脊髓型颈椎病磁共振T2加权高信号部位与颈椎手术预后的关联性研究  

Correlation between magnetic resonance T2-weighted increased signal intensity position and prognosis of cervical spondylotic myelopathy

作　　者：李凌[1] 杨志高[1] 沈洪兴[1] 侯铁胜[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中华医学杂志》2009年第31期2168-2170,共3页National Medical Journal of China

摘　　要：目的研究脊髓型颈椎病（CSM）磁共振1、2加权高信号（ISI）部位与手术疗效的相关性，探讨他加权高信号的产生原因和临床意义。方法回顾性分析72例在我院手术治疗并随访的颈椎病患者，比较高信号位于脊髓中央灰质区（A亚组）、灰质＋白质区（B亚组）和高信号阴性组之间术前临床症状（JOA评分）和术后疗效（脊髓功能改善率）的差异。结果高信号阴性组有40例患者，阳性组中A亚组有21例，B亚组有11例。组间比较：（1）阳性组（A＋B）和阴性组术前JOA评分差异有统计学意义（P〈0．05），但术后改善率无明显差别[阳性组和阴性组术后1周、14周和52周改善率分别为：（20．8±14．5）％、（51．1±15．6）％、（60．1±14．2）％和（20．3±14．3）％、（54．4±22．3）％和（61．2±22．3）％，P〉0．05]。（2）阴性组和A亚组术后52周随访改善率均优于B亚组[阴性组、A亚组和B亚组术后52周改善率分别为（61．2±22．3）％、（64．3±13．3）％和（50．1±11．2）％，P〈0．05]。结论高信号位于脊髓中央灰质患者术后疗效较高信号阴性患者无明显差异，高信号位于白质＋灰质中提示预后较差。Objective To investigate the correlation between position of the spinal cord with increased signal intensity （ISI） on magnetic resonance images （MRI） and the outcome of surgical treatment for cervical spondylotic myelopathy （CSM）. Methods Seventy-two patients with CSM who underwent preoperative MRI were selected. Pre- and post-operative clinical status was evaluated by modified Japanese Orthopedic Association （JOA） score. ISI was evaluated according to the T2-weighted sequences. The JOA score and the recovery ratios among patients with ISI in gray matter （ group A ）, in both gray and white matter （group B ） and ISI-negative group were compared. Results Forty patients were in ISI-negative group. IS/presenting only in gray matter included 21 cases （group A） and ll cases were in both gray and white matter group （ group B ）. Preoperative JOA score of ISI positive and negative group had significant difference, but the recovery ratios had no significant difference [ recovery ratios of two groups at week 1, week 14, and week 52 were （20.8± 14.5）%, （51.1 ± 15.6）%, （60.1 ±14.2）% and （20.3±14. 3 ） %, （54.4 ± 22.3 ） % and （ 61.2 ± 22.3 ） % respectively ; P 〉 0. 05 ]. The recovery ratios of negative group and group A in week 104 were superior to group B [recovery ratios of negative group, group A, and group B in week 52 were （61.2 ±22.3）%, （64.3±13.3）% and （50.1±11.2）% respectively; P〈 0. 05]. Conclusion Patients with ISI in the gray matter alone on T2-weighted MR images have no significantly different surgical outcomes as compared with those without ISI. Patients with ISI in both gray and white matter have worse surgical outcomes than those without ISI.

关 键 词：颈椎病 磁共振成像 预后 

分 类 号：R686[医药卫生—骨科学]