基于影像学和临床症状的腰椎 Basstrup 病新分类。
A new classification of lumbar Basstrup's disease based on radiographic and clinical symptoms.
机构信息
Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, People's Republic of China.
出版信息
Eur Spine J. 2024 Apr;33(4):1347-1359. doi: 10.1007/s00586-024-08128-6. Epub 2024 Jan 29.
OBJECTIVE
To propose a new classification method for lumbar Basstrup's disease based on radiographic and clinical symptoms, and to test its credibility and reproducibility.
METHODS
A retrospective analysis of 116 patients with complete data of lumbar Basstrup's disease in our hospital from January 2019 to January 2022, radiological imaging including X-ray, CT and MRI, were divided into two main types according to the number of segments: type I (single segment) and type II (multiple segments), each type was divided into a total of eight subtypes according to the degree of degeneration: Ia, Ib, Ic, Id, IIa, IIb, IIc, IId; it was further divided into 16 subtypes according to the presence or absence of clinical symptoms (i.e. low back pain or/and lower limb neurological symptoms: no 0, yes 1): Ia0, Ia1, Ib0, Ib1, Ic0, Ic1, Id0, Id1; IIa0, IIa1, IIb0, IIb1, IIc0, IIc1, IId0, IId1.The 116 patients with Basstrup's disease were successively typed twice (1 month interval) by five physicians according to the new classification method, and the reliability and reproducibility of the new classification were assessed using the Kappa consistency test.
RESULTS
Among 116 patients with lumbar Basstrup's disease: there were 60 cases of type I (single segment), accounting for 51.72%, including Ia 19 cases, Ib 16 cases, Ic 10 cases, and Id 15 cases; there were 56 cases of type II (multiple segments), accounting for 48.28%, including IIa 10 cases, IIb 20 cases, IIc 14 cases, and IId 12 cases. Of the 116 patients, 47 cases had no clinical symptoms (Ia0 16 cases, Ib0 3 cases, Ic0 6 cases, Id0 1 case, IIa0 8 cases, IIb0 2 cases, IIc0 10 cases, IId0 1 case), accounting for 40.52%; 69 cases were accompanied by low back pain or/and lower extremity nerve symptoms (Ia1 3 cases, Ib1 13 cases, Ic1 4 cases, Id1 14 cases, IIa1 2 cases, IIb1 18 cases, IIc1 4 cases, IId1 11 cases), accounting for 59.48%.Five physicians completed two rounds of a total of 1160 typings, with inter-assessor typing agreement of 82.47% (80.17-85.34%) and a mean Kappa value of 0.723 (0.771-0.831); intra-assessor typing agreement of 82.76% (77.59-86.21%) and a mean Kappa value of 0.801 (0.742-0.841).
CONCLUSION
The new classification method for lumbar Basstrup's disease based on radiographic and clinical symptoms is simple, practical, with good credibility and reproducibility, and provides some guidance for clinical treatment.
目的
提出一种基于影像学和临床症状的腰椎 Basstrup 病新分类方法，并检验其可信度和可重复性。
方法
回顾性分析 2019 年 1 月至 2022 年 1 月我院收治的 116 例腰椎 Basstrup 病患者的完整资料，影像学检查包括 X 线、CT 和 MRI，根据节段数分为两型：Ⅰ型（单节段）和Ⅱ型（多节段），每型按退变程度分为 8 个亚型：Ⅰa、Ⅰb、Ⅰc、Ⅰd、Ⅱa、Ⅱb、Ⅱc、Ⅱd；根据有无临床症状（即腰痛和/或下肢神经症状：无 0，有 1）进一步分为 16 个亚型：Ⅰa0、Ⅰa1、Ⅰb0、Ⅰb1、Ⅰc0、Ⅰc1、Ⅰd0、Ⅰd1；Ⅱa0、Ⅱa1、Ⅱb0、Ⅱb1、Ⅱc0、Ⅱc1、Ⅱd0、Ⅱd1。由 5 名医师根据新分类方法对 116 例 Basstrup 病患者进行连续 2 次分型（间隔 1 个月），采用 Kappa 一致性检验评估新分类的可靠性和可重复性。
结果
116 例腰椎 Basstrup 病患者中：Ⅰ型（单节段）60 例，占 51.72%，其中Ⅰa 19 例、Ⅰb 16 例、Ⅰc 10 例、Ⅰd 15 例；Ⅱ型（多节段）56 例，占 48.28%，其中Ⅱa 10 例、Ⅱb 20 例、Ⅱc 14 例、Ⅱd 12 例。116 例患者中无临床症状者 47 例（Ⅰa0 16 例、Ⅰb0 3 例、Ⅰc0 6 例、Ⅰd0 1 例、Ⅱa0 8 例、Ⅱb0 2 例、Ⅱc0 10 例、Ⅱd0 1 例），占 40.52%；伴腰痛和/或下肢神经症状者 69 例（Ⅰa1 3 例、Ⅰb1 13 例、Ⅰc1 4 例、Ⅰd1 14 例、Ⅱa1 2 例、Ⅱb1 18 例、Ⅱc1 4 例、Ⅱd1 11 例），占 59.48%。5 名医师共完成 1160 次分型，两两评估一致性为 82.47%（80.17%～85.34%），Kappa 值为 0.723（0.771～0.831）；医师内一致性为 82.76%（77.59%～86.21%），Kappa 值为 0.801（0.742～0.841）。
结论
基于影像学和临床症状的腰椎 Basstrup 病新分类方法简单实用，可信度和可重复性好，可为临床治疗提供一定指导。
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