脊髓型颈椎病合并椎体分节不良的临床及影像学的特点分析  

The imaging and clinical features of cervical spondylotic myelopathy with cervical fusion deformity

作　　者：张旭[1] 丁文元[1] 王辉[1] 杨大龙[1] 白智龙[1] 王海莹[1] 魏海鲲 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中华解剖与临床杂志》2016年第4期286-290,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨脊髓型颈椎病合并椎体分节不良的临床及影像学特点。方法回顾性分析2004年2月—2013年7月河北医科大学第三医院脊柱外科收治的2981例脊髓型颈椎病患者的临床资料，其中合并椎体分节不良患者71例纳入观察组，随机选取其中住院号尾数为单号的、无分节不良的单节段颈椎病患者80例为对照组。两组患者均采用前路手术完成减压和脊柱重建，观察颈椎分节不良的分布特点。比较两组患者术前颈椎活动度、颈椎曲度值、病变节段及相邻节段椎间盘退变程度、MRIT：WI髓内高信号。采用术后6个月的JOA评分及其改善率评价临床效果。结果脊髓型颈椎病合并椎体分节不良发生率为2．4％（71／2981），分节不良椎体为上位椎间隙8例、下位椎间隙53例、远隔椎间隙10例。观察组术前颈椎活动度（35．2°±6．5°）较对照组（47．3°±8．8°）低，差异有统计学意义（t=9．509，P〈0．01）；观察组和对照组术前颈椎曲度分别为24．3°±3．8°和25．8°±5．6°，差异无统计学意义（t=1．901，P〉0．05）。观察组MRIT：WI髓内高信号发生率为39．4％（28／71）显著高于对照组22．5％（18／80），差异有统计学意义（X。=4．823，P〈0．05）。观察组病变椎间盘平均退变分级高于对照组（Z=5．273，P〈0．01），而颈椎分节不良椎体下位邻近节段椎间盘与上位邻近椎间盘分级差异均无统计学意义（P值均〉0．05）。术后观察组及对照组患者平均JOA评分改善率分别为64．24％±9．49％和61．78％±11．48％，差异无统计学意义（t=1．388，P〉0．05）。结论脊髓型颈椎病合并椎体分节不良影像学上表现椎间盘突出多发生于分节不良节段下位椎间隙，退变严重，颈椎活动度变小，但相邻节段和颈椎整体曲度影响不大。此类临床表现与脊髓型颈椎病相似，选择适当术式治疗，预后良好�Objective To investigate the clinical and imaging characteristics of cervical spondylotic myelopathy with cervical fusion deformity. Methods From February 2004 to July 2013, 2 981 patients with cervical spondylotic myelopathy were involved in this retrospective study. The patients with cervical spondylotic myelopathy that combined with cervical fusion deformity were placed in the cervical fusion deformity group （n = 71 ）, and 80 patients, the hospital number mantissa were odd numbers,without cervical fusion deformity were included as control group. All patients received decompression and reconstruction by anterior approach. The distribution characteristics of cervical fusion deformity were recorded. The cervical spine activity, cervical spine curvature, the number of pathological segments and severity of adjacent segments disc degeneration, T2WI increased signal intensity were then analyzed. Preoperative and postoperative Japanese Orthopaedic Association （JOA） score and mean recovery rate were collected to evaluate the postoperative clinical effects. Results Cervical disc herniation in the most of cervical spondylotic myelopathy patients with cervical fusion deformity, occured in a total of 8 patients in the upper intervertebral space of the cervical fusion deformity, 53 patients in the lower intervertebral space, and 10 cases in the adjacent segment intervertebral space. The mean cervical spine activity in the cervical fusion deformity group （35.2°± 6.5°） was significantly lower than that in the controls （47.3°±8.8°） , the difference was statistically significant （ t = 9. 509, P 〈 0.01 ）, while the average cervical spine curvature showed no significant difference （t = 1. 901, P 〉 0.05 ）. The prevalence of MRI T2WI increased signal intensity was substantially higher in the cervical fusion deformity group （ 39.4%, 28/71 ） than that in control group （22.5%, 18/80）, the difference was statistically significant（x2 =4. 823, P 〈0.05）. There was a significant increase in t

关 键 词：颈椎病 椎体分节不良 颈椎曲度 活动度 磁共振成像 

分 类 号：R687.3[医药卫生—骨科学] R445.2[医药卫生—外科学]