| 沈一真,黄永辉,曹兴兵.神经根沉降征对于腰椎管狭窄症的诊断价值探讨.骨科,2020,11(1): 6-12. |
| 神经根沉降征对于腰椎管狭窄症的诊断价值探讨 |
| Diagnostic value of nerve root sedimentation sign for lumbar spinal stenosis |
| 投稿时间：2019-04-02 |
| DOI：10.3969/j.issn.1674-8573.2020.01.002 |
| 中文关键词: 腰椎管狭窄症 神经根沉降征 诊断 危险因素 |
| 英文关键词: Lumbar spinal stenosis Nerve root sedimentation sign Diagnosis Risk factors |
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| 中文摘要: |
| 目的 探讨神经根沉降征（nerve root sedimentation sign, NRS）对于腰椎管狭窄症（lumbar spinal canal stenosis, LSS）的诊断价值。方法 回顾性分析2015年5月至2018年8月因腰腿痛或间歇性跛行于我院就诊行MRI检查的病人162例，收集MRI影像资料，测量并计算以下影像学指标：NRS分型、椎管正中矢状径（posteroanterior diameter, PAD）、硬膜囊横截面积（dural sac cross-sectional area, DCSA）、椎管面积（cross-sectional area of the canal, CAC）、侧隐窝矢状径、DCSA变化率，按照DCSA/CAC的比值将所有入选节段分为椎管狭窄组和非狭窄组，比较上述影像学指标的组间差异，对于差异有统计学意义的指标进一步行Logistic回归分析，探讨LSS的危险因素。结果 共纳入316个节段，其中椎管狭窄节段229个，非狭窄节段87个。椎管狭窄与不狭窄节段间的NRS分型、PAD、DCSA、侧隐窝矢状径、DCSA变化率的差异均有统计学意义（P均＜0.05）。Logistic回归分析结果显示LLS的发生与NRS分型为阳性b型[与分型为阴性的病人相比，OR=16.291，95% CI（1.982，133.913），P=0.009]、DCSA≤130 mm2[DCSA值为100~130 mm2的病人与DCSA值＞130 mm2的病人相比，OR=3.814，95% CI（1.758，8.274），P=0.001；DCSA值＜100 mm2的病人与DCSA值＞130 mm2的病人相比，OR=10.189，95% CI（2.286，45.421），P=0.002]相关，NRS其余各型及其他影像学指标与LLS的发生无相关性（P均＞0.05）。将形态上存在近似的NRS阳性b、c型合并为b+c型后再次进行Logistic回归分析，结果显示LLS的发生与NRS分型为阳性b+c型、DCSA≤130 mm2相关，结果相近。结论 NRS在诊断没有发生明显形态学改变的LSS时，与DCSA相比无优越性，诊断价值有限。 |
| 英文摘要: |
| Objective To explore the diagnostic value of nerve root sedimentation sign (NRS) for lumbar spinal stenosis (LSS). Methods From May 2015 to August 2018, 162 patients subject to MRI examination due to backache together or intermittent claudication were retrospectively analyzed. The MRI data were collected, and the radiological parameters such as NRS classification, posteroanterior diameter (PAD), dural sac cross-sectional area (DCSA), cross-sectional area of the canal (CAC), sagittal diameter of lateral recess and cross-sectional area change rate were measured and calculated. All the selected segments were divided into spinal stenosis and non-stenosis groups according to the ratio of DCSA/CAC. The differences in the above imaging indexes between groups were compared. The Logistic regression analysis was carried out for indicators with statistical significance in order to analyze the key factors causing LSS. Results A total of 316 segments were included in the experiment, including 229 cases of spinal stenosis and 87 cases of non-stenotic segments. Univariate analysis showed the diagnosis of LSS was directly related with NRS, PAD, CSA, sagittal diameter of lateral recess and cross-sectional area change rate (P＜0.05 for all). The Logistic multivariate regression analysis showed that positive b type of NRS [compared with negative type, OR=16.291, 95% CI (1.982, 133.913), P=0.009], and DCSA≤130 mm2 [DCSA 100-130 mm2 vs. DCSA＞130 mm2, OR=3.814, 95% CI (1.758, 8.274), P=0.001; DCSA＜100 mm2 vs. DCSA＞130 mm2, OR=10.189, 95% CI (2.286, 45.421), P=0.002] were independent risk factors for the diagnosis of LSS. The morphologically similar NRS positive b and c types were combined into b+c type and the Logistic multivariate regression analysis revealed that LSS was related with the positive b+c type of NRS and DCSA≤130 mm2. Conclusion NRS has no superiority over DCSA in the diagnosis of LSS without obvious morphological change, and its diagnostic value is limited. |
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