磁共振弥散张量成像在多节段脊髓型颈椎病手术节段的选择和疗效评估中的应用价值  

Application Value of Magnetic Resonance Diffusion Tensor Imaging in the Selection of Surgical Segments and Evaluation of Curative Effect of Multilevel Cervical Spondylotic Myelopathy

作　　者：陈耀鑫[1] 黎松波[1] 刘先银[1] 黎建文[1] 方冠军[1] CHEN Yao-xin;LI Songbo;LIU Xianyin(Dongguan People's Hospital/Donggua People's Hospital affiliated to Southern Medical University,Dongguan Guangdong 523018)

机构地区：[1]东莞市人民医院/南方医学大学附属东莞人民医院骨科,广东东莞523018

出　　处：《医学临床研究》2020年第10期1490-1493,共4页Journal of Clinical Research

基　　金：东莞市社会科技发展(一般)项目(No.2018507150011333)。

摘　　要：【目的】探讨磁共振弥散张量成像(DT1)在多节段脊髄型颈椎病手术节段的选择和疗效评估中的应用价值。【方法】选取2018年2月至2019年2月在本院诊治多节段脊髓型颈椎病患者30例,在MRIT2WI序列上按标准进行椎管狭窄严重程度分级,再结合DTI检查结果得出各个节段脊髓的表观扩散系数(ADO值和各向异性(FA)值.判断出引起颈髓功能受损的责任节段后实施颈椎减压手术治疗,分别记录患者术前、术后6个月及12个月的日本骨科协会评怙治疗分数(JOA)评分、颈椎功能障碍指数(NDI)评分及简明健康问卷(SF-36)生活质量评分.术后常规复查X线片及CT了解内固定情况,术后6个月和12个月复查MRI平扫和DTI检查并收集相关图像数据,比较手术前后手术节段脊髓的ADC值和FA值变化,分析ADC值和FA值与JOA评分、NDI评分及SF-36生活质量评分的相关性。【结果】术前、术后6个月、术后12个月J()A评分、NDI评分、SF-36评分和ADC值、FA值比较差异具有统计意义(P<0.05)。JOA评分、SF-36评分与ADC值均呈负相关,与FA值均呈正相关(P<0.05),NDI评分与ADC值均呈正相关,与FA值均负呈相关(P<0.05),(P<0.05)。【结论】对多节段脊髓型颈椎病患者,随着FA值下降,ADC值升高,J()A评分逐渐下降,NI)I评分逐渐升高,生活质量SF-36评分下降,说明患者颈髓病变越严重,神经功能障碍越严重.生活质量越差。【Objective】To investigate the application value of diffusion tensor imaging(DTI)in the selection of surgical segments and the evaluation of curative effect of multilevel cervical spondylotic myelopathy.【Methods】P'rom February 2018 to February 2019»30 patients with multilevel cervical spondylotic myelopathy were selected The severity of spinal stenosis was graded according to T2WI sequence standard.The apparent diffusion coefficient(ADC)and anisotropy(FA)values of each segment of spinal cord were obtained based on the results of DTI.The responsible segment of cervical spinal cord function damage was determined,and then cervical decompression surgery was performed.JOA score.NDI score and SF-36 quality of life score were recorded before operation,6 months and 12 months after operation were recorded respectively.Post-operation X-ray film and CT were reviewed to understand the situation of internal fixation.MRI scan and DTI were reviewed at 6 and 12 months after operation.and relevant image data were collected.The changes of ADC value and FA value of spinal cord before and after operation were compared,and the correlation between ADC value and JOA score,NDI score and SF-36 quality of life score was analyzed.【Resuhs】There were statistically significant differences in JOA score,NDI score,SF-36 score,ADC value and FA value before operation,6 months after operation and 12 months after operation(P<0.05).JOA score and SF-36 score were negatively correlated with ADC value,and positively correlated with FA value(P<0.05).The NDI score was positively correlated with ADC value,and negatively correlated with FA value(P<0.05).【Conclusion】For patients with multilevel cervical spondylotic myelopathy,the decrease of FA value,the increase of ADC valuer the gradual decrease of JOA score,the gradual increase of NDI score,and the decrease of SF-36 score of quality of life indicate that the more serious the cervical spinal cord lesion,the more serious the neurological dysfunction,and the worse the quality of life.

关 键 词：颈椎病 务髓 磁共振成像 

分 类 号：R274[医药卫生—中医骨伤科学]