单节段脊髓型颈椎病伴下颈椎不稳的影像学表现及预后因素分析  

The imaging features and prognostic factors of mono-segmental cervical spondylotic myelopathy with lower cervical instability

作　　者：路宽[1] 丁文元[1] 杨大龙[1] 申勇[1] 张为[1] 郭旭朝[1] 杨思东[1] 王辉[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,河北省骨科生物力学重点实验室,石家庄050051

出　　处：《中华骨科杂志》2014年第3期273-279,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨单节段脊髓型颈椎病伴下颈椎不稳的MRI信号改变及影响预后的相关因素。方法回顾性分析2005年1月至2008年6月采用前路减压植骨融合内固定术治疗的109例单节段脊髓型颈椎病患者的病例资料，根据是否存在下颈椎不稳将患者分为不稳定组、稳定组。比较两组T2WI脊髓高信号的等级、发生率及术后6个月日本骨科学会（Japanese Orthopaedic Association，JOA）评分改善率、由于症状反复或出现新的脊髓压迫症状而再次就诊的例数和时间，记录患者病程和体征，包括感觉减退或消失、Hoffmann征、Babinski征、腱反射。应用多元线性回归分析术后JOA评分改善率与性别、年龄、术前JOA评分、病程、临床体征数目、脊髓高信号等级的相关性。结果不稳定组和稳定组患者性别、年龄的差异无统计学意义。（1）不稳定组％WI脊髓高信号发生率为74-3％，稳定组为41．9％，两组差异有统计学意义。（2）不稳定组的病程、术前JOA评分、临床体征数目、术后JOA评分改善率、再次就诊时间分别为（26．9±15．1）个月、（10．0±2．5）分、（2．91±0．91）个、55．6％±14．9％、（29．1±6．8）个月；稳定组分别为（17．0±9．9）个月、（11．2±2．4）分、（2．42±0．83）个、69．0％±18．0％、（57．5±21．9）个月。不稳定组较稳定组的病程长、术前JOA评分低、临床体征数目多、术后JOA评分改善率低、再次就诊时间短，两组差异均有统计学意义。（3）术后JOA评分改善率与术前JOA评分、病程和临床体征数目相关。结论单节段脊髓型颈椎病合并下颈椎不稳时，MRIT2WI上脊髓高信号的发生率高，患者病程长且临床体征多，术后疗效较差。Objective To investigate the associated factors of MRI signal changes and prognosis in mono-segmental cervical spondylotic myelopathy （CSM） accompanied by instability of lower cervical spine. Methods In this retrospective study, data of 109 CSM patients who had undergone anterior cervical disectomy and fusion （ACDF） between January 2005 and June 2008 were analyzed. All patients were divided into unstable group and stable group, according to the stability of lower cervi- cal spine. The two groups were compared in terms of spinal cord high signal on MRI T2WI and its incidence rate, JOA recovery rate six months after ACDF. The number of returned patients and the time they came back due to repeated symptoms or new symp- toms caused by spinal cord compression were recorded. Besides, course of disease and physical signs including sensory hypoesthe- sia or disappearance, Hoffmann sign, Babinski sign and tendon reflexes were recorded. Multivariate linear regression was applied to analyze the correlation of postoperative JOA recovery rate with gender, age, preoperative JOA score, course of disease, the num- ber of physical signs and high signal level of spinal cord. Results There was no significant difference in gender or age between the two groups. 1） Occurrence rate of high signal in spinal cord was 74.3% in unstable group, which was 41.9% in stable group with significant difference. 2） In unstable group, course of disease, preoperative JOA score, the numbers of physical signs and post- operative JOA recovery rate, and retreatment time were 26.9±15.1 months, 10.0±2.5 points, 2.91±0.91, 55.6%±14.9%, 29.1±6.8 months, respectively, and in stable group, 17.0±9.9 months, 11.2±2.4 points, 2.42±0.83, 69.0%± 18.0%, 57.5±21.9 months, re- spectively. Significantly, the unstable group has longer course of disease, lower preoperative JOA score and postoperative JOA re- covery rate, more physical signs, and shorter retreatment time, compared to stable group. 3） Postoperative JOA recovery rate was correlated w

关 键 词：颈椎病 预后 磁共振成像 

分 类 号：R687.3[医药卫生—骨科学]