发育性腰椎管狭窄症患者的影像参数特征及风险因素分析

Imaging characteristics and risk factors of patients with lumbar developmental spinal stenosis

目的:探索DSS患者的影像学参数特征并对其风险因素进行分析,有助于充分了解DSS的疾病特征。方法:该研究共对439例受试者行腰椎磁共振检查,并对其MRI图像上各参数进行测量。首先在腰椎MRI横断位上对各节段椎管前后径进行测量,并根据DSS定义将所有受试者分为DSS组和非DSS组。对两组研究对象的年龄、性别、BMI及其余影像学参数包括椎体大小、椎弓根间距、椎弓根宽度、硬膜囊正中间距、椎板角、关节突关节角以及椎间盘退变评分等一系列参数进行比较分析。结果:DSS组MRI横断位上椎管前后径、横断位椎体宽度、椎弓根间距、硬膜囊前后径、椎板角、关节突关节角、矢状位椎体前后径、椎间盘Pfirrmann退变分级、椎间盘突出分级及下肢放射痛与非DSS组相比差异具有显著性。进一步通过logistic回归分析发现,仅有椎板角大小及硬膜囊前后径是DSS发生的风险因素。结论:椎板角、硬膜囊前后径可能是导致DSS发生的重要原因,其中椎板角的影响因素显著高于后者;其他一些骨性参数与DSS的发生无明显相关性。此外,研究还发现椎间盘及软骨终板的退行性改变与DSS的发生无明显相关性,这也提示DSS可能是腰椎骨性结构发育异常的结果。

Objective:The aim of this research was to explore the characteristics in spinal imaging of lumbar developmental spinal stenosis(DSS)and its risk factors.Methods:In this study,a total of 439 subjects underwent lumbar magnetic resonance examination,and the parameters of their MRI images were measured.Firstly,anteroposterior vertebral canal diameters were used to differentiate those with DSS from controls.Then,the age,gender,BMI and other imaging parameters,including sagittal vertebral diameter,sagittal vertebral height,anteroposterior vertebral diameter,mid-vertebral width,interpedicular distance,pedicle width,dural sac diameter,laminar angle,were compared and analyzed.Results:Compared with the control group,DSS group had significant differences in anteroposterior vertebral diameter,mid-vertebral width,interpedicular distance,dural sac diameter,laminar Angle,facet joint angle,sagittal vertebral diameter,Pfirrmann degeneration grade,Disc herniation classification and radicular leg pain.Further logistic regression analysis showed that only laminar angle and dural sac diameter were risk factors for DSS.Conclusion:Laminar angle and dural sac diameter may be risk factors for DSS,and the influence factor of Laminar angle is significantly higher than that of the latter.Other skeletal parameters are spared.This study also found no significant correlation between the degenerative changes of intervertebral disc and DSS,which indicating that DSS may be the result of bony maldevelopment.