颈脊髓信号改变对颈椎后纵韧带骨化手术疗效的影响  

Correlation between MRI signal change and treatment outcome of posterior longitudinal ligament ossification

作　　者：张健[1] 贾连顺[1] 陈雄生[1] 周盛源[1] 董兴成[2] 王智清[1] 

机构地区：[1]第二军医大学附属长征医院脊柱三科,上海200003 [2]中国人民解放军第三0三医院脊柱外科,广西南宁530000

出　　处：《中国矫形外科杂志》2017年第17期1541-1545,共5页Orthopedic Journal of China

摘　　要：[目的]研究全椎板切除减压术(total laminectomy angioplasty)治疗的OPLL患者术前颈脊髓信号改变对术后神经功能恢复的影响。[方法]回顾性研究2012年1月~2016年1月就诊于本科并行全椎板切除减压术治疗的86例OPLL患者,根据髓内T2高信号在颈椎MRI的矢状位累及节段范围分为3组,正常组38例,单节段组29例,多节段组19例。三组患者性别、年龄、病程及减压节段等差异均无统计学意义(P>0.05),具有可比性,手术前后采用JOA评分(Japanese Orthopaedic Association Scores)评估神经功能改善情况。[结果]术后随访时间16~44个月,平均(30.10±5.20)个月。三组患者术后JOA评分和神经功能均有改善,术后3个月时JOA评分改善率在组间比较差异无统计学意义(P>0.05),在术后6个月、末次随访时正常组和单节段组JOA评分改善率明显优于多节段组,差异具有统计学意义(P<0.05),但正常组和单节段组之间的改善率差异无统计学意义(P>0.05)。[结论]OPLL患者行手术治疗可以取得较满意的效果,颈脊髓信号呈多节段改变的患者术后疗效欠佳,脊髓信号正常或者呈单节段改变的患者术后疗效差异不明显,OPLL患者术后神经功能改善情况可能与术前髓内发生的病理变化有一定关系。[Objective] To investigate the prognostic significance of preoperative cervical spinal cord signal change to postoperative recovery of neurological function after total laminectomy decompression for ossification of posterior longitudinal ligament ossification （OPLL） [Methods] A consecutive series of 86 patients with OPLL received total laminectomy decom- pression in our department from January 2012 to January 2016. Of them, 38 patients without high-signal intensity changes on sagittal T2-weighted images were enrolled group A, whereas 29 patients with the high-signal change limited to a segment were classified into group B, the remaining 19 patients who had the high-signal change involved more than 2 segment were divided into the group C. There were no significant differences among groups in term of gender, age, duration and decompression seg- ment （P 〉 0.05） . JOA scores was used to assess the postoperative neurological improvement. [Results] The patients were followed up for an average of （30.10＋5.20） months （range 16 to 44 months） . The JOA scores were significantly improved in all of the 3 groups after operation. Although the JOA score improvement rate at the 3 months after surgery showed no statistical significance among the 3 groups （P 〉 0.05） , the improvement rates in group A and group B were significantly better than that of group C at 6 month after surgery and at latest follow-up （P 〈 0.05） . However, the JOA Score improvement rate was not sta- tistically significant between the group A and group B （P〉 0.05） . [Conclusion] The high-signal changes involving more than two vertebral segments indicate a poor prognosis. By contrast, the patients without high-signal change or with changes lim- ited to one vertebral segment have a similar clinical outcome. It implies that postoperative improvement of neurological function of patients with OPLL may be related to the pathological changes within spinal cord occurred before surgery.

关 键 词：颈椎后纵韧带骨化 T2加权像高信号 髓内信号改变 

分 类 号：R687.3[医药卫生—骨科学]