腰椎退变性疾病的临床分型研究及治疗策略分析
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上海市卫生健康委员会卫生行业临床研究专项面上项目(202340128),打仗型医院军事医学专项(2024DZXYY-105).


Clinical typing and treatment strategies of lumbar degenerative diseases
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Supported by General Project of Clinical Research Project of Health Industry of Shanghai Municipal Health Commission (202340128) and Military Medicine Project for Combat-Ready Hospitals (2024DZXYY-105).

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    摘要:

    目的 提出一种腰椎退变性疾病(LDD)的临床分型及各分型的诊断标准和相应的外科治疗策略。方法 选择2017年6月至2022年5月海军军医大学第二附属医院骨科收治的LDD患者共245例,按照提出的临床分型诊断标准将患者分为神经根型(42例)、椎间盘突出型(73例)、椎管狭窄型(61例)、滑脱型(29例)和局部型(40例)。比较各分型LDD的治疗效果,应用一致性检验评估分型方法的可靠性。结果 手术治疗205例,非手术治疗40例。手术方法主要为改良经椎间孔入路腰椎椎体间融合术。患者随访时间为(20.37±6.13)个月。按照Nakai标淮,临床疗效为优146例(59.59%)、良89例(36.33%)、可8例(3.27%)、差2例(0.82%),优良率为95.92%。各分型LDD的疗效比较差异无统计学意义(P>0.05)。临床一致性评价结果证实该分型方法在观察者内、观察者间均具有良好的一致性。结论 该临床分型有助于深化对LDD发病机制的认识,提高诊断的准确率,优化治疗方案。

    Abstract:

    Objective To propose a clinical typing method for lumbar degenerative disease (LDD), including the diagnostic criteria for each type and the corresponding surgical treatment strategies. Methods A total of 245 LDD patients who were admitted to Department of Orthopaedics, The Second Affiliated Hospital of Naval Medical University from Jun. 2017 to May 2022 were enrolled and assigned to nerve root type (42 cases), disc herniation type (73 cases), spinal stenosis type (61 cases), spondylolisthesis type (29 cases), and local type (40 cases) according to our diagnostic criteria of clinical typing. Treatment outcomes of various groups were compared and the reliability of the typing method was assessed using consistency test. Results A total of 205 cases received surgical treatment and 40 cases received non-surgical treatment. The surgical approach was modified transforaminal lumbar interbody fusion. The patients were followed up for (20.37±6.13) months. According to Nakai’s evaluation criteria, the clinical effect was excellent in 146 (59.59%) cases, good in 89 (36.33%) cases, fair in 8 (3.27%) cases, and poor in 2 (0.82%) cases, with an excellent and good rate of 95.92%. There were no significant differences in the treatment effects among different types of LDD (P>0.05). The results of clinical consistency evaluation confirmed that the typing method had good consistency both within observers and between observers. Conclusion This clinical typing method can help to further understand the pathogenesis of LDD, improve the accuracy of diagnosis and optimize the treatment plan.

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  • 收稿日期:2024-06-08
  • 最后修改日期:2024-09-25
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  • 在线发布日期: 2025-06-21
  • 出版日期: 2025-06-20
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