CAJ | 학술논문

目的探讨脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者先天性颈椎管狭窄(cervical spinal stenosis,CSS)与颈椎MRI改变及预后的关系.方法回顾性分析自2006年11月至2009年11月,采用前路、后路或前后路联合手术治疗的286例CSM患者的病例资料,根据患者是否存在CSS将患者分为两组,在MRI T2加权像上评价脊髓高信号的等级以及脊髓受压程度.记录患者日本骨科学会评分标准(Japanese Orthopaedic Associatio,JOA)评分、病程和体征,包括感觉减退或者消失、Hoffman征、Babinski征、腱反射.结果在CSM患者中CSS的发生率为33.6%,先天性CSS组的年龄、JOA评分、病程均大于无CSS组,术后临床改善率小于无CSS组.两组之间性别的差异无统计学意义(x2=0.006,P=1.00),两组之间的颈椎MRI T2加权像脊髓高信号发生率的差异有统计学意义(x2=-62.396,P＜0.001),CSS组脊髓高信号的发生率为70.8%,无CSS组脊髓高信号的发生率为22.6%.先天性CSS组脊髓受压程度相对于无CSS组严重,且先天性CSS组患者体征的数目相对较多.应用多元线性回归分析法得出术后改善率与CSS、病程、临床体征的数目和年龄有关(R2=0.565).结论先天性CSS患者出现CSM时往往脊髓受压程度较重、MRI T2加权像脊髓内高信号出现的概率大,病程长且预后较差.
목적 탐토척수형경추병(cervical spondylotic myelopathy,CSM)환자선천성경추관협착(cervical spinal stenosis,CSS)여경추MRI개변급예후적관계.방법 회고성분석자2006년11월지2009년11월,채용전로、후로혹전후로연합수술치료적286례CSM환자적병례자료,근거환자시부존재CSS장환자분위량조,재MRI T2가권상상평개척수고신호적등급이급척수수압정도.기록환자일본골과학회평분표준(Japanese Orthopaedic Associatio,JOA)평분、병정화체정,포괄감각감퇴혹자소실、Hoffman정、Babinski정、건반사.결과 재CSM환자중CSS적발생솔위33.6%,선천성CSS조적년령、JOA평분、병정균대우무CSS조,술후림상개선솔소우무CSS조.량조지간성별적차이무통계학의의(x2=0.006,P=1.00),량조지간적경추MRI T2가권상척수고신호발생솔적차이유통계학의의(x2=-62.396,P＜0.001),CSS조척수고신호적발생솔위70.8%,무CSS조척수고신호적발생솔위22.6%.선천성CSS조척수수압정도상대우무CSS조엄중,차선천성CSS조환자체정적수목상대교다.응용다원선성회귀분석법득출술후개선솔여CSS、병정、림상체정적수목화년령유관(R2=0.565).결론 선천성CSS환자출현CSM시왕왕척수수압정도교중、MRI T2가권상척수내고신호출현적개솔대,병정장차예후교차.
Objective To investigate the relationship between the cervical MR images and pathological changes, prognosis in patients with cervical spinal stenosis and cervical spondylotic myelopathy. Methods From Nov. 2006 to Nov. 2009, 286 patients with cervical spondylotic myelopathy were included through retrospective analysis. All patients were divided into two groups according to whether there was cervical stenosis, the grade of increased signal intensity (ISI) in spinal cord and the degree of spinal cord compression was evaluate in T2-weighted MR images of midian sagittal slices. JOA scale, duration of disease,Hoffmann sign, Babinski sign, sensory loss or hypoesthesia, and lower-extremity/upper-extremity hyperreflexia were recorded. Results The incidence rate of cervical spinal stenosis was 33.6% in patients with cervical spondylotic myelopathy. The study showed that the age was smaller (P＜ 0.001 ), preoperative JOA score was higher(P=0.0018), duration of disease was longer(P=0.009), and the recovery rate was lower(P＜ 0.001 )in cervical spinal canal narrowing group comparing with control group. There was no significant difference between the two groups in gender (x2=0.006,P=l.00). There was significant difference between two groups in the incidence of ISI in spinal cord through x2 test(x2=62.396,P＜ 0.001 ). Multivariate analysis indicated that the likelihood of the recovery rate of cervical myelopathy decreased with the presence of cervical spinal stenosis, duration of dieaase, number of neurological signs, age (R2=0.565). Conclusion Patients with congenitally narrow cervical spinal canal have to suffer severe spinal cord compression and high incidence of ISI in spinal cord. The duration of disease is long, and prognosis is poor.