快速进展性脊髓型颈椎病的危险因素分析  

Analysis of Risk Factors of Rapidly Progressive Cervical Spondylotic Myelopathy.

作　　者：向治成 郭晓鹏[2] 岑毕文[2] 张洋 陈瑞 沈天宇 祝昊 尚晖 冯梦媛[3] XIANG Zhi-cheng;GUO Xiao-peng;CEN Bi-wen;ZHANG Yang;CHEN Rui;SHEN Tian-yu;ZHU Hao;SHANG Hui;FENG Meng-yuan(Postgraduate Training Basement of Jinzhou Medical University,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,China;Department of Spinal Surgery,Taihe Hospital of Shiyan City,Affiliated Hospital of Hubei University of Medicine,Shiyan 442000,China;Hubei University of Medicine,Shiyan 442000,China)

机构地区：[1]锦州医科大学十堰市太和医院研究生培养基地(湖北医药学院附属医院),湖北十堰442000 [2]十堰市太和医院(湖北医院学院附属医院)脊柱外科,湖北十堰442000 [3]湖北医药学院,湖北十堰442000

出　　处：《骨科》2023年第3期255-259,共5页ORTHOPAEDICS

摘　　要：目的探讨快速进展性脊髓型颈椎病(rp⁃CSM)的危险因素及其颈前路手术治疗的疗效。方法对我院2011年9月至2021年9月收治的98例脊髓型颈椎病病人进行回顾性分析,根据术前神经功能障碍的恶化时间和严重程度分为rp⁃CSM组和慢性脊髓型颈椎病(c⁃CSM)组。所有病人均行前路手术,并进行18个月的随访。采用单因素分析两组病人一般资料,包括性别、年龄、病程、身体质量指数(BMI)、基础病、是否先天性椎管狭窄以及MRI T2髓内高信号,采用美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤分级、日本骨科协会(JOA)评分以及JOA改善率评估神经功能情况,将有差异的指标纳入多因素Logistic回归分析评估rp⁃CSM的危险因素。结果98例病人中有32例(32.7%)诊断为rp⁃CSM。单因素分析显示,两组的病程、糖尿病、先天性椎管狭窄、MRI T2髓内高信号情况比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示糖尿病史(OR=4.340,95%CI:1.462~12.883,P=0.008)、先天性椎管狭窄(OR=5.714,95%CI:1.455~22.442,P=0.013)以及MRI T2髓内高信号(OR=3.390,95%CI:1.019~11.278,P=0.047)是rp⁃CSM发生的危险因素。术后18个月,两组的ASIA分级、JOA评分比较,差异均无统计学意义(P>0.05),rp⁃CSM组的JOA改善率显著高于c⁃CSM组(68.70%±10.87%vs.41.61%±20.02%),rp⁃CSM组在颈前路减压手术后表现出良好的神经恢复效率。结论合并糖尿病、MRI T2髓内高信号和先天性椎管狭窄是rp⁃CSM的独立危险因素,并且rp⁃CSM是一种可以通过早期减压手术获得良好神经功能恢复的可逆性疾病。Objective To investigate the risk factors of rapidly progressing cervical spondylotic myelopathy(rp⁃CSM)and the efficacy of anterior cervical surgery.Methods A retrospective analysis was conducted on 98 patients with CSM admitted to our hospital from September 2011 to September 2021.They were divided into the rp⁃CSM group and the chronic CSM(c⁃CSM)group based on the deterioration time and severity of preoperative neurological dysfunction.All patients underwent anterior surgery and were followed up for 18 months.Univariate analysis was used to assess the general information of two groups of patients,including gender,age,course of disease,body mass index(BMI),underlying disease,congenital spinal stenosis,and intramedullary high⁃signal intensity of T2⁃weighted images.The American Spinal Injury Association(ASIA)spinal cord injury grading,the Japanese Orthopedic Association(JOA)score,and the improvement rate of JOA were used to evaluate the neurological function,and the incorporate differentiated indicators were included in the multivariate logistic regression analysis to evaluate the risk factors of rp⁃CSM.Results Among 98 patients,32(32.7%)were diagnosed with rp⁃CSM.Univariate analysis showed that there was a statistically significant difference between the two groups in the course of disease,diabetes,congenital spinal stenosis,and intramedullary high⁃signal intensity of T2⁃weighted images(P<0.05).Multivariate Logistic regression analysis showed that the history of diabetes(OR=4.340,95%CI:1.462⁃12.883,P=0.008),congenital spinal stenosis(OR=5.714,95%CI:1.455⁃22.442,P=0.013),and intramedullary high⁃signal intensity of T2⁃weighted images(OR=3.390,95%CI:1.019⁃11.278,P=0.047)were the risk factors for the occurrence of rp⁃CSM.At 18 months after surgery,there was no statistically significant difference in the ASIA grading and JOA scores between the two groups(P>0.05).The improvement rate of JOA in the rp⁃CSM group was significantly higher than that in the c⁃CSM group(68.70%±10.87%vs.41.61

关 键 词：脊髓型颈椎病 快速进展 危险因素 颈椎前路手术 糖尿病 MRI 先天性椎管狭窄 

分 类 号：R687.3[医药卫生—骨科学]