采用腰椎椎弓根厚度预测腰椎管狭窄症的最佳临界值分析

Analysis on optimal cut-off values for prediction of lumbar spinal stenosis using lumbar pedicle thickness

目的:探讨采用腰椎椎弓根厚度(LPT)预测腰椎管狭窄症(LSSS)的最佳临界值。方法:回顾性分析滨州市中心医院2019年11月至2021年4月收治的LSSS患者64例的临床资料,并采集同时间段常规体检中包括腰椎MRI的健康志愿者48例,分别于L_(5)椎体轴向MRI的T_(2)加权上测量LPT,采用独立样本t检验比较两组之间的LPT,采用单因素方差分析LPT与年龄变化之间的关系,采用受试者工作特征曲线(ROC曲线)、最佳临界值及敏感性和特异性、曲线下面积(AUC)评估LPT诊断LSSS的有效性。结果:两组研究对象LPT与年龄变化之间差异无统计学意义(P>0.05)。LSSS患者的LPT[(13.25±1.73)mm]明显高于对照组[(8.54±1.88)mm](t=13.75,P<0.05)。ROC曲线分析结果显示,10.50 mm处为最佳临界值,敏感性为95.3%,特异性为85.4%,AUC为0.963(95%CI 0.928~0.998)。结论:LPT的增加与LSSS发病率的增加有关,LPT是预测LSSS准确、客观、清晰的形态学参数,其应用具有创新性及科学性。

Objective:To investigate the optimal cut-off values for the prediction of lumbar spinal stenosis using lumbar pedicle thickness.Methods:The clinical data of 64 patients with lumbar spinal stenosis(patient group)admitted to Binzhou Center Hospital from November 2019 to April 2021 and 48 healthy volunteers(healthy control group)who concurrently received routine physical examination involving lumbar spine MRI examination in the same hospital were retrospectively analyzed.Lumbar pedicle thickness was measured on T_(2) weighted images of the L_(5) vertebral body in the axial projection.Lumbar pedicle thickness was compared between groups using the independent sample t-test.The relationship between lumbar pedicle thickness and age change was analyzed using a one-way analysis of variance.The efficacy of lumbar pedicle thickness in the diagnosis of lumbar spinal stenosis was evaluated using the receiver operating characteristic(ROC)curve,optimal cut-off values,sensitivity,specificity,and the area under the ROC curve.Results:There was no significant correlation between lumbar pedicle thickness and age change(P>0.05).Lumbar pedicle thickness of patients with lumbar spinal stenosis was significantly higher than that of healthy controls[(13.25±1.73)mm vs.(8.54±1.88)mm,t=13.75,P<0.05].ROC curve results showed that the optimal cut-off value was 10.50 mm,with a sensitivity of 95.3%and a specificity of 85.4.The area under the ROC curve was 0.963(95%CI 0.928-0.998).Conclusion:The increase in lumbar pedicle thickness is related to the increase in the incidence of lumbar spinal stenosis.Lumbar pedicle thickness is an accurate,objective,and clear morphological parameter for the prediction of lumbar spinal stenosis.Application of lumbar pedicle thickness to predict lumbar spinal stenosis is innovative and scientific.