腰椎间盘突出症MSU分类与神经功能障碍的关系

Relationship between Michigan State University(MSU)classification and neurological dysfunction of patients with lumbar disc herniation

目的探讨腰椎间盘突出症(LDH)病人MSU分类与神经功能障碍的相关性。方法回顾性分析2015年1月至2021年4月收治的690例LDH的临床资料。根据术前MRI T2像矢状位及轴位进行MSU分类,神经功能指标包括直腿抬高试验阳性率、双下肢感觉障碍、双下肢肌力分级、视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。结果690例中,MSU分类1、2、3级分别有111、468、111例,A、B、C、AB区分别有121、301、51、217例。MSU分类与直腿抬高试验阳性率、双下肢感觉障碍、双下肢肌力分级、VAS评分、ODI有关(P<0.05)。与MSU分类1级病人相比,2级、3级病人直腿抬高试验阳性率明显增高(P<0.001)。与MSU分类A区病人相比,B区病人、C区病人及AB区病人双下肢感觉障碍、肌力障碍发生率均明显增高(P<0.001)。与MSU分类1级和2级病人相比,3级病人VAS评分≥5分比例、ODI评分≥41%比例均明显增高(P<0.001)。结论MSU分类有助于判断腰椎间盘突出的大小及位置,决定手术时机的选择及预测病人的预后。MSU分类显示腰椎间盘突出大小达到椎弓根及椎弓根尾侧层面位置病人,直腿抬高试验阳性率高,术后遗留神经功能障碍的可能性也越大;腰椎间盘突出位置越靠近椎间孔区域、椎间孔外或远侧区域,症状更重,保守治疗效果效果差,应及时选择手术治疗。

Objective To investigate the correlation between Michigan State University(MSU)classification and neurological dysfunction of patients with lumbar disc herniation(LDH).Methods The clinical data of 690 patients with LDH who were admitted to our hospital from January 2015 to April 2021 were retrospectively analyzed.MSU classification was performed according to sagittal and axial MRI T2 images on admision.Neurological function indicators included positive rate of Lasegue test,lower limb sensory impairment,MRC grade of muscle strength of both lower limbs,visual analog scale(VAS)score,and Oswestry disability index(ODI).Results Of 690 patients with LDH,111,468,and 111 patients were classified as MSU class 1,2,3,respectively;121,301,51,and 217 patients were classified as MSU region A,B,C,AB,respectively.MSU classification was related to positive rate of Lasegue test,lower limb sensory impairment,muscle strength of both lower limbs,VAS score and ODI of patients with LDH(P<0.05).The positive rates of Lasegue test of patients with MSU classes 2 and 3 were significantly higher than that of patients with MSU class 1(P<0.001).Compared with patients with MSU region A,patients with MSU regions B,C and AB had significantly higher incidence of lower limb sensory and muscle strength disorders(P<0.001).Compared with patient with MSU classes 1 and 2,the proportions of VAS score≥5 and ODI score≥41%were significantly higher in patients with MSU class 3(P<0.001).Conclusions MSU classification helps to determine the size and location of herniated discs,determine the timing of operation and predict the prognosis of patients with LDH.According to the MSU classification,patients whose herniated discs reach the pedicle and caudal level of the pedicle have a higher positive rate of Lasegue test and a greater likelihood of postoperative neurological deficits;patients whose herniated discs are closer to the foraminal region,extraforaminal or distal region have more severe symptoms and surgical treatment should be selected in time because the outcomes of conservative treatment are poor.