中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2014年
10期
983-991
,共9页
马迅%陈辉%曹凯%陈晨%冯皓宇%霍建忠
馬迅%陳輝%曹凱%陳晨%馮皓宇%霍建忠
마신%진휘%조개%진신%풍호우%곽건충
颈椎病%磁共振成像%外科手术
頸椎病%磁共振成像%外科手術
경추병%자공진성상%외과수술
Cervical spondylosis%Magnetic resonance imaging%Surgical procedures,operative
目的：探讨不同影像学特点的脊髓型颈椎病的临床特点、手术方法和临床疗效。方法回顾性分析2011年11月至2013年10月手术治疗并获得半年以上随访的221例脊髓型颈椎病患者资料，按照影像学评价标准即颈椎退变的程度和形式分成轻度、中度、重度三组。轻度组79例，男48例，女31例；年龄37～74岁，平均（54.9±10.2）岁；病程6～250个月，平均（26.1±37.2）个月。中度组89例，男61例，女28例；年龄31～82岁，平均（59.7±9.2）岁；病程6～250个月，平均（36.7±42.7）个月。重度组53例，男36例，女17例；年龄33～88岁，平均（62.9±12.1）岁；病程6～240个月，平均（43.5±47.8）个月。比较三组患者的一般资料、影像学特点、手术选择、不同术式比率和末次随访的日本骨科协会（Japanese Ortho-paedic Association，JOA）评分及其改善率；应用单因素卡方检验或方差分析对三组间JOA改善率、年龄、性别、病程、脊髓受压程度、脊髓受压节段数、颈椎退变程度、颈椎不稳、T2高信号、发育性椎管狭窄、后纵韧带骨化等进行统计学分析。结果三组患者性别无差异；轻度和重度组病程有差异；三组的平均年龄、术前JOA评分和术后JOA评分改善率有差异，轻度和中度、轻度和重度之间有差异，中度和重度组无差异。所有病例均采用前路或后路手术完成减压和重建，轻、中、重度组前路手术比率分别是91.1%（72/79）、79.8%（71/89）、35.8%（18/53）。影像学特点复杂程度越低，前路手术的比例越高，影像学特点的复杂程度越高，后路手术的比例越高。轻、中、重度组末次随访的平均改善率分别是75.4%±6.4%、67.7%±8.7%、62.8%±10.4%。年龄、病程、术前JOA评分、脊髓受压程度、受压节段数、颈椎退变程度、T2WI髓内高信号、后纵韧带骨化、发育性椎管狭窄和改善率相关。结论脊髓型颈椎病依据不同影像学标准分组，选择适当术式，临床疗效良好。
目的：探討不同影像學特點的脊髓型頸椎病的臨床特點、手術方法和臨床療效。方法迴顧性分析2011年11月至2013年10月手術治療併穫得半年以上隨訪的221例脊髓型頸椎病患者資料，按照影像學評價標準即頸椎退變的程度和形式分成輕度、中度、重度三組。輕度組79例，男48例，女31例；年齡37～74歲，平均（54.9±10.2）歲；病程6～250箇月，平均（26.1±37.2）箇月。中度組89例，男61例，女28例；年齡31～82歲，平均（59.7±9.2）歲；病程6～250箇月，平均（36.7±42.7）箇月。重度組53例，男36例，女17例；年齡33～88歲，平均（62.9±12.1）歲；病程6～240箇月，平均（43.5±47.8）箇月。比較三組患者的一般資料、影像學特點、手術選擇、不同術式比率和末次隨訪的日本骨科協會（Japanese Ortho-paedic Association，JOA）評分及其改善率；應用單因素卡方檢驗或方差分析對三組間JOA改善率、年齡、性彆、病程、脊髓受壓程度、脊髓受壓節段數、頸椎退變程度、頸椎不穩、T2高信號、髮育性椎管狹窄、後縱韌帶骨化等進行統計學分析。結果三組患者性彆無差異；輕度和重度組病程有差異；三組的平均年齡、術前JOA評分和術後JOA評分改善率有差異，輕度和中度、輕度和重度之間有差異，中度和重度組無差異。所有病例均採用前路或後路手術完成減壓和重建，輕、中、重度組前路手術比率分彆是91.1%（72/79）、79.8%（71/89）、35.8%（18/53）。影像學特點複雜程度越低，前路手術的比例越高，影像學特點的複雜程度越高，後路手術的比例越高。輕、中、重度組末次隨訪的平均改善率分彆是75.4%±6.4%、67.7%±8.7%、62.8%±10.4%。年齡、病程、術前JOA評分、脊髓受壓程度、受壓節段數、頸椎退變程度、T2WI髓內高信號、後縱韌帶骨化、髮育性椎管狹窄和改善率相關。結論脊髓型頸椎病依據不同影像學標準分組，選擇適噹術式，臨床療效良好。
목적：탐토불동영상학특점적척수형경추병적림상특점、수술방법화림상료효。방법회고성분석2011년11월지2013년10월수술치료병획득반년이상수방적221례척수형경추병환자자료，안조영상학평개표준즉경추퇴변적정도화형식분성경도、중도、중도삼조。경도조79례，남48례，녀31례；년령37～74세，평균（54.9±10.2）세；병정6～250개월，평균（26.1±37.2）개월。중도조89례，남61례，녀28례；년령31～82세，평균（59.7±9.2）세；병정6～250개월，평균（36.7±42.7）개월。중도조53례，남36례，녀17례；년령33～88세，평균（62.9±12.1）세；병정6～240개월，평균（43.5±47.8）개월。비교삼조환자적일반자료、영상학특점、수술선택、불동술식비솔화말차수방적일본골과협회（Japanese Ortho-paedic Association，JOA）평분급기개선솔；응용단인소잡방검험혹방차분석대삼조간JOA개선솔、년령、성별、병정、척수수압정도、척수수압절단수、경추퇴변정도、경추불은、T2고신호、발육성추관협착、후종인대골화등진행통계학분석。결과삼조환자성별무차이；경도화중도조병정유차이；삼조적평균년령、술전JOA평분화술후JOA평분개선솔유차이，경도화중도、경도화중도지간유차이，중도화중도조무차이。소유병례균채용전로혹후로수술완성감압화중건，경、중、중도조전로수술비솔분별시91.1%（72/79）、79.8%（71/89）、35.8%（18/53）。영상학특점복잡정도월저，전로수술적비례월고，영상학특점적복잡정도월고，후로수술적비례월고。경、중、중도조말차수방적평균개선솔분별시75.4%±6.4%、67.7%±8.7%、62.8%±10.4%。년령、병정、술전JOA평분、척수수압정도、수압절단수、경추퇴변정도、T2WI수내고신호、후종인대골화、발육성추관협착화개선솔상관。결론척수형경추병의거불동영상학표준분조，선택괄당술식，림상료효량호。
Objective To investigate the clinical features, operation procedures and clinical outcomes of cervical spondy-lotic myelopathy with different imageological characteristics. Methods Two hundred and twenty one cervical myelopathy with different imageological characteristics patients between November 2011 and October 2013 were involved in this retrospective study. Patients were distributed into three groups, namely mild group (A), moderate group (B) and severe group(C), based on severi-ty of complexity by imageological variables (severity of cervical spine degeneration, the number of spinal cord compression, severi-ty of spinal cord compression and difficulty in operation). Preoperative and postoperative Japanese Orthopaedic Association (JOA) score and mean recovery rate were collected to evaluate the postoperative clinical effects. Demographic data and imageological characteristics were recorded;Univariate analysis or analysis of variance was conducted to analyze the correlation between post-operative JOA recovery rate with gender, age, course of disease, severity of spinal cord compression, the number of segment with spinal cord compression, severity of disc degeneration, MRI T2 increased signal intensity, cervical instability, cervical kyphosis, developmental cervical spinal stenosis and ossification of posterior longitudinal ligament. Results There was no significant differ-ence in gender between three groups. There was significant difference in age, preoperative JOA score and improvement rate be-tween group A and group B (C). All patients received decompression and reconstruction by anterior or posterior approach. The ra-tio of anterior approach in group A, B and C was 91.1%(72/79), 79.8%(71/89), 35.8%(18/53). The last follow-up JOA recovery rate of group A, B and C was 75.4%±6.4%、67.7%±8.7%、62.8%±10.4%. The last follow-up JOA recovery rate was correlated with duration of disease, the number of spinal cord compression and severity of spinal cord compression. Age, duration of course, preop-erative JOA score, degree of cord compression, the number of segment with cord compression, degree of disc degeneration, MRI T 2 increased signal intensity, cervical instability, cervical kyphosis, developmental cervical spinal stenosis and OPLL. Conclusion Patients suffering from cervical myelopathy with different imageological have good prognosis by appropriate operation procedure.
