中国现代医药杂志
中國現代醫藥雜誌
중국현대의약잡지
MODERN MEDICINE JOURNAL OF CHINA
2014年
3期
19-22
,共4页
脊髓异常信号分级%脊髓型颈椎病%预后%治疗
脊髓異常信號分級%脊髓型頸椎病%預後%治療
척수이상신호분급%척수형경추병%예후%치료
Spinal cord abnormal signal classification%Cervical spondylosis myelopathy%Prognosis%Treatment
目的：将脊髓型颈椎病（CSM）患者的颈椎磁共振（MRI）上脊髓内异常信号进行分级，探讨颈椎MRI上脊髓内异常信号分级系统与手术减压后临床疗效之间的相关性。方法收集2005年2月~2010年2月在我院行颈椎后路单开门椎管扩大成形、内固定术的CSM患者213例临床资料，包括术前MRI、手术前后的JOA评分。将术前MRI脊髓内信号异常分为0～Ⅱ级：脊髓内T2WI 和 T1WI 无信号改变（0级）；脊髓内T2WI 局灶性高信号、T1WI 无信号改变（Ⅰ级）；脊髓内T2WI 广泛大片状高信号，伴 T1WI 低信号改变（Ⅱ级）。结果213例患者获随访，随访时间6~79个月，平均1年3个月。脊髓内信号异常0级共121例，平均年龄（49.3±6.3）岁，平均病程（15.6±14.8）月，术前JOA评分为（12.1±3.1）分，术后6个月JOA评分平均为（16.7±1.7）分，改善率为94.1%；Ⅰ级共67例，平均年龄（56.0±9.5）岁，平均病程（46.3±46.7）个月，术前JOA评分为（10.3±2.6）分，术后6个月 JOA 评分平均为（15.1±2.1）分，手术改善率为72.1%；域级共25例，平均年龄（62.0±10.7）岁，平均病程（106.2±85）个月，术前JOA评分平均为（8.4±3.3）分，术后6个月JOA评分平均为（12.5±3.2）分，手术改善率为47.7%。组间比较采用单因素方差分析Post Hoc多重比较，结果显示：改善率3组之间有显著性差异（P＜0.01），且0级组与Ⅰ级组之间、Ⅰ级组与Ⅱ级组之间均有显著性差异（P＜0.01）；年龄3组之间无显著性差异（P＞0.05），病程3组之间有显著性差异（P＜0.01）。结论 MRI可以清晰地显示CSM患者的脊髓髓内信号，术前对CSM的脊髓内异常信号进行分级，对评估和研究手术后治疗效果有一定的指导意义。在脊髓信号改变以前早期手术，可以提高手术疗效。
目的：將脊髓型頸椎病（CSM）患者的頸椎磁共振（MRI）上脊髓內異常信號進行分級，探討頸椎MRI上脊髓內異常信號分級繫統與手術減壓後臨床療效之間的相關性。方法收集2005年2月~2010年2月在我院行頸椎後路單開門椎管擴大成形、內固定術的CSM患者213例臨床資料，包括術前MRI、手術前後的JOA評分。將術前MRI脊髓內信號異常分為0～Ⅱ級：脊髓內T2WI 和 T1WI 無信號改變（0級）；脊髓內T2WI 跼竈性高信號、T1WI 無信號改變（Ⅰ級）；脊髓內T2WI 廣汎大片狀高信號，伴 T1WI 低信號改變（Ⅱ級）。結果213例患者穫隨訪，隨訪時間6~79箇月，平均1年3箇月。脊髓內信號異常0級共121例，平均年齡（49.3±6.3）歲，平均病程（15.6±14.8）月，術前JOA評分為（12.1±3.1）分，術後6箇月JOA評分平均為（16.7±1.7）分，改善率為94.1%；Ⅰ級共67例，平均年齡（56.0±9.5）歲，平均病程（46.3±46.7）箇月，術前JOA評分為（10.3±2.6）分，術後6箇月 JOA 評分平均為（15.1±2.1）分，手術改善率為72.1%；域級共25例，平均年齡（62.0±10.7）歲，平均病程（106.2±85）箇月，術前JOA評分平均為（8.4±3.3）分，術後6箇月JOA評分平均為（12.5±3.2）分，手術改善率為47.7%。組間比較採用單因素方差分析Post Hoc多重比較，結果顯示：改善率3組之間有顯著性差異（P＜0.01），且0級組與Ⅰ級組之間、Ⅰ級組與Ⅱ級組之間均有顯著性差異（P＜0.01）；年齡3組之間無顯著性差異（P＞0.05），病程3組之間有顯著性差異（P＜0.01）。結論 MRI可以清晰地顯示CSM患者的脊髓髓內信號，術前對CSM的脊髓內異常信號進行分級，對評估和研究手術後治療效果有一定的指導意義。在脊髓信號改變以前早期手術，可以提高手術療效。
목적：장척수형경추병（CSM）환자적경추자공진（MRI）상척수내이상신호진행분급，탐토경추MRI상척수내이상신호분급계통여수술감압후림상료효지간적상관성。방법수집2005년2월~2010년2월재아원행경추후로단개문추관확대성형、내고정술적CSM환자213례림상자료，포괄술전MRI、수술전후적JOA평분。장술전MRI척수내신호이상분위0～Ⅱ급：척수내T2WI 화 T1WI 무신호개변（0급）；척수내T2WI 국조성고신호、T1WI 무신호개변（Ⅰ급）；척수내T2WI 엄범대편상고신호，반 T1WI 저신호개변（Ⅱ급）。결과213례환자획수방，수방시간6~79개월，평균1년3개월。척수내신호이상0급공121례，평균년령（49.3±6.3）세，평균병정（15.6±14.8）월，술전JOA평분위（12.1±3.1）분，술후6개월JOA평분평균위（16.7±1.7）분，개선솔위94.1%；Ⅰ급공67례，평균년령（56.0±9.5）세，평균병정（46.3±46.7）개월，술전JOA평분위（10.3±2.6）분，술후6개월 JOA 평분평균위（15.1±2.1）분，수술개선솔위72.1%；역급공25례，평균년령（62.0±10.7）세，평균병정（106.2±85）개월，술전JOA평분평균위（8.4±3.3）분，술후6개월JOA평분평균위（12.5±3.2）분，수술개선솔위47.7%。조간비교채용단인소방차분석Post Hoc다중비교，결과현시：개선솔3조지간유현저성차이（P＜0.01），차0급조여Ⅰ급조지간、Ⅰ급조여Ⅱ급조지간균유현저성차이（P＜0.01）；년령3조지간무현저성차이（P＞0.05），병정3조지간유현저성차이（P＜0.01）。결론 MRI가이청석지현시CSM환자적척수수내신호，술전대CSM적척수내이상신호진행분급，대평고화연구수술후치료효과유일정적지도의의。재척수신호개변이전조기수술，가이제고수술료효。
Objective To investigate the correlation between the clinical curative effects of decompression operation with abnormal signal on MRI in cervical spinal cord which were classificated in CSM patients. Methods Collected the data of 213 cases of CSM patients with cervical posterior single open-door laminoplasty internal fixation from Feb 2005 to Feb 2010 in our hospital, which including the preoperative MRI and the JOA scores before and after operation. The abnormal signal in spinal cord of preoperative MRI was divided into 0~IIlevels:T2WI and T1WI no signal change(level 0 ), focal high signal in T2WI and no signal change in T1WI (level Ⅰ),widely patchy high signal in T2WI and low signal in T1WI (level II). Results 213 patients were followed up,follow-up time was 6~79 months, mean follow-up time was 1 years and 3 months. Level 0:a total of 121 cases, the mean age was (49.3±6.3)years, mean disease course was (15.6±14.8) months, preoperative JOA score was (12.1±3.1)points, and 6 months after surgery JOA score was(16.7±1.7) points which the improvement rate was 94.1%. LevelⅠ:a total of 67 cases,the mean age was (56.0±9.5) years, mean disease course was (46.3±46.7) months, preoperative JOA score was (10.3±2.6) points, and 6 months after surgery the JOA score was (15.1±2.1) points which the improvement rate was 72.1%. Level II:a total of 25 cases, the mean age was (62.0±10.7) years, mean disease course was (106.2±85) months, preoperative JOA score was (8.4±3.3) points, and 6 months after surgery the JOA score was (12.5±3.2) points which the improvement rate was 47.7%. Statistics with single factor analysis of variance , compared with single factor analysis of variance and Post Hoc mul-tiple comparison, the results showed:the improvement rates between the three groups had significant differences(P<0.01), and there were significant differences between level 0 group and level Ⅰgroup, also there were significant differences between levelⅠandⅡgroup(P<0.01);age between the three groups had no significant differences (P>0.01), disease courses were significantly different be-tween the three groups (P<0.01). Conclusion MRI can clearly display the signal of spinal cord in CSM patients, classificating the signal in spinal cord of MRI before surgery, has certain directive significance to evaluating and researching the curative effect of the operation, in the spinal cord signal change before early surgery can improve curative effect.
