MRI-T2WI髓内高信号分级对前路手术治疗脊髓型颈椎病的预后影响  

Influence of MRI-T2WI intramedullary high signal grading on prognosis ofcervical spondylotic myelopathy after anterior cervical operation

作　　者：黄嘉文 贺少杰 吴昊[1] 林振 杨裕豪 林宏生[1] 查振刚[2] 查丁胜 HUANG Jiawen;HE Shaojie;WU Hao;LIN Zhen;YANG Yuhao;LIN Hongsheng;ZHA Zhen'gang;ZHA Dingsheng(Department of Orthopedics,the First Affiliated Hospital,Jinan University,Guangzhou 510630,China;Department of Bone and Joint Surgery,the First Affiliated Hospital,Jinan University,Guangzhou 510630,China)

机构地区：[1]暨南大学第一附属医院脊柱创伤骨科,广东广州510632 [2]暨南大学第一附属医院骨关节与运动医学中心,广东广州510632

出　　处：《暨南大学学报（自然科学与医学版）》2021年第2期197-202,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：国家自然科学基金青年项目(81401766);广东省医学科研基金(B2012196);暨南大学科研培育与创新基金青年基金(N21612303);暨南大学附属第一医院培育基金(2012-1)。

摘　　要：目的:研究MRI-T2WI髓内高信号改变对脊髓型颈椎病行前路手术预后的影响.方法:回顾性分析41例行前路椎体次全切除融合术(ACCF)或椎间盘切除融合术(ACDF)治疗脊髓颈椎病患者资料.搜集患者的临床基本资料与脊髓型颈椎病相关症状的始发时间,依据其术前MRI-T2WI信号改变分3组:A组13例,呈颈髓内高信号,信号清晰,边界清楚;B组15例,颈髓内呈高信号表现,信号模糊、边界不清;C组13例,信号表现正常,无明显改变,同时,测量脊髓受压比例.随访记录术前、术后1年日本骨科协会治疗评估评分(JOA)、脊髓受压比例(a/M值)及MRI-T2WI高信号(信号明亮、边界清晰)的情况.运用多元线性回归分析,探讨术前MRI-T2WI高信号是否为前路手术治疗脊髓型颈椎病的预后的独立影响因素.结果:3组术后JOA改善率均显著提升,组间术后JOA评分与JOA改善率差异有统计学意义,其中高信号改变A组较其余两组术后JOA评分及JOA改善率明显降低.多元回归分析提示,症状持续时间、术前JOA评分、脊髓受压比例(a/M值)及MRI-T2WI高信号均为预后的独立预测因素.结论:MRI-T2WI高信号对前路手术治疗脊髓型颈椎病患者的预后有影响.其中信号正常组和信号模糊、边界不清的高信号组预后均比信号清晰、边界清楚的高信号组的预后明显改善.Objective:To investigate the effect of preoperative MRI-T2WI intramedullary hypersignal change on the prognosis of cervical spondylotic myelopathy(CSM).Methods:Retrospective analysis was performed on 41 patients with cervical spondylotic myelopathy(CSM)who underwent anterior cervical corpectomy and fusion(ACCF)or Anterior cervical discectomy and fusion(ACDF).The basic data of the patients and the onset time of the symptoms associated with cervical myelopathy were recorded.According to the results of preoperative MRI-T2WI examination,the patients were divided into three groups:high-signal Group A(13 cases)which MRI-T2WI showed high signal in the cervical spinal cord with bright signal and clear boundary;high signal group B(15 cases)which MRI-T2WI presented high signal in cervical spinal cord,with blurred signal and unclear boundary.Normal group C(13 cases)which preoperative MRI-T2WI signal showed no obvious signal change.Patients were followed up to record JOA scores before and 12 months after surgery,and JOA improvement rate was recorded.Meanwhile,the ratio of spinal cord compression was measured.Multiple linear regression analysis was used to verify whether preoperative intramedullary high signal of MRI-T2WI was an independent influencing factor.Results:The postoperative JOA improvement rate was significantly improved in the three groups,and the postoperative JOA score and JOA improvement rate were statistically significant in the three groups,in which the high signal A group were significantly lower than other two groups.Multiple linear regression analysis suggested that duration of symptom,preoperative JOA score,ratio of spinal cord compression and high signal intensity(bright signal and clear boundary)of MRI-T2WI were independent predictors of surgical prognosis.Conclusion:High signal intensity of MRI-T2WI may affect the prognosis of patients with CSM after anterior decompression.The prognosis of the normal group and the group with blurred signals and unclear boundaries is significantly improved than the grou

关 键 词：脊髓型颈椎病 颈痛 颈髓压迫 核磁共振成像 T2WI 前路手术 独立危险因素 

分 类 号：R445[医药卫生—影像医学与核医学]