腰椎间盘突出症CT影像学特征与症状严重程度关系及临床应用价值探讨

Exploration of the relationship between CT imaging features and symptom severity of lumbar disc herniation and its clinical application value

目的 探讨腰椎间盘突出症患者CT影像学特征与症状严重程度关系及对治疗决策的指导价值,以期为临床早期评估病情、制定治疗方案提供参考。方法 选取2019-12-08-2022-12-08新乡医学院第三附属医院收治的196例腰椎间盘突出症患者为研究对象。入院后均行CT检查,采用日本骨科协会腰痛评分量表(mJOA)对患者症状严重程度进行评估,比较不同症状严重程度患者CT影像学特征,logistic回归方程分析CT影像学特征与腰椎间盘突出症病情关系,受试者工作特征(ROC)曲线分析CT影像学特征对病情预测价值。治疗2周后评估疗效,并比较不同疗效患者CT影像学特征。结果 不同症状严重程度患者髓核突出类型(χ^(2)=60.851,P<0.001)、突出形状(χ^(2)=12.285,P=0.002)、髓核密度值(χ^(2)=53.873,P<0.001)、髓核突出后与神经根关系(χ^(2)=40.866,P<0.001)、髓核突出后对硬膜囊压迫程度(χ^(2)=45.089,P<0.001)、额状位突出大小(χ^(2)=10.197,P=0.001)、水平面突出大小(χ^(2)=4.872,P=0.027)、脱出率(t=33.495,P<0.001)、后突角(t=10.321,P<0.001)比较,差异有统计学意义。髓核突出类型(OR=10.347,95%CI为5.428~19.723,P<0.001)、髓核突出与神经根关系(OR=8.907,95%CI为4.735~16.756,P<0.001)、髓核对硬膜囊压迫程度(OR=13.741,95%CI为7.283~25.924,P<0.001)、脱出率(OR=11.789,95%CI为6.154~22.583,P<0.001)、后突角(OR=7.509,95%CI为3.559~15.842,P<0.001)均与腰椎间盘突出病情相关。logistic回归模型对腰椎间盘突出患者病情预测曲线下面积(AUC)为0.921,当Log(P)≤3.69时,预测敏感度为85.61%,特异度为82.81%。不同疗效患者髓核突出类型(χ^(2)=14.615,P=0.024)、髓核突出后与神经根关系(χ^(2)=10.158,P=0.038)、髓核突出后对硬膜囊压迫程度(χ^(2)=10.949,P=0.027)、脱出率(t=785.478,P<0.001)、后突角(t=30.462,P<0.001)比较,差异有统计学意义。结论 CT影像学特征可用于临床早期评估腰椎间盘突出症状严重程度,为临床评估疗效、针对性制定干预方案提供依据。

Objective To explore the relationship between CT imaging features and symptom severity in patients with lumbar disc herniation and its guiding value for treatment decision-making,in order to provide a reference for early clinical evaluation of the condition and formulation of treatment plans.Methods Totally 196 patients with lumbar disc herniation admitted to the Third Affiliated Hospital of Xinxiang Medical College from December 8,2019 to December 8,2022 were selected.All patients underwent CT examination after admission,and the severity of their symptoms was evaluated using the Modify Japanese Orthopedic Association Low Back Pain Score(mJOA).We compared the CT imaging features of patients with different severity of symptoms,analyzed the relationship between CT imaging features and the condition of lumbar disc herniation using logistic regression equation,and analyzed the predictive value of CT imaging features on the condition using receiver operating characteristic(ROC)curve analysis.After 2 weeks of treatment,we evaluated the efficacy and compared the CT imaging features of patients with different therapeutic effects.Results The type of nucleus pulposus protrusion(x=60.851,P<0.001),shape of nucleus pulposus protrusion(χ^(2)=12.285,P=0.002),density value of nucleus pulposus(χ^(2)=53.873,P<0.001),relationship between nucleus pulposus protrusion and nerve roots(x=40.866,P<0.001),compression degree of dural sac after nucleus pulposus protrusion(χ^(2)=45.089,P<0.001),frontal position(x=10.197,P=0.001),protrusion size(χ^(2)=4.872,P=0.027)and exusion rate of horizontal plane(t=33.495,P<0.001)and posterior protrusion angle(t=10.321,P<0.001)were significantly different.The type of nucleus pulposus herniation(OR=10.347,95%CI:5.428-19.723,P<0.001),the relationship between nucleus pulposus herniation and nerve roots(OR=8.907,95%CI:4.735-16.756,P<0.001),the compression degree of dural sac(OR=13.741,95%CI:7.283-25.924,P<0.001),the prolapse rate(OR=11.789,95%CI:6.154-22.583,P<0.001),and the posterior protrusion angle(OR=7.509,95%CI:3.559-15.842,P<0.001)were all correlated with the disease of lumbar disc herniation.Logistic regression model predicted area under curve(AUC)of patients with lumbar disc herniation was 0.921.When Log(P)<3.69,the prediction sensitivity was 85.61%and the specificity was 82.81%.The type of nucleus pulposus protrusion(χ^(2)=14.615,P=0.024),the relationship between nucleus pulposus protrusion and nerve roots(χ^(2)=10.158,P=0.038),the compression degree of dural sac after nucleus pulposus protrusion(χ^(2)=10.949,P=0.027),the rate of protrusion(t=785.478,P<0.001)and posterior protrusion angle(t=30.462,P<0.001)were significantly different.Conclusion CT imaging features can be used to evaluate the severity of symptoms of lumbar disc herniation in early clinical stage,and provide a reference for clinical evaluation of curative effect and targeted formulation of interventionprograms.