目的 探讨MRI测量结果在多节段腰椎管狭窄的责任节段判定中的权重,并以此建立责任节段判定的评分量表。方法 回顾性分析2015-12至2019-05北京电力医院骨二科及解放军总医院第三医学中心骨三科治疗的多节段腰椎管狭窄症患者资料,依据纳排标准共得到86例患者临床资料。所有患者均于术后1年时,依据改良Macnab评分评判腰椎功能恢复情况,评定结果为优和良者归为责任节段判定正确组,评定结果为可和差的患者归为判定错误组,比较两组临床与影像资料,得出与责任节段有关的危险因素,再以OR值为标准,按关联程度将各项危险因素分别赋分,建立责任节段判定表,采用ROC曲线确定评分表的最佳截断点。结果 纳入患者中男51例,女35例,多因素Logistic回归分析显示可以预测责任节段的危险因素包括马尾神经沉降征、L_4-5硬膜囊横截面积＜100 mm²、L₅-S₁硬膜囊横截面积＜100 mm²、L_4-5侧隐窝矢状径＜3 mm,OR值分别为18.79、11.82、13.80、16.72,按关联程度分别赋予4、4、4、4分,总分为16分。该评分表的AUC面积为0.903,其截断点为6分时对责任节段判定的敏感性和特异性分别为83.9%和83.3%。结论 基于MRI测量结果建立的责任节段判定表对多节段腰椎管狭窄症患者的责任节段判定效果良好,总得分6分以上的节段为责任节段的可能性大。

Objective To analyze the weight of MRI parameters in the determination of segments responsible for multisegmental lumbar spinal stenosis, and to establish a related score scale.Methods The clinical data on patients with multilevel lumbar spinal stenosis treated in the Second Department of Orthopaedics of Beijing Electric Power Hospital and in the Third Medical Center of the PLA General Hospital between December 2015 and May 2019 was retrospectively analyzed. A total of 86 patients were enrolled according to the admission criteria.One year after surgery, the lumbar functional recovery was evaluated according to the modified Macnab score. Patients with excellent and good results of evaluation were classified as the group of correct assessment of responsible segments, while those with fair and poor results were assigned to the group of incorrect assessment. The clinical and imaging data was compared between the two groups to obtain the risk factors for segments of responsibility. The OR value was used as the standard, and each risk factor was scored according to the degree of correlation. The judgment table of segments of responsibility was established, and the optimal cutoff point of the rating table was determined by using the ROC curve.Results The patients in our research included 51 males and 35 females. Multivariate logistic regression analysis showed that risk factors that could predict responsible segments included cauda equina syndrome, L_4-5 dural sac cross-sectional areas of less than 100 mm², L₅-S₁ dural sac cross-sectional areas of less than 100 mm² , a less-than-3mm sagittal diameter of the crypt on the L_4-5 side is, which were given 4,4,4 and 4 points respectively based on their OR value(18.79, 11.82, 13.80, 16.72).The total score was 16 points. The AUC area of the scoring table was 0.903, and the sensitivity and specificity for judgment of responsible segments were 83.9% and 83.3% respectively when the cutoff point was 6 points.Conclusions The judgment table for responsible segments established based on the results of nuclear magnetic measurement is effective in determining the segment responsible for multi-segment lumbar spinal stenosis. The segment with a total score of 6 points or above is likely to be the responsible segment.