目的:术后复发是经皮内镜腰椎间盘切除治疗腰椎间盘突出症的常见并发症,可显著增加再手术风险。性能良好的风险预测模型有助于早期识别高危人群,预防术后复发。此次研究系统评价经皮内镜腰椎间盘切除术后复发风险预测模型,为手术决策提...目的:术后复发是经皮内镜腰椎间盘切除治疗腰椎间盘突出症的常见并发症,可显著增加再手术风险。性能良好的风险预测模型有助于早期识别高危人群,预防术后复发。此次研究系统评价经皮内镜腰椎间盘切除术后复发风险预测模型,为手术决策提供借鉴。方法:检索PubMed、Embase、Web of Science、中国知网、万方、维普和生物医学文献数据库,搜集关于经皮内镜腰椎间盘切除后复发风险预测模型的相关研究,检索时限从各数据库建立至2024-07-01。由2名研究者独立筛选文献和提取资料,并采用偏倚风险评价工具和个体预后与诊断多变量预测模型报告规范(TRIPOD)清单分别对模型进行偏倚风险、适用性和报告质量评价。应用Revman 5.4软件对经皮内镜腰椎间盘切除术后复发率和相关预测因子进行Meta分析。结果:①共纳入15项研究,均为回顾性研究,包括24个经皮内镜腰椎间盘切除后复发风险预测模型;②偏倚风险评价工具评价结果显示,15项研究均为高偏倚风险;在适用性方面,2项研究为低适用性风险,13项研究为高适用性风险;③在TRIPOD报告质量方面,15项研究整体报告质量较低,主要原因包括未报告盲法、未说明样本量计算方法、缺乏对缺失数据处理方法的详细描述,同时也缺少对所使用模型的介绍等信息;④此外,纳入模型的受试者工作特征曲线下面积在0.684-0.972之间,潜在预测变量数量范围为15-28个;⑤Meta分析结果显示,通过经皮内镜腰椎间盘切除治疗的腰椎间盘突出症患者术后复发率为12%(95%CI=9.0%-15.0%),Modic改变(OR=6.72,95%CI=3.90-11.59)、体质量指数(OR=1.28,95%CI=1.10-1.49)、工作强度(OR=3.22,95%CI=1.85-5.59)、年龄(OR=2.28,95%CI=1.50-3.48)和吸烟史(OR=2.65,95%CI=1.75-4.00)是经皮内镜腰椎间盘切除术后复发的独立影响因素(均P<0.05)。结论:经皮内镜腰椎间盘切除术后复发风险预测模型整体预测性能较好,但模型总体偏倚风险和适用性风险较高,报告质量较低,且缺乏前瞻性研究和外部验证,未来风险预测模型的建立可重点关注Modic改变、体质量指数、工作强度、年龄和吸烟史等预测因子。展开更多
目的研究腰痛患者腰骶椎Modic改变(Modic changes,MCs)及其类型与骨质疏松的关系。方法选取2021年1月至2024年9月于南京中医药大学附属徐州市中医院就诊的女性腰痛患者204例为研究对象,根据磁共振成像结果将患者分为MCs组(139例)和无MCs...目的研究腰痛患者腰骶椎Modic改变(Modic changes,MCs)及其类型与骨质疏松的关系。方法选取2021年1月至2024年9月于南京中医药大学附属徐州市中医院就诊的女性腰痛患者204例为研究对象,根据磁共振成像结果将患者分为MCs组(139例)和无MCs组(65例),将MCs组按MCs分型分为Ⅰ型组(33例)、Ⅱ型组(90例)和Ⅲ型组(16例)。比较各组患者的年龄、髋部骨密度(bone mineral density,BMD)及其T值。结果MCs组和无MCs组患者的年龄、髋部BMD及相应T值比较差异均无统计学意义(P>0.05)。四组患者的髋部BMD及相应T值依次为Ⅲ型组>无MCs组>Ⅱ型组>Ⅰ型组。Ⅲ型组患者骨量多处于正常水平,其余三组患者多处于骨量减少或骨质疏松水平。Ⅱ型组与无MCs组患者的髋部BMD及相应T值比较差异均无统计学意义(P>0.05),Ⅲ型组患者的髋部BMD及相应T值均显著高于其余三组(P<0.05)。Ⅰ型组患者的髋部BMD及相应T值均显著低于其余三组(P<0.05)。结论腰痛患者不同的骨量水平有不同的MCs发病倾向:较高骨量(骨量正常)者多发生Ⅲ型MCs,骨量减少或骨质疏松者则易发Ⅰ型MCs,应重视Ⅰ型MCs患者的抗骨质疏松治疗。展开更多
Objective:To investigate the diagnostic value of magnetic resonance imaging(MRI)in patients with Modic changes and endplate sclerosis of the lumbar spine.Methods:A total of 66 patients with lumbar spine diseases who u...Objective:To investigate the diagnostic value of magnetic resonance imaging(MRI)in patients with Modic changes and endplate sclerosis of the lumbar spine.Methods:A total of 66 patients with lumbar spine diseases who underwent MRI and CT diagnostic examinations at the hospital from May 2024 to April 2025 were included in this study.The MRI findings of Modic changes were compared between Type I and Type II patients,and the presence or absence of endplate sclerosis signals and the HU value ratio on CT were analyzed.The pathological characteristics of Modic changes in Type I and Type II patients were observed.The imaging features of Modic changes in patients with lumbar spine diseases were analyzed.Results:Modic changes were present in 34 patients,with a total of 204 endplates evaluated,of which 74 were affected.MRI classification showed:Type I in 8 cases(10.81%),Type I/II mixed in 10 cases(13.51%),Type II in 51 cases(68.92%),and Type II/III mixed in 5 cases(6.76%).In CT reconstruction images,26 endplates with Modic changes on MRI showed sclerosis in the vertebral body,presenting high-density sclerotic features.These sclerotic areas did not exhibit distinct signal characteristics on MRI but pathologically demonstrated Type II Modic changes concurrently with fatty degeneration and sclerosis;In patients with Modic changes of Type I and Type II,regardless of the presence or absence of endplate sclerosis,the sagittal T1/T2 signal intensity ratio showed no statistically significant difference(P>0.05).However,the HU value ratio in Type II changes with sclerotic regions(2.74±0.61)was significantly higher than that in regions without sclerosis(1.16±0.23),with a statistically significant difference(P<0.05).Conclusion:CT reconstruction images of patients with lumbar Modic changes clearly demonstrate endplate sclerosis,a phenomenon closely associated with the bone marrow repair process.MRI has limited sensitivity for detecting sclerosis,potentially due to the following factors:first,differences in the radiographic characterization of endplate mineral content;second,the specific influence of different Modic types on signal intensity.This suggests that MRI classification should be combined with CT features for comprehensive interpretation.展开更多
文摘目的:术后复发是经皮内镜腰椎间盘切除治疗腰椎间盘突出症的常见并发症,可显著增加再手术风险。性能良好的风险预测模型有助于早期识别高危人群,预防术后复发。此次研究系统评价经皮内镜腰椎间盘切除术后复发风险预测模型,为手术决策提供借鉴。方法:检索PubMed、Embase、Web of Science、中国知网、万方、维普和生物医学文献数据库,搜集关于经皮内镜腰椎间盘切除后复发风险预测模型的相关研究,检索时限从各数据库建立至2024-07-01。由2名研究者独立筛选文献和提取资料,并采用偏倚风险评价工具和个体预后与诊断多变量预测模型报告规范(TRIPOD)清单分别对模型进行偏倚风险、适用性和报告质量评价。应用Revman 5.4软件对经皮内镜腰椎间盘切除术后复发率和相关预测因子进行Meta分析。结果:①共纳入15项研究,均为回顾性研究,包括24个经皮内镜腰椎间盘切除后复发风险预测模型;②偏倚风险评价工具评价结果显示,15项研究均为高偏倚风险;在适用性方面,2项研究为低适用性风险,13项研究为高适用性风险;③在TRIPOD报告质量方面,15项研究整体报告质量较低,主要原因包括未报告盲法、未说明样本量计算方法、缺乏对缺失数据处理方法的详细描述,同时也缺少对所使用模型的介绍等信息;④此外,纳入模型的受试者工作特征曲线下面积在0.684-0.972之间,潜在预测变量数量范围为15-28个;⑤Meta分析结果显示,通过经皮内镜腰椎间盘切除治疗的腰椎间盘突出症患者术后复发率为12%(95%CI=9.0%-15.0%),Modic改变(OR=6.72,95%CI=3.90-11.59)、体质量指数(OR=1.28,95%CI=1.10-1.49)、工作强度(OR=3.22,95%CI=1.85-5.59)、年龄(OR=2.28,95%CI=1.50-3.48)和吸烟史(OR=2.65,95%CI=1.75-4.00)是经皮内镜腰椎间盘切除术后复发的独立影响因素(均P<0.05)。结论:经皮内镜腰椎间盘切除术后复发风险预测模型整体预测性能较好,但模型总体偏倚风险和适用性风险较高,报告质量较低,且缺乏前瞻性研究和外部验证,未来风险预测模型的建立可重点关注Modic改变、体质量指数、工作强度、年龄和吸烟史等预测因子。
文摘目的研究腰痛患者腰骶椎Modic改变(Modic changes,MCs)及其类型与骨质疏松的关系。方法选取2021年1月至2024年9月于南京中医药大学附属徐州市中医院就诊的女性腰痛患者204例为研究对象,根据磁共振成像结果将患者分为MCs组(139例)和无MCs组(65例),将MCs组按MCs分型分为Ⅰ型组(33例)、Ⅱ型组(90例)和Ⅲ型组(16例)。比较各组患者的年龄、髋部骨密度(bone mineral density,BMD)及其T值。结果MCs组和无MCs组患者的年龄、髋部BMD及相应T值比较差异均无统计学意义(P>0.05)。四组患者的髋部BMD及相应T值依次为Ⅲ型组>无MCs组>Ⅱ型组>Ⅰ型组。Ⅲ型组患者骨量多处于正常水平,其余三组患者多处于骨量减少或骨质疏松水平。Ⅱ型组与无MCs组患者的髋部BMD及相应T值比较差异均无统计学意义(P>0.05),Ⅲ型组患者的髋部BMD及相应T值均显著高于其余三组(P<0.05)。Ⅰ型组患者的髋部BMD及相应T值均显著低于其余三组(P<0.05)。结论腰痛患者不同的骨量水平有不同的MCs发病倾向:较高骨量(骨量正常)者多发生Ⅲ型MCs,骨量减少或骨质疏松者则易发Ⅰ型MCs,应重视Ⅰ型MCs患者的抗骨质疏松治疗。
基金Key Laboratory of Spinal Degenerative Diseases,Xianyang City(Project No.:L2023-CXNL-CXPT-ZDSYS-010)Key Technology Innovation Team Project for Minimally Invasive Spinal Surgery,Xianyang City(Grant No.:L2022CXNLTD002)University-level Scientific Research Project,Shaanxi University of Traditional Chinese Medicine(Project No.:2020FS06).
文摘Objective:To investigate the diagnostic value of magnetic resonance imaging(MRI)in patients with Modic changes and endplate sclerosis of the lumbar spine.Methods:A total of 66 patients with lumbar spine diseases who underwent MRI and CT diagnostic examinations at the hospital from May 2024 to April 2025 were included in this study.The MRI findings of Modic changes were compared between Type I and Type II patients,and the presence or absence of endplate sclerosis signals and the HU value ratio on CT were analyzed.The pathological characteristics of Modic changes in Type I and Type II patients were observed.The imaging features of Modic changes in patients with lumbar spine diseases were analyzed.Results:Modic changes were present in 34 patients,with a total of 204 endplates evaluated,of which 74 were affected.MRI classification showed:Type I in 8 cases(10.81%),Type I/II mixed in 10 cases(13.51%),Type II in 51 cases(68.92%),and Type II/III mixed in 5 cases(6.76%).In CT reconstruction images,26 endplates with Modic changes on MRI showed sclerosis in the vertebral body,presenting high-density sclerotic features.These sclerotic areas did not exhibit distinct signal characteristics on MRI but pathologically demonstrated Type II Modic changes concurrently with fatty degeneration and sclerosis;In patients with Modic changes of Type I and Type II,regardless of the presence or absence of endplate sclerosis,the sagittal T1/T2 signal intensity ratio showed no statistically significant difference(P>0.05).However,the HU value ratio in Type II changes with sclerotic regions(2.74±0.61)was significantly higher than that in regions without sclerosis(1.16±0.23),with a statistically significant difference(P<0.05).Conclusion:CT reconstruction images of patients with lumbar Modic changes clearly demonstrate endplate sclerosis,a phenomenon closely associated with the bone marrow repair process.MRI has limited sensitivity for detecting sclerosis,potentially due to the following factors:first,differences in the radiographic characterization of endplate mineral content;second,the specific influence of different Modic types on signal intensity.This suggests that MRI classification should be combined with CT features for comprehensive interpretation.
