腰椎间盘突出症CT计量诊断的前瞻性研究(英文)

The prospective study of CT images quantitative diagnosis of lumbar disc herniation

目的评价CT计量诊断(CTQD)预测腰椎间盘突出症(lumbardischerniation,LDH)病理形态及指导临床治疗的价值。方法将1994-01/2000-01中南大学湘雅三医院收治并经手术确定了病理形态的395例LDH患者(452个椎间盘,A组)的术前CT图像特征分为5个指标14种表现,进行多因素判别分析,并以多变量判别分析时各变量的赋值为基础制订CTQD表;将A组的CTQD结果与术中所见比较,计算其诊断的敏感性、特异性和准确性;将2000-02/2002-02收治的363例LDH患者随机分为两组,分型治疗组(B组)185例,进行CTQD并按CTQD结果实施分型治疗;未分型治疗组(C组)178例,根据传统经验选择治疗方法。结果CTQD的敏感性、特异性、准确性以及阳性预测值分别为84.73%,92.81%,90.12%和85.49%;B组非手术治疗的疗效优良率明显高于C组(χ2=5.009,P<0.05),B组因非手术治疗无效改为手术治疗的比率明显低于C组(χ2=12.773,P<0.001),B组的平均住院日数明显少于C组(t=7.925,P<0.001)。结论CTQD能比较准确地预测LDH的病理形态,对选择治疗方案具有重要指导意义。

Aim To assess the practical value of CT quantitative diagnosis(CTQD) predicting pathological form of lumbar disc herniation(LDH). Methods The preoperative characteristics of CT images of 395 patients with LDH(452 lumbar discs,as the A group) and its pathological types having been defined by operation recruited from January 1994 to January 2000 in the Third Xiangya Hospital,Central South University were divided into 5 indexes and 14 manifestations and analyzed retrospectively,then the CTQD table was made on the basis of various variable endowing values when multivariate analysis.Moreover,the results of CTQD in the A group were compared with that seen during operation and the sensibility,specificity and accuracy was calculated respectively.In addition,363 patients with LDH recruited from February 2000 to February 2002 were divided randomly into two groups.Of them,185 cases (as the B group) were treated according to different types and results of CTQD;178 cases(as the C group) were treated according traditional experiences.Results The sensitivity,specificity,accuracy and positive predictive value of CTQD was 84.73% ,92.81% ,90.12% and 85.49% respectively.The excellent and good rate of non operative treatment in the B group was significantly higher than that in the C group( χ 2=5.009,P< 0.05),The rate of non operational ineffective treatment changing into operational treatment was significantly lower than that in the C group( χ 2=12.773,P< 0.001).The mean hospitalization time in the B group was significantly lower than that in the C group( t=7.925,P< 0.001) .Conclusion CTQD can accurately predict the pathological forms of LDH and has important instruction significance for choosing treatment schemes.<P>