腰椎间盘突出症患者严重程度与CT影像学特征的相关性分析

目的 探讨腰椎间盘突出症患者临床表现严重程度与CT影像学的相关性。 方法 选取2014年7月-2018年7月浙江衢化医院脊柱外科收治的167例腰椎间盘突出症患者,按照下腰痛评估量表的判定结果将其分为轻度(58例)、中度(64例)和重度(45例)。分析其严重程度与CT影像学指标的相关性,以及与硬膜囊前后径、矢状径的相关性,用Pearson相关性分析日本骨科协会制定的改良后下腰痛评分(modified Japanese orthopaedic association score,mJOA)与硬膜囊前后径、矢状径相关系数。 结果 腰椎间盘突出症轻、中、重度患者在髓核经骨突出情况、髓核突出后的病理类型、髓核密度值、髓核经额状面的突出程度、髓核经水平面的突出程度、髓核突出后与神经根的关系、髓核突出后对硬膜囊的压迫程度的差异具有统计学意义(P<0.05);轻、中、重度患者中,硬膜囊前后径依次增大(均P<0.05),矢状径依次减小(均P<0.05); mJOA评分与硬膜囊前后径呈正相关(r=0.584,P=0.017),与硬膜囊矢状径呈负相关(r=-0.603,P=0.025)。 结论 对于绝大多数腰椎间盘突出症患者,其临床表现的严重程度与部分CT影像学指标具有相关性。 

Analysis of the correlation between severity of clinical symptoms and CT imaging features in patients with lumbar disc herniation

Objective To investigate the correlation between the severity of clinical symptoms and CT imaging features in patients with lumbar disc herniation. Methods Total 167 patients with lumbar disc herniation admitted to our hospital were selected as subjects, who were divided into mild (58 cases), moderate (64 cases) and severe (45 cases) according to the judgment results of the low back pain assessment scale. The correlation between severity of clinical symptoms and CT imaging features were analyzed. The correlation between the severity of clinical manifestations and the anteroposterior diameter and sagittal diameter of the dural sac was analyzed, and the correlation between the modified Japanese orthopaedic association score (mJOA) and the anterior and posterior diameter of the dural sac was analyzed by Pearson correlation analysis. Results There were significant differences in CT imaging features between patients with mild, moderate and severe lumbar disc herniation, such as pathological type of nucleus pulposus, nucleus pulposus shape, nucleus pulp density value, the degree of protrusion of the nucleus pulposu through the frontal plane, the degree of nucleus pulposus through the horizontal plane, the relationship between the nucleus pulposus and the nerve root, and the degree of compression of the dural sac after the nucleus pulposus (P<0.05). In the patients with mild, moderate and severe, the anteroposterior diameter of the dural sac increased sequentially (P<0.05), and the sagittal diameter decreased in turn (P<0.05). The correlation analysis of Pearson showed that the mJOA score was positively correlated with the anteroposterior diameter of the dural sac (r=0.584, P=0.017), and negatively correlated with the sagittal diameter of the dural sac (r=-0.603, P=0.025). Conclusion For most patients with lumbar disc herniation, the severity of clinical symptoms is correlated with some CT imaging features.