Abstract:

Objective　To explore the value of quantitative magnetic resonance imaging (MRI) in evaluating the efficacy of acupotomy in the treatment of lumbar degenerative disease. Methods　A total of 71 patients with lumbar degenerative disease admitted to Dongguan Wanjiang Hospital from October 2021 to August 2023 were selected as the study objects, including 50 males and 21 females, aged 38-76 (52.14±3.48) years, with a disease course of 2-17 (10.75±1.42) years. All patients were treated with acupotomy once a week, and the treatment was withdrawn if it was ineffective for 3 consecutive times. Before and after treatment, the patients underwent quantitative MRI, including delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping. The MRI results were analyzed, and the glucosaminoglucide (GAG) concentration, proteoglycan content, and T1 and T2 relaxation time were compared before and after treatment. Paired t test and analysis of variance were used. Results　On MRI, there were 32 cases of annulus fibrosis degeneration, and 20 cases of lumbar vertebrae showed banded and flacy-like hypersignal on T2WI. In 27 cases, the necrotic cells in the nucleus pulposus were debris and reactive hyperplasia, and the T1WI showed spotty low signal in the nucleus pulposus. There were 8 cases of annulus fibulation, and T1WI and T2WI showed low signal in the corner of nucleus pulposus. Intervertebral disc cartilaginous endplate degeneration was observed in 4 cases with low signal on T2WI. At 12 h, 24 h, and 48 h after treatment, the GAG concentration [(77.21±5.36) mg/L, (84.45±5.84) mg/L, and (90.36±6.48) mg/L] and proteoglycan content [(5.23±0.12) μg/mg, (5.25±0.11) μg/mg, and (5.18±0.13) μg/mg] were higher than those before treatment [(51.15±4.35) mg/L and (1.82±0.21) μg/mg] (all P<0.05). At 12 h, 24 h, and 48 h after treatment, the T1 relaxation time [(712.25±58.86) ms, (698.85±57.12) ms, and (684.45±56.89) ms] was longer than that before treatment [(356.52±37.25) ms], and the T2 relaxation time [(49.21±4.36) ms, (47.25±4.11) ms, and (46.23±4.05) ms] was shorter than that before treatment [(77.25±8.15) ms] (all P<0.05).Conclusion　Quantitative MRI technique can be used to evaluate the cartilage condition and component changes in patients with lumbar degenerative diseases before and after acupotomy, and the efficacy evaluation is accurate.

Key words:

Lumbar degenerative disease, Acupotomy, Quantitative magnetic resonance imaging technology, Effect evaluation

摘要：

目的　探讨采用定量磁共振成像技术（MRI）评价针刀治疗腰椎退行性病变疗效的价值。方法　选取2021年10月至2023年8月东莞市万江医院收治的71例腰椎退行性病变患者作为研究对象，男50例，女21例，年龄38～76（52.14±3.48）岁，病程2～17（10.75±1.42）年。患者均采用针刀治疗，每周治疗1次，如连续3次无效即停止治疗。治疗前后，患者均行定量MRI检查，实施软骨延迟增强磁共振成像技术（dGEMRIC）与T2 mapping成像。分析MRI检查结果，比较治疗前后葡糖氨基糖类（GAG）浓度、蛋白多糖含量、T1和T2弛豫时间。采用配对t检验、方差分析。结果　在MRI检查中，32例纤维环退变，T2WI中20例腰椎部位见带状及片状高信号；27例可见椎间髓核内坏死细胞碎渣、反应性增生，T1WI均表现为髓核内斑点样低信号；8例纤维环内折，T1WI、T2WI均表现为椎间盘内突出髓核成角折区低信号；4例椎间盘软骨终板退变，T2WI均表现为低信号。治疗后12 h、24 h、48 h GAG浓度［（77.21±5.36）mg/L、（84.45±5.84）mg/L、（90.36±6.48）mg/L］、蛋白多糖含量［（5.23±0.12）μg/mg、（5.25±0.11）μg/mg、（5.18±0.13）μg/mg］均高于治疗前［（51.15±4.35）mg/L、（1.82±0.21）μg/mg］（均P<0.05）；T1弛豫时间［（712.25±58.86）ms、（698.85±57.12）ms、（684.45±56.89）ms］均长于治疗前［（356.52±37.25）ms］，T2弛豫时间［（49.21±4.36）ms、（47.25±4.11）ms、（46.23±4.05）ms］均短于治疗前［（77.25±8.15）ms］（均P<0.05）。结论　采用定量MRI技术可评价腰椎退行性病变患者针刀治疗前后软骨情况及成分变化，疗效评价准确。

关键词:

腰椎退行性病变, 针刀, 定量磁共振成像技术, 疗效评估