[1]代宏杰,李 凯,商 丽,等.腰椎管狭窄症CT分型在内镜减压术入路选择中的应用[J].介入放射学杂志,2025,34(09):977-982.[doi:10.3969/j.issn.1008-794X.2025.09.012]
 DAI Hongjie,LI Kai,SHANG Li,et al.Application of CT classification of lumbar spinal stenosis in the selection of endoscopic decompression surgery approach[J].J Intervent Med,2025,34(09):977-982.[doi:10.3969/j.issn.1008-794X.2025.09.012]
点击复制

腰椎管狭窄症CT分型在内镜减压术入路选择中的应用()

PDF下载中关闭

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
34
期数:
2025年09
页码:
977-982
栏目:
临床研究
出版日期:
2025-09-25

文章信息/Info

Title:
Application of CT classification of lumbar spinal stenosis in the selection of endoscopic decompression surgery approach
文章编号:
1008-794X(2025)-009-0977-06
作者:
代宏杰 李 凯 商 丽 马永阳 崔胜杰
053000 河北衡水 衡水市人民医院(哈励逊国际和平医院)脊柱微创科
Author(s):
DAI HongjieLI KaiSHANG LiMA YongyangCUI Shengjie.
Department of Minimally Invasive Spinal Surgery,Hengshui Municipal People's Hospital(Halison International Peace Hospital),Hengshui,Hebei Province 053000,China
关键词:
腰椎管狭窄症 CT分型 经皮内镜下减压手术 诊断价值 指导价值
分类号:
R681.3
DOI:
10.3969/j.issn.1008-794X.2025.09.012
文献标志码:
B
摘要:
目的 探讨CT在腰椎管狭窄症(LSS)分型诊断及经皮内镜下减压手术入路选择中的应用价值。方法 回顾性选取2018年3月至2024年12月河北衡水市人民医院(哈励逊国际和平医院)300例LSS患者,均行经皮内镜下减压手术治疗,术前均已完善CT检查,收集临床病例资料及CT影像学资料。以内镜分型为金标准,采用Kappa一致性分析CT诊断分型结果与内镜分型的一致性。并观察不同经皮内镜下减压手术入路选择的手术效果。结果 CT诊断Ⅰ型87例,其中3例Ⅲ型误诊Ⅰ型; 诊断Ⅱ型141诊; 诊断Ⅲ型72例,总符合率为97.67%。以内镜分型为金标准,CT诊断Ⅰ型、Ⅱ型、Ⅲ型Kappa值分别为0.975、1.000、0.973。300例患者均顺利根据CT分型选择不同的手术入路完成手术,且临床症状均有明显缓解,无明显并发症发生; 术后不同分型患者Oswestry功能障碍指数、腿/下腰部视觉疼痛评分均呈下降趋势(P<0.05)。术后患者总非甾体药物使用率显著低于术前(P<0.05)。结论 CT在LSS分型诊断中与内镜分型一致性较高,对经皮内镜下减压手术入路的选择具有较好的指导价值。

参考文献/References:

[1] Webb CW,Aguirre K,Seidenberg PH.Lumbar spinal stenosis:diagnosis and management[J].Am Fam Physician,2024,109:350-359.
[2]Haleem S,Malik M,Guduri V,et al.The Haleem-Botchu classification:a novel CT-based classification for lumbar foraminal stenosis[J].Eur Spine J,2021,30:865-869.
[3]Weisenthal BW,Glassman SD,Mkorombindo T,et al.When does CT myelography add value beyond MRI for lumbar degenerative disease[J]Spine J,2022,22:787-792.
[4]田 洋,唐 超,廖烨晖,等.CT和MRI在腰椎管狭窄症中测量椎管面积的一致性和可重复性[J].中国组织工程研究,2021,25:3882-3887.
Tian Y,Tang C,Liao YH,et al.Consistency and repeatability of CT and MRI in measurement of spinal canal area in patients with lumbar spinal stenosis[J].J Clin Rehabil Tis Eng Res,2021,25:3882-3887.
[5]鹿梦岩,冯国洋,郭龙军,等.CT检查参数对腰椎管狭窄症的诊断价值及与疗效、腰椎功能改善的相关性分析[J].影像科学与光化学,2021,39:251-256.
Lu MY,Feng GY,Guo LJ,et al.The diagnostic value of CT examination parameters in lumbar spinal stenosis and the correlation analysis with curative effect and improvement of lumbar function[J].Imaging Science and Photochemistry,2021,39:251-256.
[6]Zhao XB,Ma HJ,Geng B,et al.Percutaneous endoscopic unilateral laminotomy and bilateral decompression for lumbar spinal stenosis[J].Orthop Surg,2021,13:641-650.
[7]Zhai S,Zhao W,Zhu B,et al.The effectiveness of percutaneous endoscopic decompression compared with open decompression and fusion for lumbar spinal stenosis:protocol for a multicenter,prospective,cohort study[J].BMC Musculoskelet Disord,2022,23:502.
[8]Pei XW,Liang YH,Zhang H,et al.Evaluations of computed tomography images and lumbar specimens in mimic operations of transverse rotation laminoplasty for lumbar spinal stenosis[J].Chin Med J(Engl),2015,128:191-196.
[9]Park CH,Lee SH.Correlation between severity of lumbar spinal stenosis and lumbar epidural steroid injection[J].Pain Med,2014,15:556-561.
[10]勾志刚,李新宇,张宏波,等.CT对腰椎管狭窄的诊断及对手术入路选择的临床意义[J].中国CT和MRI杂志,2020,18:148-150.
Gou ZG,Li XY,Zhang HB,et al.CT in the diagnosis of lumbar spinal stenosis and its clinical significance on the choice of surgical approach[J].Chinese Journal of CT and MRI,2020,18:148-150.
[11]程继伟,王振林,刘 伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27:235-241.
Cheng JW,Wang ZL,Liu W,et al.Improvement of Oswestry disability index and its test of reliability and validity[J].Chin J Spine Spinal Cord,2017,27:235-241.
[12]Chiarotto A,Maxwell LJ,Ostelo RW,et al.Measurement properties of visual analogue scale,numeric rating scale,and pain severity subscale of the brief pain inventory in patients with low back pain:a systematic review[J].J Pain,2019,20:245-263.
[13]徐小青,穆玉娟,刘向东,等.CT引导下硬膜外前外侧间隙注射富血小板血浆与复方倍他米松治疗腰神经根性疼痛[J].介入放射学杂志,2023,32:996-1000.
Xu XQ,Mu YJ,Liu XD,et al.CT-guided epidural anterolateral space injection of platelet-rich plasma and compound betamethasone for lumbar radicular pain[J].J Interv Radiol,2023,32:996-1000.
[14]郭家全,常德勇,胡清勇,等.CT分型在腰椎管狭窄症患者内镜下减压手术的指导作用[J].河北医科大学学报,2022,43:44-48.
Guo JQ,Chang DY,Hu QY,et al.Guiding role of CT classification in endoscopic decompression surgery for patients with lumbar spinal stenosis[J].J Beijing Med Univ,2022,43:44-48.
[15]刘金玉,丁 宇,蒋 强,等.全内镜下腰椎板开窗减压有限元模拟建模及生物力学变化[J].中国组织工程研究,2020,24:4291-4296.
Liu JY,Ding Y,Jiang Q,et al.A finite element model of full endoscope lumbar fenestration and biomechanical characteristic[J].J Clin Rehabil Tis Eng Res,2020,24:4291-4296.
[16]Zheng C,Liao Z,Chen HZ.Percutaneous endoscopic posterior decompression for therapy of spinal cord compression due to ossification of the ligamentum flavum:a long-term follow-up[J].World Neurosurg,2021,156:e249-e253.
[17]Li L,Hai Y,Yang J,et al.Correlation between preoperative CT imaging parameters and clinical outcome of lumbar spinal stenosis treated with endoscopic transforaminal decompression[J].J Int Med Res,2020,48:300060519894078.
[18]杨 进,王 玉,孔清泉.腰椎侧方椎管狭窄分型在全内镜减压治疗老年退变性腰椎管狭窄症的应用[J].中国修复重建外科杂志,2020,34:415-421.
Yang J,Wang Y,Kong QQ.The application of classification of lateral region of lumbar spinal canal for treatment of lumbar spinal stenosis in geriatric patients using full endoscopic transforaminal decompression surgery[J].Chin J Repar Reconstruct Surg,2020,34:415-421.
[19]戎飞龙,尹若峰,冯蒙蒙,等.退变性腰椎滑脱症和腰椎管狭窄症与椎体周围肌容量的相关性:CT和MRI影像资料分析[J].中国组织工程研究,2019,23:3840-3845.
Rong FL,Yin RF,Feng MM,et al.Correlation between degenerative lumbar spondylolisthesis and spinal stenosis and muscle volume around the vertebral body:CT and MRI data analysis[J].J Clin Rehabil Tis Eng Res,2019,23:3840-3845.
[20]孙海涛,韩大鹏,张洪涛,等.CT定位内镜减压术治疗腰椎管狭窄症[J].中国矫形外科杂志,2021,29:1175-1179.
Sun HT,Han DP,Zhang HT,et al.CT guided endoscopic spinal canal decompression for treatment of lumbar spinal stenosis[J].Orthop J China,2021,29:1175-1179.
(收稿日期:2025-03-20)

备注/Memo

备注/Memo:
基金项目: 衡水市科技计划项目(2021014075Z)
通信作者: 崔胜杰 E-mail:dagangmaoa@163.com
更新日期/Last Update: 2025-09-25