步行负荷试验与神经根沉降征在腰椎椎管狭窄症中的诊断价值  

Diagnostic value of gait load test and nerve root sedimentation sign in lumbar spinal stenosis

作　　者：柳扬[1] 包呼日查 郝敬东[1] 范磊[1] 孙永青[1] 

机构地区：[1]首都医科大学电力教学医院,国家电网北京电力医院骨科,北京100073 [2]内蒙古自治区人民医院骨科,内蒙古自治区010017

出　　处：《脊柱外科杂志》2016年第3期154-158,共5页Journal of Spinal Surgery

摘　　要：目的初步分析步行负荷试验（GLT）,神经根沉降征（NRSS）与传统影像学（MRI）诊断的一致性,探讨2种方法的关联性,评价它们在中央型腰椎椎管狭窄症（LSS）中的诊断价值。方法对经MRI诊断为LSS的32例患者（59个节段）进行GLT及腰神经支配区皮肤感觉、肌力和腱反射等定位体征检查,统计NRSS的阳性分布特征,分析GLT、NRSS及MRI诊断的一致性。结果 GLT阳性24例（42个节段）,阴性8例（17个节段）。NRSS阳性22例（40个节段）,阴性10例（19个节段）。除L4节段外,所有节段GLT阳性与MRI诊断间差异无统计学意义（P〉0.05）;除L4,5节段外,所有节段NRSS阳性与MRI诊断间差异无统计学意义（P〉0.05）;L2~5节段GLT阳性与NRSS阳性间差异无统计学意义（P〉0.05）。3种评价方法一致性较好。结论在MRI诊断基础之上,GLT与NRSS对于LSS的诊断具有一定敏感性,二者间存在较好的一致性,二者结合有助于LSS的定位诊断。Objective To evaluate the diagnostic value of the nerve root sedimentation sign（NRSS） and gait load test（GLT）by assessing their consistency with imaging（MRI） diagnosis,and further explore the correlation between the 2 methods. Methods A total of 32 patients（59 segments） with central lumbar spinal stenosis（LSS） were included in the test. GLT was performed,followed by inspection of skin sensation,muscle strength and tendon reflex. The NRSS was assessed by 3 observers independently. Frequencies of a positive sign in each patient were calculated. The consistency of GLT,NRSS and MRI diagnosis were analyzed. Results GLT was positive in 24（42 segments） cases and negative in 8 cases（17 segments）. NRSS was positive in 22 cases（40 segments） and negative in 10 cases（19 segments）. No statistical difference between MRI diagnosis and GLT positivity was observed in all segments except L4（P〈0.05）. No statistical difference between MRI diagnosis and NRSS positivity was observed in all segments except L4,5（P〈0.05）. There was also no statistical difference in positivity rate between GLT and NRSS in L2-5（P〈0.05）. There was a good consistency among the 3 evaluation methods. Conclusion On the basis of imaging diagnosis,GLT and NRSS for the diagnosis of LSS has a certain sensitivity. There is a good consistency between the 2 methods,and the combination of them is helpful for localization diagnosis of LSS.

关 键 词：腰椎 椎管狭窄 诊断技术和方法 

分 类 号：R681.533.2[医药卫生—骨科学]