time was at least 2.5 years.There was no statistical significance between the two groups in gender,age and body mass index(BMI) (P ＞ 0.05).The lumbar MRI image of two groups of patients before surgery were collected and analyzed,with the disc degeneration grade classified.The x2 test was used to analyzed the difference of degeneration between the two groups of patients before surgery.Rank correlation analysis evaluated the correlation between disc degeneration and the period of time from the first operation to the recurrence.Results In terms of preoperative lumbar disc degeneration,there were 22 cases of low-grade disc degeneration and 3 cases of advanced disc degeneration in the relapse group and 5 cases and 20 cases respectively in the control group.there was significant difference between two groups (x2 =23.27,P ＜ 0.05),low-grade disc degeneration (grades Ⅰ and Ⅲ) was significantly more frequent in the relapse group than in the control group.The patients with low-grade disc degeneration had a higher risk of recurrence,that was the risk of recurrent disc herniation increased by a factor of 4.4 from advanced disc degeneration to low-grade disc degeneration (OR =4.4,95％ CI:1.983-9.765,P ＜0.05).In cases of recurrence,the time interval between primary surgery and the recurrence of the patient with advanced disc degeneration was longer compared with low-grade disc degeneration (r =0.733,P ＜ 0.05).Conclusions Preoperative lumbar MRI image may suggest the possibility of the recurrence lumbar disc herniation.Light disc degeneration is an important risk factor for recurrent disc herniation,and the time interval between primary surgery and the recurrence is positively correlated with severity of disc degeneration.