围手术期高压氧治疗对脊髓型颈椎病术后脊髓功能影响的DTI研究  

The effect of peri-operative hyperbaric oxygen therapy on the recovery of neurologic function of patients with cervical spondylotic myelopathy:A diffusion tensor imaging study

作　　者：申沧海[1] 冯永健[1] 宋彦澄 刘钢 刘志伟[1] 戴海洋 Shen Canghai;Feng Yongjian;Song Yancheng;Liu Gang;Liu Zhiwei;Dai Haiyang(Department of Orthopedic Surgery,Cangzhou Central Hospital,Cangzhou 061000,China;MRI Department,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院骨四科,沧州061000 [2]沧州市中心医院磁共振成像科,沧州061000

出　　处：《中华物理医学与康复杂志》2019年第11期833-837,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的观察围手术期介入高压氧治疗对脊髓型颈椎病(CSM)患者术后脊髓功能恢复的影响,并通过弥散张量成像(DTI)技术探讨其作用机制。方法采用随机数字表法将拟接受颈椎后路手术治疗的80例CSM患者分为高压氧组及对照组,每组40例。2组患者术后均给予常规治疗及康复训练,高压氧组在此基础上辅以围手术期高压氧干预。于术前、术后6个月随访时采用日本骨科学会(JOA)评分系统评估患者脊髓神经功能情况;同时于上述时间点对2组患者进行脊髓常规MRI及DTI扫描。结果术后6个月随访时2组患者JOA评分均较治疗前有不同程度提高,并且高压氧组JOA评分[(11.30±1.93)分]明显优于对照组水平(P<0.05)。经Pearson相关性分析发现,80例CSM患者术前JOA评分与术前脊髓受压节段各向异性分数(FA)、表观弥散系数(ADC)值均存在显著相关性(P<0.05);术后6个月随访时入选患者JOA评分与术后脊髓FA、ADC值仍存在显著相关性(P<0.05);随着脊髓损伤程度加重,其FA值逐渐降低,ADC值逐渐升高。术后6个月随访时2组患者受损脊髓FA值均较术前显著升高,ADC值均较术前明显降低(P<0.05);并且高压氧组脊髓FA值(0.726±0.087)显著高于对照组水平(P<0.05),ADC值[(1.148±0.079)×10-3 mm2/s]显著低于对照组水平(P<0.05)。结论DTI量化指标能客观显示脊髓微观结构改变,真实反映脊髓病理状态;围手术期高压氧治疗能进一步改善CSM患者术后脊髓神经功能,其作用机制可能与改善受损脊髓缺血、缺氧状态、促进脊髓神经细胞及神经纤维修复有关。Objective To observe the clinical effect of hyperbaric oxygen therapy on cervical spondylotic myelopathy(CSM)in the peri-operative period,and to explore its neural mechanism.Methods Eighty patients who underwent surgical decompression for CSM were randomly divided into a hyperbaric oxygen group(n=40)and a control group(n=40).Both groups received cervical laminoplasty and systematic rehabilitation treatment after the surgery,while the hyperbaric oxygen group was additionally provided with hyperbaric oxygen therapy in the peri-operative period.The patients′neurological status was evaluated using Japanese Orthopaedic Association(JOA)scores.Both groups received conventional MRI and diffusion tensor imaging(DTI)before and 6 months after the surgery.Results After the surgery,both groups gained significant improvement in their average JOA score,with the improvement of the hyperbaric oxygen group significantly greater than in the control group.Pearson correlation analysis showed that the average pre-operative JOA score was significantly correlated with the anisotropic fraction(FA)and the apparent dispersion coefficient(ADC)of the compressed spinal cord.Six months after the surgery such correlation still persisted.During the six months,significant increase was observed in the average FA and significant decrease in the average ADC in both groups,with the average FA of the hyperbaric oxygen group(0.726±0.087)significantly higher at the end of the 6 months than that in the control group.The average ADC(1.148±0.079)×10-3 mm2/s was significantly lower.Conclusions DTI′s quantitative indicators can objectively show changes in the microstructure and pathological state of spinal cords.Exposure to hyperbaric oxygen may relieve ischemia and hypoxia of the spinal cord,promoting the repair of injured neurons and accelerating the regeneration of nerve fibers.

关 键 词：高压氧 脊髓型颈椎病 单开门椎管扩大成形术 弥散张量成像 

分 类 号：R68[医药卫生—骨科学]