内窥镜下髓核摘除术后硬膜外瘢痕的MRI测量及评估

A new MRI grading system to evaluate epidural fibrosis after microendoscopic discectomy

中文关键词:  硬膜外瘢痕  MED  腰椎间盘突出症  相关性

英文关键词:Epidural fibrosis  Microendoscopic discectomy  Lumbar disc herniation  Coefficiency

中文摘要:

  【摘要】　目的：观察后路内窥镜下髓核摘除术（MED）后3个月硬膜外瘢痕的MRI表现，探讨面积测量结合分级评分法评估硬膜外瘢痕临床应用价值。方法：选择2010年3月至2010年8月行MED治疗的32例单节段单侧腰椎间盘突出症患者，术后3个月复查腰椎平扫+增强MRI。3位评估者应用面积测量结合分级评分法分别独立评估测量32例患者的术后增强MRI，计算硬膜外瘢痕平均面积及瘢痕指数。采用组内相关系数（ICC）检验分析评估者间测量一致性。结果：3位评估者测得3组硬膜外瘢痕平均面积的组间差异无统计学意义（P>0.05），评估者间一致性良好（ICC值为0.771，95%可信区间[0.715，0.819]）。3位评估者测得3组硬膜外瘢痕指数组间差异无统计学意义（P>0.05），评估者间一致性良好（ICC值为0.788，95%可信区间[0.659，0.881]）。结论：面积测量结合分级评分法可对术后硬膜外瘢痕情况进行定量，操作简单可行，具有一定的临床指导意义。

英文摘要:

  【Abstract】 Objective：To present a new grading system for evaluating the Magnetic Resonance Image （MRI）appearance of epidural fibrosis 3 months after microendoscopic discectomy （MED），and to evaluate its reliability as well as clinical practice.Method：Between March 2010 and August 2010，32 patients undergoing MED　were enrolled for the research.MRI of the lumber spine were obtained following a standard protocol at three months postoperatively，without and with gadolinum intensifying.Three individuals evaluated the MRI independently.Epidural scar area and epidural fibrosis index were obtained.Intraclass correlation coefficient （ICC） statistic was used to estimate the reliability of the new grading system.Result：The epidural scar area in three groups showed no difference（P>0.05）.The estimated ICC value was 0.771 with 95% confidence interval of [0.715，0.819].There was no statistical significance with respect to epidural fibrosis index among three groups（P>0.05）.The ICC of epidural fibrosis index for the three groups was 0.788 with 95% confidence interval of [0.659，0.881] which showed excellent agreement.Conclusion：The new grading system is of high efficiency and excellent agreement to evalutate the degree of epidural fibrosis appeared in MRI after discectomy.