改良Lee分级系统在评估椎间孔型腰椎间盘突出症患者椎间孔狭窄程度中的临床应用价值  

Clinical application value of modified Lee grading system to evaluate the degree of foraminal stenosis in patients with intervertebral foraminal lumbar disc herniation

作　　者：李淑玲[1] 张国伟[1] 曲德鑫 李翔 朱振利 谭江威 曲正伟 唐小锋[1] 刘旭林 Li Shuling;Zhang Guowei;Qu Dexin;Li Xiang;Zhu Zhenli;Tan Jiangwei;Qu Zhengwei;Tang Xiaofeng;Liu Xulin(Department of Radiology,Yantaishan Hospital of Yantai City,Yantai 264001,China;Department of Radiology,Yantai International Travel Healthcare Center,Yantai 264001,China;Department of Radiology,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,China;Departmentof Education Division,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,China;Department of Spinal Surgery,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,China)

机构地区：[1]烟台市烟台山医院影像科,烟台264001 [2]烟台国际旅行卫生保健中心,烟台264001 [3]滨州医学院烟台附属医院影像科,烟台264100 [4]滨州医学院烟台附属医院教育处,烟台264100 [5]滨州医学院烟台附属医院脊柱外科,烟台264100

出　　处：《中华医学杂志》2023年第15期1140-1147,共8页National Medical Journal of China

基　　金：山东省烟台市科技计划(2021YD072,2015WS069,2011236)

摘　　要：目的探讨改良Lee分级系统(简称改良系统)在评估椎间孔型腰椎间盘突出症(FLDH)患者椎间孔狭窄(IFS)程度中的临床应用价值。方法回顾性收集2018年3月至2021年2月滨州医学院烟台附属医院和烟台市烟台山医院83例FLDH-IFS患者(手术组34例,保守组49例)的MRI资料,其中男43例,女40例,年龄34~82(61±10)岁。由两名放射科医师2次分别采用临床常用的Lee分级系统(简称Lee系统)及改良系统对所选择患者的MRI图像进行盲法、独立地评估、记录。比较两种系统的评估级别(简称评级)差异及观察者对两种系统评级结果的一致性,分析两种分级系统的评级与临床治疗方式之间的相关性。结果两种分级系统行保守治疗有效的非3级(0~2级)百分比分别为94.6%(139/147)、64.2%(170/265),两种分级系统需要手术治疗有效的3级百分比分别为69.2%(128/185)、61.2%(41/67);结果在改良系统与Lee系统的评级之间差异具有统计学意义(Z=-5.16,P=0.001)。使用Lee系统分级,两名放射科医师观察者内Kappa值分别为0.735、0.542,高度、中等一致性;观察者间Kappa值为0.426~0.521,中等一致性。使用改良系统分级,两名放射科医师观察者内Kappa值分别为0.900、0.921,几乎完全一致;观察者间Kappa值为0.783~0.861,高度一致性或几乎完全一致。Lee系统评级与临床治疗方式之间具有相关性(r_(s)=0.39,P<0.001);改良系统评级与临床治疗方式之间具有相关性(r_(s)=0.61,P<0.001)。结论对于FLDH-IFS,改良系统能全面、准确地分级,可信度和可重复性高,评级与临床治疗方式之间具有较高的相关性。Objective To investigate the clinical application value of the modified Lee grading system(abbreviated as the modified system)in evaluating the degree of intervertebral foraminal stenosis(IFS)in patients with foraminal lumbar disc herniations(FLDH).Methods MRI data of 83 patients with FLDH-IFS(34 patients in the operation group and 49 patients in the conservative group)in Yantai Affiliated Hospital of Binzhou Medical Univer_(s)ity and Yantai Yantaishan Hospital from March 2018 to February 2021 were retrospectively collected.There were 43 males and 40 females,ranged from 34 to 82 year_(s)old,with an average of(61±10)year_(s).MRI images of selected patients were independently evaluated and recorded by two radiologists in a blind method,using both the Lee grading system(abbreviated as Lee system)and the modified system,respectively and each method was evaluated twice.The difference between the evaluation level of the two systems,and the agreement of observer assessments of the two systems were compared,and the correlation between the evaluation level of the two grading systems and the clinical treatment modalities was analyzed.Results The percentage of nongrade 3(grade 0-2)patients with effective conservative treatment according to the two grading systems was 94.6%(139/147)and 64.2%(170/265),respectively.The percentage of grade 3 patients requiring surgical treatment according to the two grading systems was 69.2%(128/185)and 61.2%(41/67),respectively.There was a statistically significant difference between the evaluation levels of the modified system and the Lee system(Z=-5.16,P=0.001).In the Lee system,the intra-observer observation consistency Kappa values of the two radiologists were 0.735 and 0.542,respectively,which were highly and moderately consistent;and the inter-observer observation consistency Kappa values were 0.426-0.521,which were moderate consistency.In the modified system,the intra-observer consistency Kappa values of the two radiologists were 0.900 and 0.921,respectively,and the consistency was alm

关 键 词：放射学 T_(2)加权脂肪抑制序列 间盘移位 椎间孔狭窄 分级 可重复性 横断面研究 

分 类 号：R681.53[医药卫生—骨科学]