中国骨与关节损伤杂志

目的 研究MRI扩散张量成像（Diffusion tensor imaging,DTI）参数与单侧神经根受压腰椎间盘突出症患者疼痛及非手术治疗效果的关系。方法 回顾性分析自2021-08—2024-05采用非手术治疗的364例单侧神经根受压腰椎间盘突出症，根据患者神经根疼痛程度分为轻度疼痛组（109例）、中度疼痛组（201例）、重度疼痛组（54例），根据疗效分为疗效欠佳组（73例）、疗效良好组（291例）。采用多因素Logistic回归分析单侧神经根受压腰椎间盘突出症患者非手术治疗效果的影响因素，采用Pearson相关系数分析MRI参数与患者疼痛的相关性，采用受试者工作特征曲线分析MRI参数对患者非手术治疗效果的预测价值。结果 轻度疼痛组、中度疼痛组、重度疼痛组正常侧与受压侧腰大肌横截面面积差值差异无统计学意义（P>0.05），而3组间两侧多裂肌横截面面积差值和受压侧髓核区T2值、纤维环区T2值、FA值、ADC值差异有统计学意义（P<0.05）。单侧神经根受压腰椎间盘突出症患者受压侧神经根疼痛VAS评分与髓核区T2值、纤维环区T2值、FA值呈负相关，ADC值与疼痛VAS评分呈正相关。Lee 4区、椎间盘退行性改变程度为Ⅳ级、合并Ⅰ度腰椎滑脱、合并纤维环破裂、髓核区T2值较低、纤维环区T2值较低、FA值较低、ADC值较高均为单侧神经根受压腰椎间盘突出症患者非手术治疗效果欠佳的危险因素（P<0.05）。受试者工作特征曲线分析结果显示髓核区T2值、纤维环区T2值、FA值、ADC值联合预测单侧神经根受压腰椎间盘突出症患者非手术治疗效果的曲线下面积大于四者单独检测。结论 单侧神经根受压腰椎间盘突出症患者的MRI参数中髓核区T2值、纤维环区T2值、FA值、ADC值出现变化，而且变化水平与受压侧神经根疼痛明显相关；此类患者非手术疗效欠佳的危险因素包括Lee 4区、Ⅳ级椎间盘退行性改变、合并Ⅰ度腰椎滑脱、合并纤维环破裂，以及髓核区T2值、纤维环区T2值、FA值较低和ADC值较高；同时，髓核区T2值、纤维环区T2值、FA值、ADC值联合预测单侧神经根受压腰椎间盘突出症患者非手术治疗效果的精准度高于单独检测。

Objective To study the relationship between the parameters of diffusion tensor imaging(DTI) of MRI and the pain and the effect of non-surgical treatment of lumbar disc herniation with unilateral nerve root compression.Methods Three hundred and sixty-four cases of lumbar disc herniation with unilateral nerve root compression from August 2021 to May 2024 were analyzed retrospectively. According to the degree of nerve root pain, they were divided into the mild pain group(109 cases), the moderate pain group(201 cases) and the severe pain group(54 cases). According to the therapeutic effect, they were divided into the poor outcome group(73 cases) and the good outcome group(291 cases). Multivariate Logistic regression was used to analyze the influencing factors of non-surgical treatment effect in patients with unilateral nerve root compression of lumbar disc herniation, Pearson correlation coefficient was used to analyze the correlation between MRI parameters and patients' pain, and receiver operating characteristic curve was used to analyze the predictive value of MRI parameters for patients' non-surgical treatment effect.Results There was no significant difference in the cross-sectional area of psoas major between normal side and compressed side in the mild pain group, the moderate pain group and the severe pain group(P>0.05), but there were significant differences in the cross-sectional area of multifidus muscle on both sides and the T2 value of nucleus pulposus, T2 value of annulus fibrosus, FA value and ADC value of compressed side among the three groups(P<0.05). The VAS score of nerve root pain in patients with unilateral nerve root compression lumbar disc herniation was negatively correlated with T2 value in nucleus pulposus area, T2 value in annulus fibrosus area and FA value, while ADC value was positively correlated with the VAS score of pain. Lee zone 4, degree of intervertebral disc degeneration, combined with grade I lumbar spondylolisthesis, combined with rupture of annulus fibrosus, lower T2 value in nucleus pulposus area, lower T2 value in annulus fibrosus area, lower FA value and higher ADC value were all risk factors for poor non-surgical treatment effect in patients with unilateral nerve root compression of lumbar disc herniation(P<0.05). Receiver operating characteristic curve analysis showed that the combined area under the curve of T2 value in nucleus pulposus area, T2 value in annulus fibrosus area, FA value and ADC value to predict the non-surgical treatment effect of patients with unilateral nerve root compression lumbar disc herniation was larger than that detected by any of the four methods alone.Conclusion The MRI parameters of lumbar disc herniation patients with unilateral nerve root compression showed changes in T2 value in nucleus pulposus area, T2 value in annulus fibrosus area, FA value and ADC value,and the change level is obviously related to the pain of the nerve root on the compression side. The risk factors of poor non-operative curative effect in this kind of patients include disc degeneration of grade IV in Lee zone 4, combined with lumbar spondylolisthesis of grade I, combined with rupture of annulus fibrosus, lower T2 value in nucleus pulposus area, lower T2 value in annulus fibrosus area, lower FA value and high ADC value. At the same time, the accuracy of combined prediction of T2 value in nucleus pulposus, T2 value in annulus fibrosus, FA value and ADC value for non-surgical treatment of lumbar disc herniation with unilateral nerve root compression is higher than that of single detection.