基于CT影像学特征评估高龄腰椎间盘突出症病情程度及预后转归价值

Evaluation of the Severity and Prognosis of Lumbar Disc Herniation in the Elderly Based on CT Imaging Characteristics

目的:探讨基于CT影像学特征评估高龄腰椎间盘突出症病情程度及预后转归价值。方法:选取2018年1月~2022年6月收治的95例高龄腰椎间盘突出症患者作为研究对象,各患者均接受CT影像学检查,并用日本骨科协会(JOA)评分判定患者病情程度,按照评分结果将患者分为轻度组、中度组、重度组,对比分析各组患者CT影像学检查特征。结果:轻度组髓核突出型髓核突出率达59.38%、髓核突出形状弧形边缘光滑率81.25%、髓核密度值≤80达84.38%、神经根和突出髓核的关系紧贴神经根率81.25%、硬膜囊的受压程度脂肪间隙缩小78.13%高于中度组(14.71%、14.71%、20.59%、17.65%、23.53%)、重度组(3.57%、17.24%、20.69%、17.24%、17.24%),差异有统计学意义(P<0.05);轻度组硬膜囊前后径低于中度组、重度组,硬膜囊矢状径高于中度组、重度组,中度组硬膜囊前后径低于重度组,硬膜囊矢状径高于重度组(P<0.05)。结论:临床可通过CT影像学特征评估高龄腰椎间盘突出症患者病情程度和疾病预后状况,部分CT测量指标和疾病症状、JOA评分有密切关系,所以,临床采用CT影像学进行判定的作用明显。但因CT影像学表现与高龄腰椎间盘突出症表现存在一定差异,临床在实际评估判定时,勿完全依赖于CT检查结果,需综合考虑患者病程、病史、疾病症状表现、影像学检查、体格检查等,进而确保临床诊疗准确性。

Objective:To evaluate the severity and prognosis of lumbar disc herniation in the elderly based on CT imaging characteristics.Methods:95 elderly patients with lumbar disc herniation admitted from January 2018 to June 2022 were selected as the study subjects.All patients received CT imaging examination,and the severity of each patient’s condition was determined by the Japanese Orthopedic Association(JOA)score.The patients were divided into mild group,moderate group and severe group according to the score results,and the CT imaging examination characteristics of each group were compared and analyzed.Results:The rate of nucleus pulposus protrusion in the mild group was 59.38%,the smooth rate of the curved edge of the nucleus pulposus protrusion shape was 81.25%,the density of nucleus pulposus≤80 was 84.38%,the rate of the relationship between the nerve root and the nucleus pulposus protrusion close to the nerve root was 81.25%,the compression degree of the dural sac was 78.13%smaller than that in the moderate group(14.71%,14.71%,20.59%,17.65%,23.53%),and the severe group(3.57%,17.24%,20.69%,17.24%,17.24%),the difference was statistically significant(P<0.05);The anterior and posterior diameter of dural sac in mild group was lower than that in moderate group and severe group,the sagittal diameter of dural sac was higher than that in moderate group and severe group,the anterior and posterior diameter of dural sac in moderate group was lower than that in severe group,and the sagittal diameter of dural sac was higher than that in severe group(P<0.05).Conclusion:The disease severity and prognosis of elderly patients with lumbar disc herniation can be evaluated clinically through CT imaging characteristics.Some CT measurement indicators are closely related to disease symptoms and JOA scores.Therefore,CT imaging plays an important role in clinical judgment.However,due to the differences between CT imaging and the manifestations of lumbar disc herniation in the elderly,the clinical evaluation and judgment should not rely entirely on the CT examination results,but should comprehensively consider the patient’s course of disease,history,disease symptoms,imaging examination,physical examination,etc.,so as to ensure the accuracy of clinical diagnosis and treatment.