退行性腰椎管狭窄症临床功能障碍程度与影像学参数的相关性分析

Correlation of imaging parameters with degree of clinical dysfunction for degenerative lumbar spinal stenosis

目的分析退行性腰椎管狭窄症临床功能障碍程度与影像学参数的相关性。方法回顾性分析自2018-05—2021-04诊治的68例退行性腰椎管狭窄症,17例为轻中度功能障碍(ODI指数<40%,Ⅰ组),30例为重度功能障碍(ODI指数40%~60%,Ⅱ组),21例为严重功能障碍(ODI指数>60%,Ⅲ组)。比较3组硬膜囊面积(S1)与椎管面积(S2)的比值(S1/S2)、S2与椎体面积(S3)的比值(S2/S3)、椎间隙高度、腰椎前凸Cobb角,分析ODI指数、疼痛VAS评分、S1/S2与椎间隙高度、腰椎前凸Cobb角、S2/S3的相关性。结果3组间S1/S2、椎间隙高度、腰椎前凸Cobb角、S2/S3差异有统计学意义(P<0.05),且Ⅲ组低于Ⅱ组,Ⅱ组低于Ⅰ组。相关性分析结果显示,ODI指数、疼痛VAS评分与椎间隙高度、腰椎前凸Cobb角、S2/S3呈负相关(P<0.05);S1/S2与椎间隙高度、腰椎前凸Cobb角、S2/S3呈正相关(P<0.05)。结论椎间隙高度丢失、腰椎生理曲度强直、骨性椎管狭小是退行性腰椎管狭窄症临床功能障碍程度较为严重的预测指标。

ObjectiveTo analyze the correlation between clinical dysfunction and imaging parameters in patients with degenerative lumbar spinal stenosis.MethodsA retrospective analysis of 68 patients with degenerative lumbar spinal stenosis admitted to our hospital from May 2018 to April 2021 was conducted,17 patients with mild to moderate dysfunction(ODI index<40%,groupⅠ),30 patients severe dysfunction(ODI index 40%-60%,groupⅡ),and 21 cases were very severe dysfunction(ODI index>60%,groupⅢ).The correlation of the following indicators in the three groups was analyzed:ratio of dural sac area(S1)to spinal canal area(S2)(S1/S2),S2 to vertebral body area(S3)(S2/S3),intervertebral space height,Lumbar lordosis Cobb angle,ODI index,pain VAS score,S1/S2 and intervertebral space height,and lumbar lordosis Cobb angle.ResultsThere were significant differences in S1/S2,intervertebral space height,Cobb angle of lumbar lordosis,and S2/S3 among the three groups(P<0.05),and groupⅢwas lower than groupⅡ,groupⅡwas lower than groupⅠ.The results of correlation analysis showed that ODI index and VAS score were negatively correlated with intervertebral space height,lumbar lordosis Cobb angle,and S2/S3(P<0.05);S1/S2 was positively correlated with intervertebral space height,Cobb angle of lumbar lordosis,and S2/S3(P<0.05).ConclusionLoss of intervertebral space height,stiffness of lumbar physiologic curvature,and narrowing of bony spinal canal are predictors of severe clinical dysfunction in degenerative lumbar spinal stenosis.