腰椎间盘突出症密歇根州立大学改良分型在脊柱微创外科临床治疗策略的指导作用

Clinical guidance for treatment strategie of modified MSU classification(MMSU) for lumbar disc herniation in minimally invasive spinal surgery

中文关键词:  腰椎间盘突出症  MSU分型  改良  脊柱微创外科

英文关键词:Lumbar disc herniation  MSU classification  Modify  Minimally invasive spine surgery

中文摘要:

  【摘要】 目的：比较椎间盘突出症密歇根州立大学分型（the Michigan State University classication，MSU）和改良MSU分型（modified MSU classification，MMSU）的临床一致性，探讨MMSU在脊柱微创外科临床治疗策略的指导作用。方法：回顾性分析2023年1月～12月空军特色医学中心骨科收治的84例腰椎间盘突出症患者的临床资料，男48例，女36例，年龄20～69岁（44.37±12.85岁）。首先进行MMSU分级分区的准确界定：确定双侧上关节突顶点连线（a线）及双侧下关节突顶点连线（b线），突出在a线以内为1级，a/b线之间为2级，超过b线为3级；以双侧下关节突顶点垂直椎间盘横轴做垂线，两线平行，其间为椎管区，将椎管区域3等分，中间为A区，两侧为B区；经双侧上关节突外缘做垂线，其内为C区，即椎间孔区；两线外侧为D区，即极外侧区。由本院骨科8名熟悉两种分型的脊柱外科主治医生对84例患者的腰椎MRI实施阅片，分别进行MSU和MMSU分区分级。收集数据进行统计学分析，比较两种分型的一致率（即对每名患者核磁两种分型的一致性比率），包括平均一致率、100%一致率例数（8名医生的分型判断全部相同）、一致率＞50%例数（至少5名医生分型判断相同，不包含全部8名医生分型相同）和一致率≤50%例数（不超过4名医生分型相同，包括4名）。结果：MMSU分型和MSU分型比较，平均一致率[（71.13±17.15）% vs （61.00±17.67）%]、一致率100%例数[10（11.9%） vs 1（1.90%）]、一致率≤50%例数[14（16.67%） vs 33（39.29%）]，MMSU分型优于MSU分型，差异具有统计学意义（P＜0.05）；一致率＞50%例数[60（71.43%） vs 50（59.52%）]比较差异无统计学意义（P＞0.05）。结论：腰椎间盘突出症MMSU分型细化了突出的分级和分区，通过命名方式明确了轴位上突出的方向、位置、程度，增加了矢状位上移或者下移的分级，对于脊柱微创外科的手术方案选择具有现实指导意义，也有利于临床学术交流。

英文摘要:

  【Abstract】 Objectives: To compare the clinical consistency between Michigan State University(MSU) classification and modified MSU(MMSU) classification of intervertebral disc herniation, and to investigate the clinical guidance for treatment strategies of MMSU classification in minimally invasive spinal surgery. Methods: A retrospective analysis was conducted on the clinical data of 84 patients with lumbar disc herniation admitted to the Department of Orthopedics, Air Force Medical Center from January to December 2023, including 48 males and 36 females, aged 20 to 69 years(mean, 44.37±12.85 years). After defining the line connecting the peak of the bilateral upper articular processes as line-a and the line connecting the peak of the bilateral lower articular processes as line-b, MMSU grading was defined as: protrusion not exceeding line-a was grade-1, protrusion between line-a and b was grade-2, protrusion exceeding line-b was grade-3. After drawing two parallel vertical lines with the vertices of the bilateral inferior articular processes perpendicular to the transverse axis of the intervertebral disc, where the area between was the spinal canal, MMSU zones was defined by dividing the spinal cannal into three equal quarters along the bilateral intra-facet line, with zone A in the middle and zone B on both sides; Drawing two vertical lines along the outer edges of the bilateral superior articular processes with the zone C inside, which was the intervertebral foramen area; The outer side of the two lines was zone D, which was the extremely outer zone. Eight attending physicians in spinal surgery who were familiar with the two types of classification reviewed the lumbar MRI films of 84 patients and classified them into MSU and MMSU zones and grades, respectively. Data were collected for statistical analysis and consistency rates of the two types of classification were compared(the consistency ratio of the two classification for each MRI image), including average consistency rate, 100% consistency rate cases(same classification in all 8 doctors), >50% consistency rate cases(same classification in at least 5 doctors, excluding same classification in all 8 doctors), ≤50% consistency rate cases(same classification in no more than 4 doctors). Results: MMSU classification was better than MSU classification in the average consistency rate[(71.13±17.15)% vs (61.00±17.67)%], number of cases with 100% consistency rate[10(11.9%) vs 1(1.90%)], and number of cases with ≤50% consistency rate[14(16.67%) vs 33(39.29%)], and the differences were statistically significant(P＜0.05). There was no statistically significant difference in the number of cases with a consistency rate of＞50%[60(71.43%) vs 50(59.52%)] between the MMSU and MSU classification(P＞0.05). Conclusions: The MMSU classification of lumbar disc herniation has refined the grading and zoning of protrusion, highlighted the direction, position and degree of protrusion on the axis position through naming methods, increased the grading degree of sagittal upward or downward shift, therefore is of clinical importance for surgical plans in minimally invasive spinal surgery and useful in communication among spine surgeons.