症状性腰椎管狭窄症患者中无症状性颈椎管狭窄症的发生率和预测因素  

Prevalence and predictors of asymptomatic cervical spinal stenosis in patients with symptomatic lumbar spinal stenosis

作　　者：郭仁艺 陈悄悄 张敬 林丁 田珺 GUO Ren-yi;CHEN Qiao-qiao;LIN Ding;TIAN Jun(Rehabilitation Medicine Department,the First Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570102,China;Ultrasound Medicine Department of the Fourth People’s Hospital of Haikou,Haikou,Hainan 571199,China;The Third Outpatient Department of the 986th Air Force Hospital,Xi'an,Shanxi 710068,China.)

机构地区：[1]海南医学院第一附属医院康复医学科,海南海口570102 [2]海口市第四人民医院超声医学科,海南海口571199 [3]空军第九八六医院第三门诊部,陕西西安710068

出　　处：《颈腰痛杂志》2023年第6期975-978,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：海南省卫生健康科研项目(编号:20A200216)。

摘　　要：目的探讨症状性腰椎管狭窄症(lumbar spinal stenosis,LSS)患者中无症状性颈椎管狭窄症(asymptomatic cervical spinal stenosis,ASCSS)的患病率和预测因素。方法选择2018年1月~2022年3月在本院经MRI诊断为LSS的233例患者作为研究对象,所有患者均行腰椎和颈椎T2加权MRI检查,评估患者的马尾神经冗余症(redundant nerve roots,RNR)、硬膜囊横截面积(dural sac cross-sectional area,DCSA)、小关节角(facet-joint angle,FJA)、腰椎前凸角(lumbar lordosis angle,LLA)、骨盆入射角(pelvic incidence,PI)、颈椎管率(torg-pavlov ratio,TPR)、腰骶移行椎(lumbosacral transitional vertebra,LSTV)等资料,观察ASCSS患病率及影响因素,观察颈椎管狭窄指数(cervical spinal stenosis index,CSI)和腰椎管狭窄指数(lumbar spinal stenosis index,LSI)的相关性。结果233例LSS患者有93例诊断为ASCSS,占39.91%。ASCSS和非ASCSS患者的年龄、性别、体质量指数、共病指数(Charlson comorbidity index,CCI)、LSS节段、FJA、LSTV等差异均无统计学意义(P>0.05);ASCSS患者症状时间、RNR占比、LLA、PI均高于非ASCSS患者,DCSA低于非ASCSS患者,差异均有统计学意义(P<0.05)。ASCSS患者C_(3)~C_(6)节段TPR低于非ASCSS患者,两组患者C 7节段TPR差异无统计学意义(P>0.05);ASCSS患者C_(3)~C_(7)节段测量矢状径均低于非ASCSS患者,两组患者C 7节段测量矢状径差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,LLA≥37°、DCSA<83.4 mm 2是ASCSS的风险因素(P<0.05)。Spearman相关性分析显示,CSI和LSI存在显著正相关(r=0.530,P<0.001)。结论LSS患者出现LLA增大和DCSA降低者,应进行颈椎MRI检查,以排除颈椎病变的存在。Objective To study the prevalence and predictive factors of asymptomatic cervical spinal stenosis(ASCSS)in patients with symptomatic lumbar spinal stenosis(LSS).Methods A total of 233 patients with LSS diagnosed by MRI in our hospital from January 2018 to March 2022 were selected as the research objects.All patients underwent T2 weighted MRI of lumbar spine and cervical spine to evaluate the patients’redundant nerve roots(RNR),dural sac cross-sectional area(DCSA),facet joint angle(FJA),lumbar lordosis angle(LLA),pelvic angle of incidence(PI),torg-pavlov ratio(TPR)and lumbosacral transitional vertebra(LSTV).The prevalence and influencing factors of ASCSS were observed,and the correlation between cervical spinal stenosis index(CSI)and lumbar spinal canal stenosis index(LSI)was observed.Results Altogether 93 of 233 patients with LSS were diagnosed as ASCSS,accounting for 39.91%.There was no significant difference in age,sex,body mass index,Charlson comorbidity index(CCI),LSS segment,FJA and LSTV between ASCSS and non ASCSS patients(P>0.05).The symptom time,RNR,DCSA,LLA and PI of the two groups were significantly higher than those of non ASCSS patients(P<0.05).The C_(3)-C_(6)segment TPR of ASCSS patients was lower than that of non ASCSS patients(P<0.05),and there was no significant difference in C_(7)segment TPR between the two groups(P>0.05).The sagittal diameter measured at C_(3)to C_(7)segments in ASCSS patients was lower than that in non ASCSS patients,and there was no statistically significant difference in sagittal diameter measured at C_(7)segment between the two groups of patients(P>0.05)Multivariate logistic analysis showed that LLA≥37°and DCSA<83.4mm 2 were the risk factors for ASCSS(P<0.05).Spearman correlation showed that there was a significant positive correlation between CSI and LSI(r=0.530,P<0.001).Conclusion LSS patients with increased LLA and decreased DCSA should undergo cervical MRI examination to rule out the presence of cervical lesions.

关 键 词：腰椎管狭窄症 颈椎管狭窄症 颈腰综合征 患病率 预测因素 

分 类 号：R681.5[医药卫生—骨科学]