神经根沉降症与腰椎管狭窄的相关性研究  

The study of relationship between the nerve root sedimentation syndrome and lumbar spinal stenosis

作　　者：汪大明[1] 杨庆国[1] 高胜山[1] 王磊[1] 张银顺[1] 

机构地区：[1]安徽医科大学第一附属医院骨科,合肥230022

出　　处：《安徽医科大学学报》2013年第5期520-523,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的评价神经根沉降症在非特异性下腰痛(LBP)和症状性腰椎管狭窄症(LSS)鉴别诊断中的价值。方法该研究包括140例病例。LSS组(n=70)表现为跛行,伴或不伴LBP和腿痛,硬膜囊代表性区域<80 mm2,行走距离<200 m;LBP组(n=70)为非特异性腰痛,无腿痛和跛行,硬膜囊代表性区域>120 mm2,行走距离>1 000 m。比较两组阳性神经根沉降症出现机率。结果 LSS组70例病例观察到66例出现阳性神经根沉降症,而LBP组0例。两组间疼痛的视觉模拟评分(VAS)差异无统计学意义。LBP组中Oswe-stry功能障碍指数(ODI)评价有更严重的功能障碍(LBP组65%,LSS组61%,P<0.05)。LBP组中代表性区域面积(CSA)明显大于LSS组,两组间比较差异有统计学意义(P<0.01)。ODI和最小硬膜囊CSA相关系数R=0.14(P=0.099),两者间无明显相关性。结论阳性神经根沉降症广泛地出现于LSS病例中,表示其在临床实践中的可用性。假如可证实该症的高度特异性,一个阳性沉降症将可诊断LSS,而高敏感性被证实,则一个阴性的沉降症可排除LSS。Objective To evaluate the significance of sedimentation in the differential diagnosis of nonspecific lowback pain （LBP） from symptomatic lumbar spinal stenosis （LSS）. Methods The study included 140 cases. Patients in LSS group （n = 70） showed elaudieation with or without LBP and leg pain, dural representative area 〈 80 mm^2, walking distance 〈 200 m ; patients in LBP group （ n = 70） showed non-specific low back pain, no leg pain and claudieation, the dural sac representative area 〉 120 mm2 and walking distance 〉 1 000 m. The probability of positive sedimentation syndrome was compared between the two groups. Results 66 of 70 eases （94%） was observed to have positive sedimentation syndrome in LSS group, but none in the LBP group. The difference was not statistically significant between the 2 groups in VAS pain score. However, patients in the LBP group experienced a higher severity of functional limitation as measured by the ODI （65% in LBP group vs 61% in LSS group;P 〈 0. 05 ）. The LBP group CSA was significantly greater than the LSS group, and a significant difference was statistically significant between the two groups （P 〈0.01 ）. No correlation was noted between ODI and the smallest CSA of the dural sac was R = 0. 14 （P = 0. 099 ）. Conclusion The positive sedimentation sydrome is of extensive and reliable appearance in LSS, indicating its availability in clinical practice. A positive sedimentation sydrome of the disease, if eomfirmed to be specific, will be valuable for the LSS diagnosis and the negative sedimentation sydrome, if sensitive, may exclude the LSS.

关 键 词：腰椎管狭窄症 敏感性和特异性 神经根沉降 磁共振成像 

分 类 号：R681.533.2[医药卫生—骨科学] R445.2[医药卫生—外科学]