腰椎间盘突出症中医分型与磁共振Pfirrmann分级相关性研究

Correlation Between TCM Classification and Magnetic Resonance Pfirrmann Classification of Lumbar Disc Herniation

目的通过LIDP中医辨证分型与1.5T磁共振Pfirrmann标准分级的对照研究,提高腰椎间盘突出症的中医辨证分型准确率。方法本研究共招募120例LIDP患者进行中医辨证分型和1.5T常规腰椎MRI检查,对扫描的600个腰椎间盘行Pfirrmann腰椎间盘退变分级,并采用Kendall等级相关检验评估LIDP中医辨证分型与椎间盘Pfirrmann标准分级的相关性。结果 Kendall等级相关检验显示LIDP中医辨证分型与Pfirrmann标准分级呈正相关(H=315.27,P <0.05)。LIDP中医证型的不同也对应着不同程度的腰椎间盘退变,两者的对应关系具体如下:PfirrmannⅠ级诊断接近于血瘀气滞证椎间盘退变程度,PfirrmannⅡ～Ⅲ级诊断接近于湿热痰滞证和风寒湿滞证椎间盘退变程度,PfirrmannⅣ～Ⅴ级诊断接近于肝肾亏虚证椎间盘退变程度。结论在一定程度上,Pfirrmann标准分级对应着LIDP中医辨证分型,两者结合可进一步指导LIDP中医辨证施治,并且使LIDP中医辨证施治有了可量化的理论依据。

Objective To improve the accuracy of TCM syndrome differentiation and typing of lumbar intervertebral disc herniation by comparing LIDP with 1.5T magnetic resonance Pfirrmann standard grading.Methods 120 patients with LIDP were examined by TCM syndrome differentiation and 1.5T MRI.A total of 600 lumbar intervertebral discs were scanned.The correlation between TCM syndrome differentiation of LIDP and Pfirrmann standard classification of intervertebral discs was evaluated.Results Correlation tests results like Kendall tau rank correlation coefficient showed the syndrome differentiation of TCM and Different Grades of Pfirrmann Grading System were positively correlated with each other (H=315.27,P<0.05). Different types of TCM syndrome of LIDP also correspond to different degrees of lumbar disc degeneration,the specific corresponding relationship as follows:Diagnosis of Pfriimann grade,is equal to the degeneration degree of lumbar intervertebral disc in the qi stagnation and blood stasis syndrome;diagnosis of Pfriimann grade Ⅱ~Ⅲ is close to the degeneration degree of lumbar intervertebral disc in the damp-heat and phlegm stagnation syndrome and wind-cold and damp stagnation syndrome;diagnosis of Pfriimann grade Ⅳ~Ⅴ was close to the degeneration degree of lumbar intervertebral disc in the liver and kidney deficiency syndrome.Conclusion The TCM syndrome differentiation of LIDP has a certain corresponding relationship with Pfirrmann standard grading,which can be used as a quantitative reference for the treatment of LIDP.