颈脊髓压迫中医证候群结合影像学表现对选择手术治疗的指导意义  

The Symptoms of Traditional Chinese Medicine Combined with Radiology on the Therapy Choice of Spondylotic Cervical Cord Compression

作　　者：万宏波[1] 姚若愚 尹萌辰[1] 莫文[1] 邬学群[1] 马俊明[1] 陈雯[1] 

机构地区：[1]上海中医药大学附属龙华医院,上海200032

出　　处：《中国中医骨伤科杂志》2015年第11期36-40,44,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：上海市教育委员会预算内科研项目(2010JW42);上海市中医药事业发展三年行动计划(2014-2016年);上海市髓行性病中医临床研究基地建设(ZY3-LCPT-1-1003)

摘　　要：目的:通过对颈脊髓压迫症患者的中医临床证候的观察及影像学检查的分析,以探讨祖国传统医学临床证候,结合现代影像学医学对手术治疗方案的选择的指导意义,从中医辨病辨证的角度对手术指证作出指导性建议。方法:回顾133例符合纳入标准的颈脊髓压迫症患者的临床资料,比较手术治疗与非手术治疗的患者在性别、年龄、病程、症状、NDI指数、中医证候评分及影像学资料上的差别,并进一步行Logistic回归分析,探究两种治疗方式的选择与临床证候及影像学之间的联系。结果:根据治疗方法不同,将病例分为2组,A组107例采用非手术治疗,B组26例采用手术治疗。两组患者在年龄、性别及病程上差异无统计学意义(P>0.05),而在中医证候评分、NDI指数、JOA评分、Nagata分级及MRI T2加权像髓内信号上差异有统计学意义(P<0.05)。可预测患者行手术治疗的Logistic回归方程具有显著的统计学意义(F=71.549,P<0.001)。结论:中医证候评分高(主症评分为主)、T2加权像髓内高信号、Nagata分级高以及二便异常是选择手术治疗的危险因素,建议尽早手术。Objective： This research is supposed to make the choice of treatment by analysing the traditional chinese medicine （TCM） symptoms and medical imageology performance so as to probe a suggestion of surgical indications by TCM syndrome and disease differentiation type. Methods： The clinical data of 133 patients with cervical spinal cord compression were reviewed retrospectively, and comparison of surgical and non-surgical treatment patients in the gender, age, course of disease, symptom, NDI scores, TCM symptom scores and medical imageology performance was made. Then the relationship between the two treatment options and clinical symptoms and imaging was explored by Logistic regression. Results： We divided patients into two groups by the different treatment, group A of 107 patients with non-surgical treatment, and group 13 of 26 patients with surgical treatment. There was no significant difference in gender, age and course of disease between the two groups （P〉0.05）, but the difference of TCM symptom scores, NDI scores, JOA scores, Nagata degree and intramedullary signal intensity on T2-weighted imaging of MRI had statistical signifieance（P〈0.05）. Logistic regression equation for patients with surgical treatment can be predicted sta-tistically significant （ F = 71. 549, P〈 0. 001 ）. Conclusion： The high scores of TCM symptom, the intramedullary signal intensity on T2-weighted imaging, abnormal urine and stool, and higher Nagata degree are the risk factors for surgical treatment which is as soon as possible.

关 键 词：颈脊髓压迫症 中医证候 影像学 

分 类 号：R681.5[医药卫生—骨科学]