腰椎间盘突出症突出髓核对硬膜囊机械作用的临床对照试验.pdfVIP

中国骨伤2007年12月第2O卷第12期 China J Orthop＆Trauma，Dec 2007，Vo1．20，No 12 ·803· · 临 床 研 究 · 腰椎问盘突出症突出髓核对硬膜囊机械作用的 临床对照试验 冯伟，冯天有，王飞，毕永民 (空军总医院，北京 100036) 【摘要】 目的：探讨腰椎间盘突出症突出髓核对硬膜囊机械作用的不同机制。方法：观察腰椎间盘突出症患者 38例(男20例，女18例；年龄21—51岁)，根据患者MRI矢状位图像特点将突出髓核对硬膜囊的机械作用分为占位 组和支撑组，采用脊柱(定点)旋转复位法治疗，测量并比较手法治疗前后两组患者椎间盘矢状径指数(sI)值及患侧 直腿抬高角度。结果：27例为占位组，l1例为支撑组，治疗前椎间盘矢状径指数(s1)值两组间比较差异无统计学意义 (P0．05)，患侧直腿抬高角度支撑组明显低于占位组(P0、05)。治疗后两组患侧直腿抬高角度均显著提高(P 0．05)，支撑组亦低于占位组(P0．05)。治疗后两组患者椎间盘矢状径指数(si)值无显著改变(P0．05)。结论：髓 核压迫硬膜囊存在占位和支撑2种机制，作用机制不同可能是导致临床表现不同的原因之一。 【关键词】 腰椎；椎间盘移位； 骨科疗法； 临床对照试验 The mechanical effect of herniated disk 011 the thecal sac in lumbar disk herniation and its clinical meanings FENG Wei，FENG Tian—you，WANG Fei，BI y0 一min．General Hospital ofAirforce，Beijing 100036，China ABSTRACT Objective：To discuss the different mechanism of the mechanical effect of herniated disk on the thecal sac． Methods：Thirty—eight patients of lumbar disk herniation with the compressed thecal sac were divided into two groups(encroac— hing and straining group)according to the character of sagittal picture of MRI，all patients were treated by FENG Tian—you spi— nal manipulation、The degree of the straight leg rising(SLR)of the affected side and the sagittal index(SI)of lumbar disk were measured and analyzed before and after the treatment between two groups．Results：There were 27 patients in encroaching group and 1 1 in straining group．The degree of SLR in straining group was lower than that of patients in encroaching group be— fore treatment(P0．05)，but it increased a lot in both groups after treatment(P0．05)，while the degree of SLR of strai— ning group was still low compared with encroaching group(P0．05)．There was no statistical difference of SI between the two groups both before and after treatment(P0．05)．Conclusion：There exists two kinds of mechanism on the thecal sac con· pressed by herniated