神经根沉降征新四分型法对腰椎管放射性狭窄程度的诊断价值及其与预后的关系  

Diagnostic value and prognosis of radiation-stenosis degree of lumbar spinal canal by new quadriculation of nerve root subsidence sign

作　　者：王芬[1] 杨利[2] 马远博 张静 李娜[1] 王沛然 WANG Fen;YANG Li;MA Yuan-bo;ZHANG Jing;LI Na;WANG Pei-ran(CT Room,the Fourth People's Hospital of Hengshui,Hengshui 053000;Department of Radiology,the Fourth People's Hospital of Hengshui,Hengshui 053000;Department of Clinical Medicine,Chengde Medical College,Chengde 067050,Hebei,China)

机构地区：[1]衡水市第四人民医院,CT室,河北衡水053000 [2]衡水市第四人民医院,放射科,河北衡水053000 [3]承德医学院临床医学系,河北承德067050

出　　处：《川北医学院学报》2024年第12期1659-1663,共5页Journal of North Sichuan Medical College

基　　金：河北省衡水市科技计划项目(2021014069Z)。

摘　　要：目的:探讨神经根沉降征新四分型法对腰椎管不同放射性狭窄程度的诊断价值及其与预后的关系。方法:选取220例腰椎管狭窄(LSS)患者作为研究对象,根据硬膜囊面积(CSA)分为三组;CSA 130~180 mm^(2)为轻度组;CSA为100~130 mm^(2)为中度组;CSA<100 mm^(2)为重度组。采用神经根沉降征(NRS)新四分型法将各组患者分为NRS阴性、a型、b型和c型。所有患者均行磁共振成像(MRI)横断面扫描,分析各组患者NRS分型对LSS及其严重程度的符合率,比较三组患者NRS分型构成、视觉模拟评分(VAS)、CSA、Oswestry功能障碍指数(ODI)等指标,采用多因素分析确定NRS分型与LSS预后的相关性。结果:轻度组NRS阴性构成比74.3%更高,中度组NRS a型构成比46.2%更高,重度组NRS b型、NRS c型构成比35.3%、30.9%更高;三组患者NRS阴性、a型、b型和c型构成比较,差异有统计学意义(P<0.05)。重度放射性狭窄的节段,NRS的敏感度约为93%,特异度约为65%;中度放射性狭窄的节段敏感度约为67%,特异度约为58%;轻度放射性狭窄节段中的敏感度约为25%,特异度约为83%;三组患者NRS敏感度、特异度比较(P<0.05)。采用单因素方差分析,各组CSA评分比较:轻度组>中度组>重度组,各组VAS、ODI评分比较:重度组>中度组>轻度组(P<0.05)。多因素分析显示,NRS分型是影响LSS预后的独立危险因素(P<0.05),NRS分型越高,预后越差。结论:NRS新四分型法是一种简便、有效的LSS诊断方法,能较好地反映椎管狭窄程度,且NRS对于诊断重度形态学狭窄的LSS具有较高敏感度和特异度,同时也是影响LSS预后的重要因素。Objective:To investigate the diagnostic value of the new quadritype of nerve root settlement sign in different degree of radiation stenosis of lumbar spinal canal and its relationship with prognosis.Methods:220 patients with lumbar spinal stenosis(LSS)were divided into three groups according to the dural sac area(CSA):mild group with CSA of 130~180 mm^(2),moderate group with CSA of 100~130 mm^(2),and severe group with CSA less than 100 mm^(2).Each group of patients was further divided into four subgroups using the new four-point classification of the neurological root descent sign(NRS)as follows:negative,type A,type B,and type C.All patients underwent magnetic resonance imaging(MRI)sagittal section scans,and the agreement rates between NRS subtypes and LSS and its severity were analyzed.The distribution of NRS subtypes,visual analog scale(VAS)scores,CSA,and Oswestry disability index(ODI)were compared among the three groups of patients.The correlation between NRS subtypes and the prognosis of LSS was determined by multivariate analysis.Results:NRS negative composition was higher in mild group(74.3%),NRS type a composition was higher in moderate group(46.2%),and NRS type b and NRS type c composition was higher in severe group(35.3%and 30.9%).NRS negative,type a,type b and type c were compared among the three groups,and the difference was statistically significant(P<0.05).The sensitivity and specificity of NRS were about 93%and 65%in the severely radiostricted segment.The segmental sensitivity and specificity of moderate radiation stenosis were 67%and 58%respectively.The sensitivity and specificity of mild radioactive stenosis segments were about 25%and 83%respectively.There were statistically significant difference in NRS sensitivity and specificity among three groups(P<0.05).By one-way analysis of variance,CSA score was higher in the mild group,and VAS and ODI score in the severe group were higher,and the differences in VAS,CSA and ODI scores among the three groups were statistically significant(P<0.05).Multivaria

关 键 词：神经根沉降征 腰椎管狭窄 硬膜囊面积 NRS分型 预后评估 

分 类 号：R687.3[医药卫生—骨科学]