动态MRI检测颈椎健康者、颈肩部不适者脊髓型颈椎病未确诊及确诊者的价值  

Dynamic MRI detection of cervical spondylotic myelopathy in the healthy and individuals with neck discomfort

作　　者：李智斐[1] 钟远鸣[1] 张家立[1] 许建文[1] 杨光[1] 韦家鼎[1] 伍亮[1] 马显生[1] 唐福波[1] 

机构地区：[1]广西中医学院第一附属医院脊柱外科,广西壮族自治区南宁市530023

出　　处：《中国组织工程研究与临床康复》2010年第48期8998-9002,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：广西卫生医疗重点课题(2008-20):脊髓型颈椎病早期诊断及社区内早期防治方案的研究;广西自然基金课题(桂科自0848010):动态颈椎MRI对脊髓型颈椎病早期诊断意义;广西科学与技术开发计划项目(桂科攻0993003A-14):脊髓型颈椎病早期诊断及社区内早期防治方案的研究~~

摘　　要：背景:目前MRI对于颈椎病的检查多是常规的中立仰卧位静态平扫,是在非运动和非承重的条件下完成的,容易忽略脊髓在人体中承重和动态下脊髓的器质性改变。目的:分析颈椎动态MRI结合临床表现早期诊断脊髓型颈椎病的临床意义。方法:对随机抽取的正常人群10名(正常组)、有颈肩部不适的亚健康人群20名(亚健康组)、有脊髓型颈椎病症状体征但常规MRI不支持的患者20名(MRI正常脊髓型颈椎病组)、符合现行脊髓型颈椎病诊断标准的患者20名(脊髓型颈椎病组)进行JOA评分,颈椎正侧位片、颈椎中立位MRI及颈椎动态MRI检查,并随访18个月以上,观察4组研究对象各项观察指标的变化情况及4组人群的转归情况。结果与结论:脊髓型颈椎病组20例患者均在入组半年内手术治疗;MRI正常脊髓型颈椎病组20例中有16例在入组16个月内行手术治疗,其中4例入组1年内在中立位MRI检查尚无明显改变时即行手术治疗,12例在入组1年后颈椎中立位MRI也已有脊髓型颈椎病的典型改变时行手术治疗,前者治疗效果明显优于后者(P<0.05);亚健康组有4例出现了脊髓型颈椎病的症状体征,发现此4例患者动态颈椎MRI检查均有椎管变窄脊髓受压征象,但中立位MRI仅发现1例由此改变,且此例动态MRI在入组12个月时已经发现脊髓受压。在正常组随访中动态MRI与中立位MRI检查均发现1例有椎管变窄脊髓受压征象,但患者没有任何不适症状,考虑为假阳性;二者假阳性率相同。结果表明,颈椎动态MRI检查较中立位MRI能够更早期、更真实客观地发现脊髓受压征象;在临床症状、体征检查的基础上将常规的中立位MRI检查与动态MRI检查相结合将会更早期发现脊髓型颈椎病。BACKGROUND：MRI examination of cervical spondylotic myelopathy（CSM）is static plain scanning in a supine position with no movement or loading.Therefore,the spinal organic changes under loading and movement are omitted.OBJECTIVE：To investigate the clinical significance of clinical manifestations in combination with cervical dynamic MRI in early diagnosis of CSM.METHODS：A random sample of 10 normal population（normal group）,20 sub-health population with neck and shoulder discomfort（subhealth group）,20 patients with symptoms and signs of CSM,but not supported by conventional MRI（normal MRI CSM group）,20 CSM patients consistent with current diagnostic criteria（CSM group）were subjected to evaluation of JOA score,cervical spine lateral view,the neutral position of cervical spine MRI and dynamic MRI.They were followed up for at least 18 months,and index changes and transformations in four groups were observed.RESULTS AND CONCLUSION：CSM group were enrolled within six months treatment;Of 20 cases in normal MRI CSM group,16 cases were treated in 16 months,and 4 in 1 year in the neutral position during MRI,which displayed no significant change;12 patients with typical changes in 1 year in the neutral position after the cervical MRI underwent CSM surgical treatment,and the former treatment was better than the latter（P 0.05）;4 cases in the subhealth group displayed CSM symptoms and signs,and the finding of their dynamic cervical MRI had signs of spinal canal narrowing of spinal cord compression,but the neutral position MRI revealed only one case of this change,who showed spinal cord compression on dynamic MRI at 12 months.In the follow-up of normal group,MRI in neutral position and dynamic MRI showed one case had spinal canal narrowing of spinal cord compression signs,but no symptoms were considered false-positive;the false positive rate was identical.Results showed that compared with MRI in neutral position,dynamic MRI can earlier and more realistic objective to display signs of spinal cord compr

关 键 词：颈椎 动态MRI 早期诊断 脊髓型颈椎病 亚健康 

分 类 号：R318[医药卫生—生物医学工程]