Abstract: Background　Lumbar spinal stenosis（LSS） is a common lumbar spineal degenerative disease with no significant objective signs that is difficult to diagnose.Although many scholars put forward that cauda equina nerve root sedimentation sign（SedS） has no significant value in diagnosing LSS，SedS has been found to be more common in central LSS，and its prevalence is positively associated with the degree of stenosis.However，there are no studies involving the prevalence of SedS in different types and responsible segments of LSS.Objective　To discuss the diagnostic and therapeutic value of SedS in LSS by observing and analyzing its prevalence in different types and responsible segments of LSS.Methods　From 264 cases of LSS receiving treatment in Orthopedic Center，Rehabilitation Department，Acupuncture and Massage Department，the First Affiliated Hospital of Xinjiang Medical University during 2016 to 2017，58 cases were enrolled.A comparative retrospective analysis was performed on their medical records and imaging information between those with SedS in segment of LSS and those without，including sex ratio，mean age，Visual Analogue Score（VAS），Oswestry Dysfunction Index（ODI），body mass index（BMI），duration of low back pain，duration of lower limb pain，and surgical treatment rate.The prevalence of SedS in three types of LSS was analyzed.Inter-observer consistency and repeatability in the assessment of accuracy of SedS in identifying LSS were calculated.Results　There were 133 stenosis segments in the 58 patients，including 61（45.9%） central stenosis segments，34（25.5%） lateral stenosis segments，and 38（28.6%） mixed stenosis segments.The prevalence of SedS in central，lateral and mixed segments was 91.8%（56/61），41.2%（14/34） and 97.4%（37/38），respectively.The prevalence of SedS in responsible segments was 91.9%（34/37），60.0%（6/10） and 96.2%（25/26） in central，lateral and mixed stenosis，respectively.The consistent Kappa value of SedS in diagnosing LSS was 0.84，and the repeatable Kappa value was 0.87.Conclusion　The prevalence rate of SedS is higher in patients with long course of disease，and is higher in central and mixed spinal stenosis segments，and in responsible segments in central and mixed spinal stenosis rather than in the lateral type.SedS had high sensitivity，good consistency and repeatability in the diagnosis of the central and mixed types.

Key words: Spinal stenosis, Lumbar spinal stenosis, Cauda equina sedimentation sign, Stage of responsibility, Diagnostic value, Sensitivity

摘要： 背景　腰椎管狭窄（LSS）是一种常见的腰椎退行性病变，客观体征少，诊断困难。不少学者认为马尾神经沉降征（SedS）对LSS的诊断价值有限。有研究发现SedS更多出现在中央型椎管狭窄中，且出现率与狭窄程度呈正比。但目前未见就SedS在不同类型LSS及责任节段中的出现率进行的研究。目的　观察并分析SedS在不同类型LSS和责任节段中的分布情况，进一步探讨SedS对LSS的诊治意义。方法　回顾性分析2016—2017年新疆医科大学第一附属医院骨科中心、康复科、针灸推拿科住院的264例LSS患者的病历和影像学信息。经筛选纳入58例患者作为研究对象，根据有/无SedS阳性节段，将其分为SedS阳性组（n=46）与SedS阴性组（n=12），比较两组患者性别、年龄、疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、体质指数（BMI）、腰痛病程、下肢痛病程、手术治疗率。分析SedS在3种类型狭窄节段中的分布情况和责任节段的相符率；计算SedS诊断LSS的一致性和可重复性。结果　58例患者共有133个狭窄节段，其中中央型椎管狭窄节段61个（45.9%），侧方型椎管狭窄节段34个（25.5%），混合型椎管狭窄节段38个（28.6%）。SedS在中央型、侧方型及混合型椎管狭窄节段中阳性率分别为91.8%（56/61）、41.2%（14/34）、97.4%（37/38）；SedS在中央型、侧方型及混合型责任节段中阳性率分别为91.9%（34/37）、60.0%（6/10）、96.2%（25/26）。SedS诊断LSS的一致性Kappa值为0.84，可重复性Kappa值为0.87。结论　SedS阳性LSS患者病程更长，在中央型和混合型椎管狭窄节段中阳性率和责任节段相符率均高于侧方型。SedS对中央型和混合型椎管狭窄具有较高的灵敏度和良好的一致性、可重复性。

关键词: 椎管狭窄, 腰椎管狭窄, 马尾神经沉降征, 责任节段, 诊断价值, 灵敏度