CT分型在腰椎管狭窄症患者内镜下减压手术的指导作用

Guiding role of CT classification in endoscopic decompression surgery for patients with lumbar spinal stenosis

目的探讨CT分型对腰椎管狭窄症(lumbar spinal stenosis,LSS)患者内镜下减压手术的指导作用。方法选取LSS患者64例,均于术前行CT检查。以手术病理分型结果为金标准,分析CT分型结果与手术病理分型结果的一致性,并分析手术方式选择与术后效果。结果CT诊断结果显示,64例患者中Ⅰ型19例,Ⅱ型30例,Ⅲ型15例。手术病理结果显示,64例患者中Ⅰ型18例,Ⅱ型30例,Ⅲ型16例。CT分型与手术病理分型符合率为98.44%,CT诊断LSS患者Ⅰ型、Ⅱ型、Ⅲ型的准确率分别为98.44%、100.00%、98.44%,与手术病理分型结果一致性检验的Kappa值分别为0.962、1.000、0.957(P<0.001)。64例患者中,18例Ⅰ型者采用经椎板间入路行椎间盘切除术;30例Ⅱ型者接受椎间孔镜下改良TESSY技术联合神经根减压治疗;16例Ⅲ型LSS患者中4例接受椎间孔镜下改良TESSY技术联合神经根减压治疗,12例接受经椎板间入路手术治疗。所有患者术后均无永久性神经损伤、感染等手术并发症,间歇性跛性、腿痛、腰骶部痛等临床症状均明显缓解。结论LSS患者术前CT分型诊断准确性较高,对经皮内镜下减压手术入路的选择具有一定临床指导意义。

Objective To explore the guiding role of CT classification in endoscopic decompression surgery for patients with lumbar spinal stenosis(LSS).Methods In total,64 LSS patients were selected and all received CT examination before operation.With results of surgical and pathological classification as the gold standard,the consistency between CT classification results and results of surgical and pathological classification was analyzed,and the selection of surgical methods and postoperative results were analyzed.Results CT diagnosis showed that there were 19 cases of typeⅠ,30 cases of typeⅡand 15 cases of typeⅢamong the 64 patients.The pathological results showed that there were 18 cases of typeⅠ,30 cases of typeⅡand 16 cases of typeⅢamong the 64 patients.The coincidence rate between CT classification and surgical and pathological classification was 98.44%;the accuracy of CT in diagnosing typeⅠ,typeⅡand typeⅢLSS were 98.44%,100.00%and 98.44%,respectively,and the Kappa values of consistency test with the results of surgical and pathological classification were 0.962,1.000 and 0.957,respectively(P<0.001).Of 64 patients,18 patients with typeⅠunderwent discectomy via translaminar approach;30 patients with typeⅡunderwent modified TESSY technique combined with nerve root decompression under foraminal microscopy;among the 16 patients with typeⅢLSS,4 patients received modified TESSY technique combined with nerve root decompression under foraminal microscopy,and 12 patients received surgery via interlaminar approach.All patients had no postoperative complications such as permanent nerve injury and infection,and the clinical symptoms such as intermittent claudication,leg pain and lumbosacral pain were significantly relieved.Conclusion The accuracy of preoperative CT classification of LSS patients is relatively high,which has certain guiding significance for the selection of percutaneous endoscopic surgical approach in clinical practice.