CAJ | 학술논문

目的评价 CT计量诊断( CTQD)预测腰椎间盘突出症( lumbar disc herniation, LDH )病理形态及指导临床治疗的价值.方法将 1994- 01/2000- 01中南大学湘雅三医院收治并经手术确定了病理形态的 395例 LDH患者( 452个椎间盘, A组)的术前 CT图像特征分为 5个指标 14种表现,进行多因素判别分析,并以多变量判别分析时各变量的赋值为基础制订 CTQD表;将 A组的 CTQD结果与术中所见比较,计算其诊断的敏感性、特异性和准确性;将 2000- 02/2002- 02收治的 363例 LDH患者随机分为两组,分型治疗组( B组) 185例,进行 CTQD并按 CTQD结果实施分型治疗;未分型治疗组( C组) 178例,根据传统经验选择治疗方法.结果 CTQD的敏感性、特异性、准确性以及阳性预测值分别为 84.73% ,92.81% ,90.12%和 85.49%; B组非手术治疗的疗效优良率明显高于 C组(χ 2=5.009,P< 0.05), B组因非手术治疗无效改为手术治疗的比率明显低于 C组(χ 2=12.773,P< 0.001), B组的平均住院日数明显少于 C组( t=7.925,P< 0.001).结论 CTQD能比较准确地预测 LDH的病理形态,对选择治疗方案具有重要指导意义.
목적평개 CT계량진단( CTQD)예측요추간반돌출증( lumbar disc herniation, LDH )병리형태급지도림상치료적개치.방법장 1994- 01/2000- 01중남대학상아삼의원수치병경수술학정료병리형태적 395례 LDH환자( 452개추간반, A조)적술전 CT도상특정분위 5개지표 14충표현,진행다인소판별분석,병이다변량판별분석시각변량적부치위기출제정 CTQD표;장 A조적 CTQD결과여술중소견비교,계산기진단적민감성、특이성화준학성;장 2000- 02/2002- 02수치적 363례 LDH환자수궤분위량조,분형치료조( B조) 185례,진행 CTQD병안 CTQD결과실시분형치료;미분형치료조( C조) 178례,근거전통경험선택치료방법.결과 CTQD적민감성、특이성、준학성이급양성예측치분별위 84.73% ,92.81% ,90.12%화 85.49%; B조비수술치료적료효우량솔명현고우 C조(χ 2=5.009,P< 0.05), B조인비수술치료무효개위수술치료적비솔명현저우 C조(χ 2=12.773,P< 0.001), B조적평균주원일수명현소우 C조( t=7.925,P< 0.001).결론 CTQD능비교준학지예측 LDH적병리형태,대선택치료방안구유중요지도의의.
Aim To assess the practical value of CT quantitative diagnosis(CTQD) predicting pathological form of lumbar disc herniation(LDH). Methods The preoperative characteristics of CT images of 395 patients with LDH(452 lumbar discs,as the A group) and its pathological types having been defined by operation recruited from January 1994 to January 2000 in the Third Xiangya Hospital,Central South University were divided into 5 indexes and 14 manifestations and analyzed retrospectively,then the CTQD table was made on the basis of various variable endowing values when multivariate analysis.Moreover,the results of CTQD in the A group were compared with that seen during operation and the sensibility,specificity and accuracy was calculated respectively.In addition,363 patients with LDH recruited from February 2000 to February 2002 were divided randomly into two groups.Of them,185 cases (as the B group) were treated according to different types and results of CTQD;178 cases(as the C group) were treated according traditional experiences.Results The sensitivity,specificity,accuracy and positive predictive value of CTQD was 84.73% ,92.81% ,90.12% and 85.49% respectively.The excellent and good rate of non- operative treatment in the B group was significantly higher than that in the C group(χ 2=5.009,P< 0.05),The rate of non- operational ineffective treatment changing into operational treatment was significantly lower than that in the C group(χ 2=12.773,P< 0.001).The mean hospitalization time in the B group was significantly lower than that in the C group( t=7.925,P< 0.001) .Conclusion CTQD can accurately predict the pathological forms of LDH and has important instruction significance for choosing treatment schemes.