退变性中央型腰椎管狭窄硬膜囊横截面积与神经根沉降征相关性研究

Correlation between cross sectional area of dural sac and nerve root subsidence sign in degenerative central lumbar spinal stenosis

目的利用MRI测量退变性中央型腰椎管狭窄(LSS)硬膜囊横截面积(CSA),研究其与神经根沉降征(NRS)相关性,探讨NRS对LSS的诊断价值。方法选择2017年4月至12月于大连大学附属中山医院就诊经MRI诊断中央型LSS患者500例,其中男性189例,女性311例;年龄45~80岁,平均年龄62.83岁;临床主要表现为腰腿痛、下肢无力、下肢麻木及间歇性跛行等症状。根据最小CSA分组,并获取每组内所有狭窄节段NRS的阳性病例,计算其阳性率。运用SPSS 20.0统计学软件行统计学分析,获得NRS阳性发生率与CSA间的相关性及退变性LSS在不同腰椎节段中的分布特点。结果500例患者中1 038个狭窄节段共43.0%病变节段位于L_(4~5)节段,39.1%位于L_(3~4)节段,17.9%位于L_(2~3)节段;其中NRS阳性组550个狭窄节段,NRS阴性组488个狭窄节段。阳性NRS在L_(2~3)、L_(3~4)、L_(4~5)节段的分布差异有统计学意义(χ~2=8.688,P<0.05);经两两比较得NRS阳性率在L_(3~4)、L_(4~5)节段的分布差异有统计学意义(P<0.05),L_(4~5)节段的NRS阳性率高于L_(3~4)节段。LSS轻度狭窄中NRS阳性103例,NRS阴性332例;LSS中度狭窄中NRS阳性147例,NRS阴性122例;LSS重度狭窄中NRS阳性300例,NRS阴性34例;NRS阳性率与最小CSA的变化呈显著的负相关(r=-0.940,P<0.05),CSA越小,阳性NRS的发生率越高。LSS组中NRS阳性率,单节段<双节段<多节段,差异有统计学意义(χ~2=65.612,P<0.05)。结论退变性中央型LSS中NRS阳性与CSA具有显著相关性,NRS阳性可提示椎管狭窄,并可以作为临床评估和量化LSS的一种辅助方法。

Objective To measure the cross-sectional area（CSA）of dural sac of degenerative central lumbar spinal stenosis（LSS）by magnetic resonance imaging（MRI）,observe the nerve root sedimentation sign（NRS）and its correlation,and detect diagnostic value of NRS in LSS.Methods A total of 500 patients with central LSS diagnosed by MRI were enrolled from April2017 to December 2017,which included 189 males and 311 females,aged 45-80 years old with mean age of 62.83 years old.The main clinical manifestations were lumbocrural pain,lower extremity weakness,lower limb numbness and intermittent claudica.Patients were divided into several groups according to the minimun CSA.The positive cases of NRS in all narrow segments of each group was obtained and the positive rate was calculated.Correlation between NRS positive rate and CSA,and the distribution characteristics of degenerative LSS in different lumbar segments were calculated by SPSS 20.0 statistics software.Results Of 500 patients（1 038 segments）,43.0%lesions were located in L_（4~5）segments,39.1%located in L_（3~4）segments,17.9%were located in L_（2~3）segments.The NRS positive group was 550 segments and NRS negative group of 488 segments.The distribution of positive NRS in L_（2~3）,L_（3~4）and L_（4~5）segments was statistically significant（χ~2=8.688,P〈0.05）.By pairwise comparison,the distribution of NRS positive rate in L_（3~4）,L_（4~5）segment was statistically significant（P〈0.05）.In mild stenosis of LSS,103 cases were positive NRS and 332 of negative NRS.In moderately stenosis of LSS,147 cases were positive NRS and 122 of negative NRS.In severe stenosis of LSS,300 cases were positive NRS and 34 of negative NRS.There was significant negative correlation between incidence of positive NRS and CSA changes（r=-0.940,P〈0.05）.There was the smaller CSA with the higher incidence of NRS positive rate.The NRS positive rate of NRS positive group,which was single segmentdouble segmentmulti-segment,and the difference was statistically significant（χ~2=65.612,P〈0.05）.Conclusion It is demonstrated that there is a significant correlation between NRS positive and CSA in degenerative central lumbar spinal stenosis.NRS positive can indicate spinal canal stenosis and can be used as a supplementary method for clinical evaluation and quantification of LSS.