脊髓型颈椎病患者的磁共振弥散张量成像长期随访研究  

A long‑term follow up study of cervical spondylotic myelopathy using diffusion tensor imaging

作　　者：韩超凡 海涌[1] 刘玉增[1] 张希诺[1] 潘爱星 丁红涛 张瀚文 李越 关立[1] Han Chaofan;Hai Yong;Liu Yuzeng;Zhang Xinuo;Pan Aixing;Ding Hongtao;Zhang Hanwen;Li Yue;Guan Li(Orthopedic Department,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中华医学杂志》2021年第43期3594-3599,共6页National Medical Journal of China

基　　金：北京市自然科学基金(7182056)。

摘　　要：目的通过弥散张量成像(DTI)技术测定脊髓型颈椎病(CSM)患者颈脊髓最大压迫节段(MCL)的弥散信号,分析术前至术后5年的DTI参数同患者临床功能评分的相关性。方法采用前瞻性的研究方法分析北京朝阳医院2014年2月至2020年2月37例手术治疗的CSM患者临床资料,使用DTI对MCL进行研究。比较颈椎前路间盘切除融合术(ACDF)术前至术后5年CSM患者弥散指标变化[各向异性(FA)]和患者临床功能评分,包括改良日本骨科协会评分(mJOA)、颈椎功能障碍指数(NDI)和疼痛视觉模拟评分(VAS)。在每个随访点采集相关数据,并观察MRI T2加权像(T2WI)中是否可观测到脊髓髓内高信号。对比术前和术后随访节点的变化,并分析FA值和临床功能评分的相关性。结果最终37例患者纳入研究,年龄(55±10)岁,男14例,女23例。所有患者均顺利完成手术,髓性症状改善明显。术后3个月mJOA相较术前平均改善(2.62±1.41)分(P<0.001),FA值平均改善(0.14±0.11)(P<0.01),且mJOA和FA值在术前及术后两年各随访节点相互之间差异均有统计学意义(均P<0.05)。在MCL节段,术前及术后FA值和mJOA评分呈正相关(rs=0.770、0.729,均P<0.01)。mJOA同NDI和VAS之间无相关性(均P>0.05)。结论DTI可敏感地反映脊髓功能的改善,可作为预测及评价CSM脊髓功能障碍状态的重要工具。Objective To analyze the correlation between the parameters of diffusion tensor imaging(DTI)and the clinical function scores before and 5 years after anterior cervical discectomy and fusion(ACDF)by measuring the DTI signal of the maximum compression level(MCL)of the cervical spinal cord in patients with cervical spondylotic myelopathy(CSM).Methods A prospective study was conducted and clinical data of 37 patients with CSM treated by ACDF in Beijing Chaoyang Hospital from February 2014 to February 2020 were analyzed.The MCL was studied with diffusion tensor imaging(DTI)of MRI.The changes of diffusion indexes(fractional anisotropy(FA)),and clinical function score including Modified Japanese Orthopedic Association(mJOA),neck disability index(NDI)and visual analog scale(VAS)of pain were compared among each follow-up point.The FA value and clinical function score were collected and the data was analyzed to determine whether the high signal intensity could be observed in T2-weighted imaging(T2WI)at each follow-up point.The changes of preoperative and postoperative data were compared,and the correlation between FA value and other two clinical function score were analyzed at each follow-up point.Results There were 14 males and 23 females with a mean age of(55±10)years in this study.All patients received the surgery and the medullary symptoms improved significantly postoperatively.After 3 months,the mJOA and FA value were improved by 2.62±1.41 and 0.14±0.11 on average,respectively(both P<0.05);and there were significant differences in these two indexes between each follow-up point in two years after the operation(all P<0.05).At the MCL,there were strong correlations between the FA value and mJOA score pre-and postoperatively(rs=0.770,0.729,both P<0.01).There was no significant correlation between mJOA,NDI and VAS(both P>0.05).Conclusions The DTI sensitively reflects the improvement of spinal cord function and can be used as an important tool to predict and evaluate the state of spinal cord dysfunction in patients with

关 键 词：弥散张量成像 脊髓型颈椎病 颈椎前路间盘切除固定融合术 长期随访 

分 类 号：R681.55[医药卫生—骨科学]