CAJ | 학술논문

目的探讨腰椎SPECT显像对关节突关节源性下腰痛的诊断价值.方法 2006年7月至2007年3月共35例下腰痛患者被纳入该研究,根据腰椎SPECT显像结果分为腰椎关节突关节阳性组和阴性组.阳性组行关节突关节注射治疗,阴性组行保守治疗或手术治疗.记录治疗前腰痛情况和显像阳性组随访治疗后1,3及6个月的腰痛情况,并比较分析,阴性组记录相关治疗和治疗后6个月的腰痛情况.采用SPSS 10.0软件,2组患者治疗前相应参数比较用完全随机设计的成组比较t检验,显像阳性组患者治疗前后视觉模拟比例尺(VAS)评分比较采用配对t检验.结果腰椎SPECT显像检出关节突关节病变15例,随访行关节突关节注射治疗的14例患者(另1例因治疗后在外院又行手术治疗,排除在外),治疗后1,3和6个月疼痛缓解人数比例分别为12/14(85.7%),11/14(78.6%)和7/14(50.0%).治疗后1,3和6个月疼痛评分[VAS分别为(31.33±7.69),(38.21±10.67),(44.64±12.63)mm]与治疗前[VAS为(69.67±5.81)mm]相比差异有统计学意义(t值分别为12.55,8.36,5.54,P均<0.01).显像阴性20例,其中手术治疗3例,保守治疗17例,随访6个月14例(70.0%)患者治疗有效.结论腰椎SPECT显像有助于检出关节突关节源性下腰痛,筛选适合行关节突关节治疗的患者,以减轻疾病症状,提高患者生活质量.
목적 탐토요추SPECT현상대관절돌관절원성하요통적진단개치.방법 2006년7월지2007년3월공35례하요통환자피납입해연구,근거요추SPECT현상결과분위요추관절돌관절양성조화음성조.양성조행관절돌관절주사치료,음성조행보수치료혹수술치료.기록치료전요통정황화현상양성조수방치료후1,3급6개월적요통정황,병비교분석,음성조기록상관치료화치료후6개월적요통정황.채용SPSS 10.0연건,2조환자치료전상응삼수비교용완전수궤설계적성조비교t검험,현상양성조환자치료전후시각모의비례척(VAS)평분비교채용배대t검험.결과 요추SPECT현상검출관절돌관절병변15례,수방행관절돌관절주사치료적14례환자(령1례인치료후재외원우행수술치료,배제재외),치료후1,3화6개월동통완해인수비례분별위12/14(85.7%),11/14(78.6%)화7/14(50.0%).치료후1,3화6개월동통평분[VAS분별위(31.33±7.69),(38.21±10.67),(44.64±12.63)mm]여치료전[VAS위(69.67±5.81)mm]상비차이유통계학의의(t치분별위12.55,8.36,5.54,P균<0.01).현상음성20례,기중수술치료3례,보수치료17례,수방6개월14례(70.0%)환자치료유효.결론 요추SPECT현상유조우검출관절돌관절원성하요통,사선괄합행관절돌관절치료적환자,이감경질병증상,제고환자생활질량.
Objective Bone scintigraphy with SPECT of the lumbar spine allows identification of lesions not seen with planar imaging, in patients with chronic low back pain. The aim of this study was to investigate the value of SPECT bone scans in diagnosis of patients with zygapophyseal joint pain. Methods Thirty-five consecutive patients in Ruijin hospital from July 2006 to March 2007 with low back pain were enrolled. All patients underwent bone scintigraphy with SPECT. According to the results of SPECT, patients with isotope-uptake joints received injections at the levels where abnormalities were identified on the scan.Patients with negative scans received other treatment (conservative treatment or surgery) but not facet joint injection. Clinical records were collected at 1-, 3-, and 6-month in SPECT-positive group after their initial treatment. And the SPECT-negative group were followed up at 6-month after therapy. Statistical analysis was performed with SPSS 10.0. Patients with SPECT-pesitive and -negative results were performed with the grouped t-test. Visual analog scales (VAS) were with the paired t-test used in patients with positive scans at before and after treatment. Results Fifteen cases had facetal uptake of isotope on SPECT bone scans.After facet joint injection, 85.7 % patients (12/14, 1 patient was excluded for operation) had improvement in pain score at 1-month, 78.6% (11/14) at 3-month, and 50.0% (7/14) at 6-month. Of 20 negative cases, 3 were treated by surgery and 17 by conservative treatment. All 20 cases were followed up for 6 months and 70.0% (14/20) had long time pain relief. Conclusion SPECT bone scans are helpful to identify patients with low back pain who would benefit from facet joint injections.