腰椎管狭窄症内镜减压影像与临床资料的相关性  

Correlation between imaging and clinical data in endoscopic decompression for lumbar spinal stenosis

作　　者：王生伟[1] 谈应东[2] 陈丽娟[1] 毛义义 运彩虹 WANG Sheng-wei;TAN Ying-dong;CHEN Li-juan;MAO Yi-yi;YUN Cai-hong(Department of Radiology,People's Hospital of Jiuquan City,Jiuquan735000,China;Department of Orthopedics,People's Hospital of Jiuquan City,Jiuquan735000,China)

机构地区：[1]甘肃省酒泉市人民医院放射科,甘肃酒泉735000 [2]甘肃省酒泉市人民医院骨科,甘肃酒泉735000

出　　处：《中国矫形外科杂志》2024年第3期220-225,共6页Orthopedic Journal of China

摘　　要：[目的]探讨腰椎管狭窄症(lumbar spinal stenosis,LSS)内镜减压影像与临床资料的相关性。[方法]2020年1月—2022年8月本院对76例LSS患者行经皮经椎间孔内镜减压术。末次随访时按改良Macnab评价临床疗效将患者分组,比较患者临床与影像资料,分析末次随访影像参数与VAS评分、ODI指数的相关性。[结果]按Macnab标准,末次随访时临床结果评定为优36例,良32例,可8例,此三组患者的VAS评分[(1.3±0.2)vs(1.7±0.4)vs(2.6±0.8),P<0.001]、ODI指数[(20.9±4.3)%vs(25.5±5.3)%vs(32.4±3.4)%,P<0.001]、中央椎管横断面积[(169.3±18.3)mm^(2)vs(164.5±15.8)mm^(2)vs(156.4±13.4)mm^(2),P<0.001]、侧隐窝前后径[(5.3±0.7)mm vs(4.9±0.6)mm vs(4.2±0.4)mm,P<0.001]、椎间孔矢状面积[(90.2±9.0)mm^(2)vs(86.4±8.1)mm^(2)vs(80.5±6.8)mm^(2),P<0.001]、硬膜囊横断面积[(138.5±10.3)mm^(2)vs(134.4±9.2)mm^(2)vs(126.3±8.6)mm^(2),P<0.001]和硬膜囊最大矢状径[(21.7±4.0)mm vs(19.6±3.3)mm vs(17.9±2.8)mm,P<0.001]的差异均有统计学意义。相关分析表明:VAS评分与中央椎管横断面积(r=-0.429,P<0.001),侧隐窝前后径(r=-0.346,P<0.001),椎间孔矢状面积(r=-0.354,P<0.001),硬膜囊横断面积(r=-0.216,P=0.023)和硬膜囊最大矢状径(r=-0.254,P=0.014)均呈显著负相关;ODI评分与中央椎管横断面积(r=-0.420,P<0.001)、侧隐窝前后径(r=-0.335,P<0.001)、椎间孔矢状面积(r=-0.373,P<0.001)、硬膜囊横断面积(r=-0.213,P=0.022)和硬膜囊最大矢状径(r=-0.252,P=0.013)均呈显著负相关。[结论]LSS经皮经椎间孔脊柱内镜治疗后CT、MRI影像测量参数与临床疼痛、功能障碍评分具有显著关联。[Objective]To investigate the correlation between imaging and clinical data in endoscopic decompression for lumbar spinal stenosis(LSS).[Methods]From January 2020 to August 2022,76 patients with LSS underwent percutaneous transforaminal endoscopic decompression in our hospital.At the last follow-up,patients were grouped according to the clinical efficacy evaluated by modified Macnab criteria.The clinical and imaging data of patients were compared,and the correlation between the imaging parameters and VAS score or ODI score was analyzed.[Results]According to Macnab criteria,36 cases were excellent,32 cases were good,and 8 cases were fair at the last follow-up.There were significantly differences in terms of VAS score[(1.3±0.2)vs(1.7±0.4)vs(2.6±0.8),P<0.001],ODI score[(20.9±4.3)%vs(25.5±5.3)%vs(32.4±3.4)%,P<0.001],as well as the radiographic measurements including central canal cross-sectional area(CCCSA)[(169.3±18.3)mm^(2)vs(164.5±15.8)mm^(2)vs(156.4±13.4)mm^(2),P<0.001],lateral recess anteroposterior diameter(LRAPD)[(5.3±0.7)mm vs(4.9±0.6)mm vs(4.2±0.4)mm,P<0.001],sagittal area of the intervertebral foramen(SAIF)[(90.2±9.0)mm^(2)vs(86.4±8.1)mm^(2)vs(80.5±6.8)mm^(2),P<0.001],dural sac cross-sectional area(DSCSA)[(138.5±10.3)mm^(2)vs(134.4±9.2)mm^(2)vs(126.3±8.6)mm^(2),P<0.001]and the dural sac maximum sagittal diameter(DSMSD)[(21.7±4.0)mm vs(19.6±3.3)mm vs(17.9±2.8)mm,P<0.001].As results of correlation analysis,the VAS score was significantly negatively correlated with CCCSA(r=-0.429,P<0.001),LRAPD(r=-0.346,P<0.001),SAIF(r=-0.354,P<0.001),DSCSA(r=-0.216,P=0.023)and DSMSD(r=-0.254,P=0.014).Similarly,the ODI score proved significantly negatively correlated with CCCSA(r=-0.420,P<0.001),LRAPD(r=-0.335,P<0.001),SAIF(r=-0.373,P<0.001),DSCSA(r=-0.213,P=0.022)and DSMSD(r=-0.252,P=0.013).[Conclusion]After percutaneous transforaminal endoscopic decompression for LSS,the measured parameters of CT and MRI images are significantly correlated with clinical pain and dysfunction scores.

关 键 词：腰椎管狭窄症 经皮经椎间孔脊柱内镜治疗 影像学参数 疗效 

分 类 号：R681.5[医药卫生—骨科学]