神经根沉降征在腰椎管狭窄和腰椎间盘突出症中的差异

Difference of nerve root sedimentation sign between patients with lumbar spinal stenosis and lumbar disc herniation

目的研究神经根沉降征在腰椎管狭窄症(LSS)和腰椎间盘突出症(LDH)中的差异。方法选取2013年4月至2015年4月安徽医科大学第一附属医院骨科住院患者183例,其中LSS患者63例,包括中央型LSS组50例,侧隐窝型LSS组13例,LDH组120例。术前采用日本骨科协会评分(JOA评分)、视觉模拟评分(VAS评分)、腰痛评分标准(ODI)功能障碍指数及步行负荷实验评价两组患者临床表现,并记录所有患者在MRI扫描中最小硬膜囊横截面积(CSA)。比较3组患者MRI扫描中神经根沉降征阳性率大小。结果 LSS患者中,中央型LSS组中出现神经根阳性数46(92%),侧隐窝型LSS组中出现阳性数为3(23%),LDH组中出现神经根阳性数为18(15%),差异有统计学意义(P<0.05)。3组患者JOA评分、VAS评分、ODI功能障碍指数比较差异无统计学意义(P>0.05),步行距离、CSA比较差异有统计学意义(P<0.05)。在LSS组中神经根沉降征阳性患者与阴性患者VAS评分、ODI功能障碍指数、CSA与步行距离比较,差异有统计学意义(P<0.05),JOA评分差异无统计学意义(P>0.05)。结论神经根沉降征阳性也存在于LDH患者中,但广泛存在于LSS患者中,尤其对中央型LSS诊断具有较高的敏感性。

Objective To evaluate the difference of nerve root sedimentation sign between the patients with lumbar spinal stenosis( LSS) and with lumbar disc herniation( LDH). Methods 183 patients hospitalized in ourorthopedic department from Apr 2013 to Apr 2015 were recruited in the study,in which 63 cases were divided into the LSS group,including 50 cases ofcentral stenosis and 13 cases of lateral stenosis,and the other 120 cases into the LDH group. The Japanese orthopedic association( JOA) score,visual analog score( VAS),Oswestry disability index( ODI) and walking load experiment were used to evaluatethe clinical presentation of patients in the two groups before surgery,and the minimal dural sac cross-sectional area( CSA) ofall MRI scanning patients were recorded. Thepositive rate of nerve root sedimentation signinthe MRI scanning in the groups of central LSSpatients,lateral LSS patients,and LDH patientswere compared. Results The positive results of nerve root sedimentation sign were observed in 46 cases( 92%) of the central LSSsub group,but in the lateral LSSsub group and the LDH group the results were 3 cases( 23%) and 18 cases( 15%),respectively,with significant differences( P < 0. 05). The differences were not statistically signi ficantamong the three groups of patients in the JOA score,VAS and ODI( P > 0. 05),but in the walking distance and CSA,those differences were statistically significant( P < 0. 05). In the LSS group,there were statistically sign ificant differencesinthe VAS,ODI,CSA and walking distance between the positive and negative patients with nerve root sedimentation sign( P < 0. 05),withno statistical significance in the JOA score between them( P > 0. 05). Conclusion A positive nerve root sedimentation sign might appear in the LDHpatients,although it widely exists in the central LSS patients,and so it is more sensitivein the diagnosis of central LSS.