中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (9): 2262-2268.doi: 10.12307/2026.502

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

神经根沉降征影响腰椎管狭窄症经皮内镜减压效果的MRI评价

王  楠，陈  双，席志鹏，钱宇章，张啸宇，顾  军，康  然，谢  林   

  1. 南京中医药大学附属中西医结合医院，江苏省中西医结合医院，江苏省中医药研究院，江苏省南京市  210000
  • 收稿日期:2024-09-19 接受日期:2024-12-14 出版日期:2026-03-28 发布日期:2025-09-06
  • 通讯作者: 谢林，博士，主任中医师，研究员，博士生导师，南京中医药大学附属中西医结合医院，江苏省中西医结合医院，江苏省中医药研究院，江苏省南京市 210000
  • 作者简介:王楠，男，1993年生，博士，中医师，主要从事脊柱退行性变中西医结合防治方面的研究。

MRI evaluation of nerve root subsidence sign affecting efficacy of percutaneous endoscopic decompression in lumbar spinal stenosis

Wang Nan, Chen Shuang, Xi Zhipeng, Qian Yuzhang, Zhang Xiaoyu, Gu Jun, Kang Ran, Xie Lin   

  1. Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China 

  • Received:2024-09-19 Accepted:2024-12-14 Online:2026-03-28 Published:2025-09-06
  • Contact: Xie Lin, MD, Chief physician, Researcher, Doctoral supervisor, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China
  • About author:Wang Nan, MD, Physician, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China

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摘要：


文题释义：

腰椎管狭窄症：是指腰椎椎管、神经根管、侧隐窝或椎间孔因退行性变，导致骨性或纤维结构形态和容积异常，造成管腔狭窄，引起神经根、马尾受压而产生相应的临床症状。
神经沉降征：在平卧位行MRI扫描时，正常椎管内的马尾神经会因为重力作用沉降在硬膜囊背侧。

摘要
背景：神经根沉降征作为腰椎管狭窄的新评估指标，提高了对腰椎管狭窄症的影像学认识，但是关于神经根沉降征是否影响全内窥镜下腰椎管减压的预后疗效，目前仍存在争议。
目的：探讨神经根沉降征对全内窥镜下腰椎管减压治疗腰椎管狭窄症疗效的影响。
方法：回顾性分析江苏省中西医结合医院2018年9月至2022年9月收治的69例腰椎管狭窄症患者行全内窥镜下腰椎管减压的病历资料。根据MRI下神经根是否沉降将患者分为2组，阳性组45例，阴性组24例。比较两组患者一般资料、腰痛及腿痛目测类比评分、Oswestry功能障碍指数及Macnab疗效优良率，对比治疗前后腰椎椎管矢状径、横径、椎管面积及腰椎前凸角的变化。
结果与结论：①两组患者术后腰腿痛目测类比评分及Oswestry功能障碍指数均较术前有所降低，差异有显著性意义(P < 0.05)；组间比较而言，阳性组治疗后1周、1年腰腿痛目测类比评分明显低于阴性组，差异有显著性意义(P < 0.05)；②两组术后椎管面积、椎管矢状径及椎管横径均较术前明显扩大，差异有显著性意义(P < 0.05)；③两组术后腰椎前凸角均未产生明显影响，术前、术后相比差异均无显著性意义(P > 0.05)；④通过改良MacNab标准评估患者术后1年疗效，阳性组优30例，良11例，可3例，差1例，优良率为91%；阴性组优16例，良4例，可4例，优良率为83%，但两组间差异无显著性意义(P > 0.05)；⑤结果表明，全内窥镜下腰椎管减压治疗腰椎管狭窄症疗效突出，可达到精确减压，MRI上可得到良好的体现，而伴或不伴马尾神经根沉降征对术后疗效无明显影响。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: ">神经根沉降征, 腰椎管狭窄症, 全内窥镜技术, MRI, 椎管面积, 腰椎前凸角, 回顾性研究

Abstract: BACKGROUND: The nerve root sedimentation sign has improved the imaging understanding of lumbar spinal stenosis as a new assessment index for it, but controversy still exists as to whether the nerve root sedimentation sign affects the prognostic efficacy of total endoscopic lumbar spinal decompression surgery.
OBJECTIVE: To investigate the effect of nerve root sedimentation sign on the efficacy of lumbar spinal stenosis treated by full endoscopic techniques. 
METHODS: Clinical data of 69 patients with lumbar spinal stenosis who underwent full endoscopic lumbar decompression from September 2018 to September 2022 in Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively analyzed. The patients were divided into positive group (n=45) and negative group (n=24) according to whether the cauda equina was sedated under MRI. The general data, visual analog scale scores for low back pain and leg pain, Oswestry disability index scores and Macnab efficacy ratings of the two groups were compared, and the changes in the sagittal diameter of the lumbar spinal canal, transverse diameter of the spinal canal, the area of the spinal canal, and the angle of anterior convexity of the lumbar spine were compared between the pre- and post-treatment periods.
RESULTS AND CONCLUSION: (1) Postoperative visual analog scale scores and Oswestry disability index scores of the two groups were reduced compared with those of the preoperative period, and the differences were statistically significant (P < 0.05). Comparing the two groups, the scores of the positive group in terms of low back pain were significantly lower than those of the negative group in both the 1-week and the 1-year periods after treatment, and the differences were statistically significant (P < 0.05). (2) The area of the spinal canal, the sagittal diameter of the spinal canal, and the transverse diameter of the spinal canal were significantly enlarged after the operation in both groups compared with the preoperative period, and the difference was statistically significant (P < 0.05). (3) The lumbar anterior convexity angle was not significantly affected in both groups after surgery, and the difference was not statistically significant compared with the preoperative and postoperative periods (P > 0.05). (4) The 1-year postoperative efficacy of the patients was evaluated by MacNab: positive group: 30 cases were excellent, 11 cases were good, 3 cases were average, and 1 case was poor, with an excellent and good rate of 91%; negative group: 16 cases were excellent, 4 cases were good, 4 cases were average, with an excellent and good rate of 83%. No significant difference was detected between the two groups (P > 0.05). (5) The above results show that total endoscopic lumbar spinal canal decompression in the treatment of lumbar spinal stenosis has outstanding efficacy, which can achieve accurate decompression and can be well reflected on MRI, while the presence or absence of nerve root sedimentation sign has no obvious effect on the postoperative efficacy. 

Key words: ">nerve root subsidence sign, lumbar spinal stenosis, full endoscopic technique, MRI, spinal canal area, lumbar lordosis angle, retrospective study

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