椎管扩大椎板成形术联合MRI T2加权像髓内高信号节段单侧侧块螺钉内固定治疗多节段脊髓型颈椎病  

Expansive laminoplasty combined with unilateral lateral mass screw fixation at intramedullary MRI T2-weighted increased signal intensity segment for treatment of multi-segment cervical spondylotic myelopathy

作　　者：窦一博 魏磊鑫 黄迟 王永立 徐辰 胡博 沈晓龙 田野 陈华江 袁文 曹鹏 Dou Yibo;Wei Leixin;Huang Chi;Wang Yongli;Xu Chen;Hu Bo;Shen Xiaolong;Tian Ye;Chen Huajiang;Yuan Wen;Cao Peng(Department of Orthopaedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学长征医院骨科,上海200003

出　　处：《脊柱外科杂志》2023年第5期289-295,共7页Journal of Spinal Surgery

基　　金：国家自然科学基金面上项目(81972088)。

摘　　要：目的探讨椎管扩大椎板成形术联合MRIT2加权像髓内高信号(ISI)节段单侧侧块螺钉内固定治疗多节段脊髓型颈椎病(MCSM)的临床疗效。方法2015年1月-2019年1月收治伴MRIT2加权像髓内ISI的MCSM患者59例,其中26例采用椎管扩大椎板成形术联合MRIT2加权像髓内ISI节段单侧侧块螺钉内固定治疗(A组),33例采用单纯椎管扩大椎板成形术治疗(B组)。记录2组手术时间、术中出血量及并发症发生情况。采用日本骨科学会(JOA)评分及其改善率评价神经功能状态。在颈椎X线片上测量C_(2-7)Cobb角,计算颈椎整体活动度(ROM)。测量髓内信号改变比值(SCR=ISI区域光密度值/C_(7)~T_(1)正常区域光密度值),定量评估髓内ISI程度,并进一步分析SCR变化值对JOA评分及其改善率的影响。结果所有手术顺利完成。2组手术时间、术中出血量差异无统计学意义(P>0.05)。A组术后JOA评分及其改善率、术后SCR及其变化值明显高于B组,差异均有统计学意义(P<0.05)。2组术后C_(2-7)Cobb角、颈椎整体ROM及其保留率差异无统计学意义(P>0.05)。2组并发症发生率差异无统计学意义(P>0.05)。SCR变化值显著改变组的JOA评分改善率最高,中度改变组次之,轻度改变组最低,3组间两两相比,JOA评分改善率差异均有统计学意义(P<0.05)。结论对于伴MRIT2加权像髓内ISI的MCSM患者,椎管扩大椎板成形术联合MRIT2加权像髓内ISI节段单侧侧块螺钉内固定具有较好的临床和影像学结果,尤其在术后髓内ISI的改善方面具有一定优势。Objective To investigate the clinical efficacy of expansive laminoplasty combined with unilateral lateral mass screw fixation at MRI T2-weighted intramedullary increased signal intensity(ISI)segment for treatment of multi-segment cervical spondylotic myelopathy(MCSM).Methods From January 2015 to January 2019,59 patients with MCSM accompanied with MRI T2-weighted intramedullary ISI were admitted.Among them,26 patients underwent laminoplasty combined with unilateral lateral mass screw fixation at MRI T2-weighted intramedullary ISI segment(group A),while 33 underwent laminoplasty alone(group B).The operation time,intraoperative blood loss and complications were recorded in the 2 groups.The neurological function was evaluated by the Japanese Orthopaedic Association(JOA)score and its improvement rate.C_(2-7)Cobb angle were measured on roentgenographs,cervical overall range of motion(ROM)was calculated.Signal change ratio(SCR=ISI area optical density value/C_(7)-T_(1) normal area optical density value)was measured to evaluate ISI lesion degree.The effect of SCR variation on JOA score and its improvement rate was further analyzed.Results All the operations were completed successfully.There was no significant difference in operation time and intraoperative blood loss between the 2 groups(P>0.05).JOA score and its improvement rate,SCR and its change value in group A were significantly higher than those in group B,all with a statistical significance(P<0.05).There was no significant difference in C_(2-7)Cobb angle,cervical ROM and its retention rate between the 2 groups(P>0.05).There was no significant difference in the incidence of complications between the 2 groups(P>0.05).The improvement rate of JOA score in the obviously changed SCR group was the highest,followed by the moderately changed group,and the mildly changed group was the lowest.Pairwise comparison among the 3 groups showed significant differences in improvement rate of JOA score(P<0.05).Conclusion For MCSM patients with MRI T2-weighted intramedullary ISI,lamin

关 键 词：颈椎 颈椎病 减压术 外科 内固定器 

分 类 号：R681.531.1[医药卫生—骨科学]