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目的评价CT计量诊断(CTQD)预测腰椎间盘突出症(lumbardischerniation,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(χ2=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(χ2=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。
Objective To evaluate the value of computed tomography (CTQD) in predicting the lumbar disc herniation (LDH) pathology and guiding the clinical treatment. Methods The preoperative CT images of 395 LDH patients (452 discs, group A) who were admitted to Xiangya Third Hospital of Central South University from January 1994 to January 2000 were divided into 5 indexes , Making multi-factor discriminant analysis and making CTQD table based on the assignment of variables during multivariate discriminant analysis. The results of CTQD in group A were compared with those in operation to calculate the sensitivity, specificity and accuracy of diagnosis. A total of 363 patients with LDH admitted from February 2000 to February 2002 were randomly divided into two groups. One hundred and eighty-five patients in group B were treated with CTQD and typed according to CTQD. ) 178 cases, according to the traditional experience choose treatment. Results The sensitivity, specificity, accuracy and positive predictive value of CTQD were 84.73%, 92.81%, 90.12% and 85.49% respectively. The excellent and good rates of non-surgical treatment in group B were significantly higher than those in group C (χ2 = 5.009, P < 0.05). The rate of surgical treatment in group B was significantly lower than that in group C (χ2 = 12.773, P <0.001). The average length of stay in group B was significantly less than that in group C (t = 7.925, P <0.001) ). Conclusions CTQD can predict LDH pathology more accurately and has important guiding significance for the selection of treatment regimen.