腰椎管狭窄症临床症状与MRI轴位成像结果之间的关系

Relationship between clinical symptoms and axial MRI findings of lumbar spinal stenosis

目的探讨腰椎管狭窄症临床症状与MRI轴位成像结果之间的关系。方法选择2017年1月~2021年12月在本院初次诊断的LSS患者87例作为研究组,按照性别相同、年龄±1岁和1:1的原则选择同期在本院健康体检的87例受试者作为对照组。收集患者MRI轴面椎管横截面积(spinal canal cross-sectional area,SCA)和硬膜囊横截面积(duralsac cross-sectional area,DSA),并测量最狭窄椎间层面的黄韧带横截面积(ligamentum flavum cross-sectional area,LFA)和黄韧带厚度(ligamentum flavum thickness,LFT)。观察两组患者SCA、DSA、LFA、LFT差异,观察SCA、DSA、LFA、LFT与腰痛视觉模拟评分(VAS)、腿痛VAS、下肢麻木VAS、Oswestry功能障碍指数(ODI)和主观步行距离(SWD)的相关性。结果研究组男性、女性和总体SCA、DSA均低于对照组(P<0.05),LFA、LFT均高于对照组(P<0.05)。Spearman相关显示,SCA和DSA与腰痛VAS、腿痛VAS、下肢麻木VAS评分、ODI指数均存在显著负相关性(P<0.05);LFA和LFT与腰痛VAS、腿痛VAS、下肢麻木VAS评分、ODI指数和SWD均呈显著正相关(P<0.05)。多元线性回归分析显示,腰痛VAS、腿痛VAS、下肢麻木VAS评分与SCA、DSA、LFA、LFT不存在独立相关性(P>0.05);ODI指数与LFA、LFT存在正相关(P<0.05),与DSA、SCA不存在相关性;SWD与LFA、LFT不存在相关性(P>0.05),与DSA和SCA存在显著相关(P<0.05)。结论LFA和LFT与ODI指数显著相关,LFA和LFT值越大则ODI值越高,DSA、SCA和SWD存在显著的线性关联,DSA和SCA较大数值与更长的SWD相关。

Objective To investigate the relationship between the clinical symptoms of lumbar spinal stenosis and the results of MRI axial imaging.Methods 87 patients with LSS initially diagnosed in our hospital from January 2017 to December 2021 were selected as the study group,and 87 subjects who underwent physical examination in our hospital in the same period were selected as the control group according to the principle of the same gender,age±1 year and 1:1.The axial canal cross-sectional area(SCA)and dural sac cross-sectional area(DSA)of MRI were collected,and the ligamentum flavum cross-sectional area(LFA)and ligamentum flavum thickness(LFT)of the narrowest intervertebral layer were measured.The differences of SCA,DSA,LFA and LFT between the two groups were observed,and the correlation between SCA,DSA,LFA and LFT and visual analog score(VAS),leg pain VAS,lower limb numbness VAS,Oswestry dysfunction index(ODI)and subjective walking distance(SWD)was observed.Results The SCA and DSA of men,women and the whole population in the study group were lower than those in the control group(P<0.05).The LFA and LFT of men,women and the whole in the study group were higher than those in the control group(P<0.05).Spearman correlation showed that SCA and DSA were significantly negatively correlated with low back pain VSA,leg pain VAS,lower limb numbness VAS and ODI(P<0.05).LFA and LFT were significantly positively correlated with VAS of low back pain,VAS of leg pain,VAS of lower limb numbness,ODI and SWD(P<0.05).Multiple linear regression showed that there was no independent correlation between low back pain VAS,leg pain VAS and lower limb numbness VAS and SCA,DSA,LFA and LFT(P>0.05).The ODI was positively correlated with LFA and LFT(P<0.05),but not with DSA and SCA(P>0.05).The SWD was not correlated with LFA and LFT(P>0.05),but significantly correlated with DSA and SCA(P<0.05).Conclusion The LFA and LFT are significantly correlated with ODI.The greater the value of LFA and LFT,the higher the value of ODI.There is a significant linear correlation between DSA,SCA and SWD.The larger the value of DSA and SCA is associated with longer SWD.