MRI显示神经根沉降征在腰椎管狭窄症中的应用价值  

Application value of nerve root sedimentation sign in lumbar spinal stenosis revealed on MRI

作　　者：陈延超[1] 余作冲[1] 曹蓉 尹望平[1] 

机构地区：[1]复旦大学附属金山医院,上海市201508

出　　处：《中国组织工程研究》2017年第31期5043-5048,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:神经根沉降征在腰椎管狭窄症患者中的应用价值目前仍未有专家共识。目的:探讨神经根沉降征在腰椎管狭窄症患者中的阳性率及其关系。方法:收集281例由于腰痛或腰腿痛在复旦大学附属金山医院骨科门诊或病房申请行腰椎MRI检查的患者,其中男管119例,女162例。对患者腰椎管横截面积及椎管矢状径进行定量测量,以腰椎管横截面积及椎矢状径是否狭窄进行分组,比较各组间神经根沉降征阳性率的差异。结果与结论:(1)单独以硬膜囊横截面积是否狭窄进行分组:神经根沉降征在重度腰椎管狭窄症患者中的阳性率为91.4%,在非狭窄患者中阳性率为39.6%,在轻度腰椎管狭窄患者中阳性率为53.5%,差异有显著性意义(P<0.05),但在轻、中度与中、重度狭窄患者中阳性率差异无显著性意义;(2)单独以腰椎管矢状径是否狭窄进行分组:非狭窄和狭窄患者的神经根沉降征阳性率差异有显著性意义(44.3%,76.1%,χ~2=21.469,P=0.000);(3)联合硬膜囊横截面积和腰椎管矢状径两个指标分组:硬膜囊横截面积<120 mm^2或者腰椎管矢状径<10 mm提示存在腰椎管狭窄,非狭窄和狭窄患者的神经根沉降征阳性率差异有显著性意义(40.6%,80.6%,χ~2=30.539,P=0.000);(4)结果表明,神经根沉降征是否可以作为诊断腰椎管狭窄症的一项指标仍有待进一步探讨,尽管在重度狭窄患者中阳性率较高,但在非狭窄人群中同样有较高的阳性率,单纯以沉降征诊断腰椎管狭窄存在假阳性,结合硬膜囊横截面积和椎管矢状径及神经根沉降征共同诊断腰椎管狭窄的意义较大。BACKGROUND： Clinical value of the nerve root sedimentation sign in patients with lumbar spinal stenosis （LSS） is stilluncertain.OBJECTIVE： To investigate the positive rate and correlation of the nerve root sedimentation sign in patients with LSS.METHODS： Totally 281 patients complaining lumbago or low back pain underwent MRI examination in the OrthopedicClinic or Ward of Jinshan Hospital of Fudan University, including 119 males and 162 females. The cross-sectional areaand sagittal diameter of the spinal canal were measured, and the patients were then divided into two groups according tothe presence and absence of LSS. Finally, the positive rate of nerve root sedimentation sign was compared.RESULTS AND CONCLUSION： （1） Grouping based on the presence and absence dural sac cross-sectional areastenosis： the positive rate of nerve root sedimentation sign in sever, non, and mild LSS patients was 91.4%, 39.6%,and 53.5%, respectively, and the difference was significant （P 〈 0.05）, but the positive rate showed no significantdifference between mild and moderate as well as moderate and severe LSS patients. （2） Grouping according to thepresence and absence spinal canal sagittal diameter stenosis： there was a significant difference in the positive rate ofnerve root sedimentation sign between non-LSS and LSS patients （44.3% vs. 76.1%, χ2=21.469, P=0.000）. （3）Grouping based on the dural sac cross-sectional area combined with spinal canal sagittal diameter： the dural saccross-sectional area 〈 120 mm2 or the spinal canal sagittal diameter 〈 10 mm indicating LSS, there was a significantdifference in the positive rate of nerve root sedimentation sign between non-LSS and LSS patients （40.6% vs.80.6%,χ2=30.539, P=0.000）. （4） These results indicate that the diagnosis value of nerve root sedimentation sign inLSS is still under discussion. Although a positive sedimentation sign exclusively and reliably occurs in patients withsevere LSS, it is also higher in patients without LSS. It ma

关 键 词：骨科植入物 脊柱植入物 腰椎管狭窄症 神经根沉降征 硬膜囊横截面积 矢状径 阳性率 假阳性 

分 类 号：R318[医药卫生—生物医学工程]