神经根周围注射甲基强的松龙对椎间盘突出症自然吸收的影响。
Effect of periradicular methylprednisolone on spontaneous resorption of intervertebral disc herniations.
作者信息
Autio Reijo A, Karppinen Jaro, Kurunlahti Mauno, Haapea Marianne, Vanharanta Heikki, Tervonen Osmo
机构信息
Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
出版信息
Spine (Phila Pa 1976). 2004 Aug 1;29(15):1601-7. doi: 10.1097/01.brs.0000132511.46818.67.
STUDY DESIGN
Prospective comparison of periradicular infiltration with steroid versus saline on the spontaneous resorption of herniated nucleus pulposus in a randomized controlled trial.
OBJECTIVES
To evaluate whether periradicular steroid retards the resorption of herniated nucleus pulposus.
SUMMARY OF BACKGROUND DATA
Rim enhancement around herniated nucleus pulposus is associated with spontaneous resorption of disc herniations. As rim enhancement consists of a macrophage infiltrate, periradicular steroid could theoretically interfere with the resorption process. METHODS.: Patients with disc herniation-induced sciatica were randomized to receive either periradicular methylprednisolone (in combination with bupivacaine) or saline. Lumbar magnetic resonance imaging (MRI) was performed at baseline, at 2 months, and at 12 months. Disc herniation volume (mm3), coverage of rim enhancement (%), and rim enhancement thickness (mm) were evaluated by a radiologist blinded to the allocation. Operated patients were excluded from the 1-year imaging. Changes in the parameters from baseline to 2 months, and from 2 to 12 months, were evaluated with the Mann-Whitney U test.
RESULTS
Change in herniation volume from baseline to 2 months was measurable in 34 patients of both groups, and from 2 to 12 months in 26 patients of the steroid group and 24 patients of the saline group. Significant spontaneous resorption of disc herniations occurred in both groups during the 1-year follow-up. In the subgroup analysis, there tended to be even faster resorption in the steroid group from baseline to 2 months for extrusions, and from 2 months to 12 months for contained herniations. No significant differences were observed in the enhancement parameters (coverage and thickness) between the two treatments.
CONCLUSIONS
Periradicular corticosteroid does not have a negative effect on the spontaneous resorption of the herniated nucleus pulposus.
研究设计
在一项随机对照试验中，对使用类固醇与生理盐水进行神经根周围浸润治疗后，突出髓核的自发吸收情况进行前瞻性比较。
目的
评估神经根周围注射类固醇是否会延缓突出髓核的吸收。
背景数据总结
突出髓核周围的边缘强化与椎间盘突出的自发吸收有关。由于边缘强化由巨噬细胞浸润组成，理论上神经根周围注射类固醇可能会干扰吸收过程。方法：将因椎间盘突出导致坐骨神经痛的患者随机分为两组，分别接受神经根周围注射甲基泼尼松龙（联合布比卡因）或生理盐水。在基线、2个月和12个月时进行腰椎磁共振成像（MRI）检查。由对分组不知情的放射科医生评估椎间盘突出体积（mm³）、边缘强化覆盖率（%）和边缘强化厚度（mm）。接受手术的患者被排除在1年成像检查之外。使用曼-惠特尼U检验评估从基线到2个月以及从2个月到12个月参数的变化。
结果
两组中均有34例患者在从基线到2个月时可测量到突出体积的变化，类固醇组有26例患者、生理盐水组有24例患者在从2个月到12个月时可测量到突出体积的变化。在1年的随访期间，两组的椎间盘突出均出现了显著的自发吸收。在亚组分析中，对于游离型突出，从基线到2个月，类固醇组的吸收趋势更快；对于包容性突出，从2个月到12个月，类固醇组的吸收趋势更快。两种治疗方法在强化参数（覆盖率和厚度）上没有观察到显著差异。
结论
神经根周围注射皮质类固醇对突出髓核的自发吸收没有负面影响。
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