摘要
目的调查腰4/5椎管狭窄症患者中黄韧带肥厚定量影像学指标与临床症状和预后的相关性。方法本研究为回顾性研究,选取2019年1月至2023年12月于天津市人民医院脊柱外科被诊断为单节段(L4/5)腰椎管狭窄的80例患者。根据患者跛行严重程度将患者分为两组:间歇性跛行距离>200 m为轻度组(37例),间歇性跛行距离≤200 m为重度组(43例)。采用视觉模拟评分法(visual analogue scale,VAS)量化腰痛和下肢痛,并在治疗后6个月评估Oswestry功能障碍指数(Oswestry disability index,ODI)、健康调查量表36(short-form 36 health survey,SF-36)得分和MacNab标准。使用MRI测量患者基线椎管横截面积、黄韧带面积、椎间盘突出面积、硬脊膜囊面积、脂肪面积和黄韧带厚度。对上述指标进行比较分析以评估影像学指标和临床效能之间的相关性。最后对接受手术的65例患者进行比较分析,30例行椎板减压和黄韧带切除术的患者为单纯减压组,35例行腰椎融合手术患者为融合组,比较两组患者之间的影像学差异以及与临床效果之间的关系。结果两组患者ODI和SF-36得分差异有统计学意义(P<0.05),其他基线数据均差异无统计学意义(P均>0.05)。两组患者黄韧带面积、黄韧带厚度、脂肪面积、硬脊膜囊面积差异有统计学意义(P<0.05),而椎管横截面积和椎间盘突出面积两组比较差异无统计学意义(P>0.05)。多因素logistic回归分析显示,黄韧带厚度(OR=1.81,95%CI:1.33~2.35)是导致跛行严重程度的影响因素。单纯减压组与融合组患者在临床结果方面腰痛和下肢痛VAS评分、ODI、SF-36评分和MacNab满意度差异无统计学意义(P>0.05)。结论对腰4/5椎管狭窄症的患者而言,黄韧带厚度可能是导致腰椎管狭窄跛行严重程度的主要因素。
Objective To investigate quantitative MRI imaging indicators of ligamentum flavum thickness at L4/5 in lumbar spinal stenosis in patients with LSS at L4/5 and explored the correlation between these indicators and clinical outcomes.Methods This study was a retrospective study.A total of 80 patients diagnosed with single-segment(L4/5)spinal stenosis were included.Patients were divided into two groups based on the severity of claudication:mild group(n=37)with an intermittent claudication distance>200 m,and severe group(n=43)with an intermittent claudication distance≤200 m.The visual analogue scale(VAS)was used to quantify low back pain and leg pain.The Oswestry disability index(ODI),SF-36 Short Form Health Survey scores,and MacNab criteria were assessed six months after treatment.MRI imaging was used to measure baseline cross-sectional area of the spinal canal,area of the ligamentum flavum,area of disc herniation,area of the dural sac,fat area,and thickness of the ligamentum flavum.Comparative analyses were conducted to assess the correlation between imaging indicators and clinical efficacy.Finally,a further comparative analysis was performed on 65 patients who underwent surgery:30 patients who underwent laminectomy and ligamentum flavum resection were classified as the decompression-only group,and 35 patients who underwent lumbar fusion surgery were classified as the fusion group.The imaging differences between the two groups and their relationship with clinical outcomes were compared.Results Except for statistically significant differences in ODI and SF-36 scores(P<0.05),there were no differences in baseline data between Groups A and B(P>0.05).There were statistically significant differences in baseline imaging indicators such as the area of the ligamentum flavum,thickness of the ligamentum flavum,fat area,and dural sac area between the two groups(P<0.05).However,there were no statistically significant differences in spinal canal area and disc herniation area between the two groups(P>0.05).Among various imaging factors,the thickness of the ligamentum flavum(OR=1.81,95%CI:1.33-2.35)was the only major factor influencing the severity of claudication in multivariate logistic regression analysis.There were no statistically significant differences in clinical outcomes between the decompression-only group and the fusion group regarding VAS scores for low back pain and lower limb pain,ODI,SF-36 scores,and MacNab satisfaction(P>0.05).Conclusions In patients with lumbar spinal stenosis at the L4/5 level,the thickness of the ligamentum flavum may be a primary factor contributing to the severity of claudication.
作者
江泽华
张洪杰
崔皓竣
任志帅
张伯裕
于浩
周蒙蒙
艾全
朱如森
Jiang Zehua;Zhang Hongjie;Cui Haojun;Ren Zhishuai;Zhang Boyu;Yu Hao;Zhou Mengmeng;Ai Quan;Zhu Rusen(Department of Spine Surgery,Tianjin Union Medical Center,the First Affiliated Hospital of Nankai University,Tianjin 300121,China;Department of Orthopedics,Dehong People′s Hospital,Kunming Medical University Affiliated Dehong Hospital,Mangshi 678400,Yunnan,China;Tianjin Medical University,Tianjin 300070,China;Department of Joint and Spine Surgery,Wuqing District People's Hospital,Tianjin 301700,China)
出处
《中国医学前沿杂志(电子版)》
北大核心
2026年第1期63-68,共6页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
天津市卫生健康委员会科技项目青年项目(TJWJ2022QN040,TJWJ2024QN045)
云南省英才兴边计划(2023RC006)。
关键词
腰椎管狭窄
间歇性跛行
黄韧带肥大
影像学
临床效能
Lumbar spinal stenosis
Intermittent claudication
Ligamentum flavum hypertrophy
Imaging
Clinical efficacy
