颈椎动态MRI对脊髓型颈椎病手术入路选择的意义  

The significance of cervical vertebra dynamic MRI for choosing the surgical approach of cervical spondylotic myelopathy

作　　者：李智斐[1] 钟远鸣[1] 张家立[1] 杨光[1] 韦家鼎[1] 伍亮[1] 宁运乾[1] 

机构地区：[1]广西中医学院第一附属医院脊柱外科,广西南宁市530023

出　　处：《中国脊柱脊髓杂志》2009年第11期832-835,共4页Chinese Journal of Spine and Spinal Cord

基　　金：广西卫生医疗重点课题(编号:2008-20);广西自然科学基金课题(编号:2008-48-10)

摘　　要：目的:探讨颈椎动态MRI在脊髓型颈椎病手术入路及术式选择中的指导作用。方法:对26例在常规MRI上显示为前方1个或2个相邻节段脊髓受压的脊髓型颈椎病(CSM)患者行颈椎动态MRI检查,有15例患者在颈椎动态MRI上表现为多节段脊髓前后方受压,对此15例患者采用"颈椎后路单开门椎管成形术"。术前、术后及术后1年进行JOA评分,计算手术改善率;观察颈椎前凸角变化。结果:15例患者术后JOA评分较术前明显改善(P<0.05),颈椎前凸角术前术后无显著性差异(P>0.05),术后12个月神经功能改善率为优者12例,良2例,好转1例。结论:动态颈椎MRI可以更客观真实了解脊髓受压情况,帮助术者更准确地选择手术入路及术式,取得更好的治疗效果。Objective：To understand the guidance effect of cervical vertebra dynamic MRI on the choice of surgical approach and method for the treatment of cervical spondylotic myelopathy（CSM）.Method：26 cases of CSM whose routine MRI showed anterior compression of spinal cord at one or two adjacent segments underwent cervical vertebra dynamic MRI,among them,15 cases presented both anterior and posterior cord compression at multilevel on their cervical vertebral MRI.Such 15 cases received open-door laminoplasty from posterior approach（Hirabayashi）,JOA score was assessed at pre- and post-operation and one year after operation respectively,effective rate of the operation was calculated.Result：The post-operative JOA score of these 15 cases was significantly improved compared that of pre-opertion（P〈0.05）,and the anterior curvature of cervical spine between pre-and post-operation showed no singnificant difference （P〉0.05）.The improvement rate in a year after operation was excellent in 12,good in 2,fair in 1.Conclusion：Dynamic cervical vertebra MRI can objectively indicate the true condition of spinal cord compression,it is helpful to select a right surgical approach and method and get a better outcome.

关 键 词：脊髓型颈椎病 动态MRI 手术入路 

分 类 号：R681.5[医药卫生—骨科学] R445.2[医药卫生—外科学]