Magnetic Resonance Imaging in Follow-up Assessment of Sciatica

通过磁共振成像对坐骨神经痛进行的随访评定

（编者按）坐骨神经痛是指坐骨神经通路及其分布的疼痛，即在臀部大腿后侧、小腿后外侧和足外侧的疼痛。若疼痛反复发作，日久会出现患侧下肢肌肉萎缩，或出现跛行。 Vleggeert-Lankamp博士等人通过磁共振成像对坐骨神经痛进行随访评定，其MRI研究成果与疗效的相关性还存在争议。

原文链接：http://www.nejm.org/doi/full/10.1056/NEJMoa1209250

Background

研究背景

Magnetic resonance imaging (MRI) is frequently performed during follow-up in patients with known lumbar-disk herniation and persistent symptoms of sciatica. The association between findings on MRI and clinical outcome is controversial.

在对已知腰椎盘突出和持久性坐骨神经痛患者的随访过程中经常会用到磁共振成像（MRI）。MRI的研究结果与疗效之间的相关性还存在争议。

Methods

研究方法

We studied 283 patients in a randomized trial comparing surgery and prolonged conservative care for sciatica and lumbar-disk herniation. Patients underwent MRI at baseline and after 1 year. We used a 4-point scale to assess disk herniation on MRI, ranging from 1 for “definitely present” to 4 for “definitely absent.” A favorable clinical outcome was defined as complete or nearly complete disappearance of symptoms at 1 year. We compared proportions of patients with a favorable outcome among those with a definite absence of disk herniation and those with a definite, probable, or possible presence of disk herniation at 1 year. The area under the receiver-operating-characteristic (ROC) curve was used to assess the prognostic accuracy of the 4-point scores regarding a favorable or unfavorable outcome, with 1 indicating perfect discriminatory value and 0.5 or less indicating no discriminatory value.

在一项随机试验中，我们研究了283例患者，对坐骨神经痛和腰椎间盘突出的手术与长期保守治疗进行了比较。患者在试验初始和一年后接受了MRI检测。我们采用4绩点量表对椎间盘突出患者的MRI进行评估，从1“明确患有”到4“明确未患”。把一年中症状完全或者几乎完全消失定义为一个良好的疗效。。我们比较了一年中具有良好疗效（在未患有椎间盘突出患者以及椎间盘突出的确定性患者，很可能或可能性患者之中）的患者的比例。受试者工作特征（ROC）曲线下的面积可用于评估4分制评分标准对于疗效良好与否的预后准确性，1表示差值很大，0.5或0.5以下表示无差值。

Results

结果

At 1 year, 84% of the patients reported having a favorable outcome. Disk herniation was visible in 35% with a favorable outcome and in 33% with an unfavorable outcome (P=0.70). A favorable outcome was reported in 85% of patients with disk herniation and 83% without disk herniation (P=0.70). MRI assessment of disk herniation did not distinguish between patients with a favorable outcome and those with an unfavorable outcome (area under ROC curve, 0.48).

一年后， 84%的患者疗效良好。35%的疗效良好的患者和33%的疗效不好的患者有椎间盘突出症状（P=0.70）。85%的椎间盘突出患者和83%的未患有椎间盘突出的患者疗效良好（P=0.70）。椎间盘突出的MRI评估未区分疗效良好以及不好的患者。（ROC曲线下的面积，0.48）

Conclusions

结论

MRI performed at 1-year follow-up in patients who had been treated for sciatica and lumbar-disk herniation did not distinguish between those with a favorable outcome and those with an unfavorable outcome.

我们在对因坐骨神经痛和腰椎间盘突出而治疗的患者的1年随访期间进行MRI检测，发现MRI没有区分疗效良好以及不好的患者。

责任编辑：陈烨 马黎 李锡海