手术治疗脊髓型颈椎病预后因素分析  

Predictors of surgical outcome in cervical spondylotic myelopathy

作　　者：董钊[1] 王伟[1] 张永兴[1] 刘长安[2] 刘大鹏[1] 

机构地区：[1]解放军第二五二医院脊柱外科,河北保定071000 [2]白求恩国际和平医院骨科,河北石家庄050082

出　　处：《临床军医杂志》2016年第3期241-247,共7页Clinical Journal of Medical Officers

摘　　要：目的确定磁共振(MRI)成像和脊髓型颈椎病(CSM)患者的临床、人口统计学指标是否与基线功能评分独立相关,探讨其是否能够预测术后功能结果。方法对2010年7月至2011年5月解放军252医院收治的61例CSM患者进行前瞻性分析。采用改良日本骨科协会(mJOA)评分量化患者入院时及术后12个月的病残程度。对患者年龄、性别、症状持续时间、脊髓病变的严重程度、脊柱轴线、手术技术、压迫节段、前后径、最大脊髓压迫部位的横向面积、MRI成像信号强度的变化进行评估。研究收集的数据包括:患者人口统计学数据;术前基线mJOA评分;术后12个月mJOA评分;MRI影像学数据,如脊柱轴线,前后位直径(AP),最大压迫部位的横截面积(TA),脊髓信号强度(SI),压迫节段。数据分析采用Spearman秩相关检验,方差分析采用Mann-Whitney U检验和多元逐步回归。结果更高基线mJOA评分水平与低龄(年龄≤65岁)、症状持续时间较短,更大的横截面积相关(P<0.05)。更好的恢复率与低龄和高基线mJOA评分相关(P<0.05)。mJOA评分变化较高的与高基线mJOA水平相关(P<0.05)。使用多变量分析显示,脊髓型颈椎病术后的功能预后最佳预测因子是基线mJOA评分和患者年龄。结论年龄和基线mJOA评分是接受手术治疗的CSM患者功能预后的显著预测因子。脊髓受压程度和核磁共振T1/T2加权图像上信号强度的变化并不是独立预测因子,但发现其与患者当时的功能状态、年龄等相关。症状的持续时间与术前功能状态密切相关,但并没有影响术后的结果。Objective To explore the clinical and demographic indicators of magnetic resonance imaging（ MRI） in patients with cervical spondylotic myelopathy（ CSM）,that were independently associated with baseline functional scores and which were also predictors of postoperative functional outcomes. Methods This prospective study included 61 consecutive patients with CSM treated in our hospital from July 2010 to May 2011. The modified Japanese Orthopaedic Association（ mJOA） scale was set to quantify disability at admission and at 12-month follow-up. Age,sex,duration of symptoms,severity of myelopathy,spinal column alignment,surgical technique,levels of compression,anteroposterior diameter and transverse area at the site of maximal cord compression,and MRI signal intensity changes were assessed. Research data were collected including patient demographic data,preoperative baseline mJOA score,12 months after surgery,mJOA score,MRI imaging data,such as the spinal axis,anteroposterior diameter（ AP）,cross-sectional area maximum compression site（ transverse area,TA）,spinal cord signal intensity（ signal intensity,SI） and compression section. Data were analyzed using Spearman rank correlation test,analysis of variance,Mann-Whitney U test,and stepwise multivariate regression. Results Higher baseline mJOA scores were associated with younger age（ Age ≤65）（ P 〈 0. 05）,shorter duration of symptoms（ P 〈 0. 05）,and greater transverse area（ P 〈 0. 05）. Better recovery ratio was associated with younger age（ P 〈 0. 05） and higher baseline mJOA score（ P 〈0. 05）. Greater changes in mJOA score were associated with higher baseline mJOA score（ P 〈 0. 05）. Using multivariate analysis,the functional outcomes after surgery were best predicted by baseline mJOA score and age of patient. Conclusion Age and baseline mJOA scores were highly predictive of outcome for patients undergoing surgical treatment of CSM. The degree of spinal cord compression and patterns of signal intensity changes on

关 键 词：脊髓型颈椎病 MRI信号强度变化 手术结果预测 基线mJOA水平 

分 类 号：R681.5[医药卫生—骨科学]