CAJ | 학술논문

目的探讨单节段脊髓型颈椎病伴下颈椎不稳的MRI信号改变及影响预后的相关因素.方法回顾性分析2005年1月至2008年6月采用前路减压植骨融合内固定术治疗的109例单节段脊髓型颈椎病患者的病例资料,根据是否存在下颈椎不稳将患者分为不稳定组、稳定组.比较两组T2WI脊髓高信号的等级、发生率及术后6个月日本骨科学会(Japanese Orthopaedic Association,JOA)评分改善率、由于症状反复或出现新的脊髓压迫症状两再次就诊的例数和时间,记录患者病程和体征,包括感觉减退或消失、Hoffmann征、Babinski征、腱反射.应用多元线性回归分析术后JOA评分改善率与性别、年龄、术前JOA评分、病程、临床体征数目、脊髓高信号等级的相关性.结果不稳定组和稳定组患者性别、年龄的差异无统计学意义.(1)不稳定组T2WI脊髓高信号发生率为74.3％,稳定组为41.9％,两组差异有统计学意义.(2)不稳定组的病程、术前JOA评分、临床体征数目、术后JOA评分改善率、再次就诊时间分别为(26.9±15.1)个月、(10.0±2.5)分、(2.91±0.91)个、55.6％±14.9％、(29.1±6.8)个月；稳定组分别为(17.0±9.9)个月、(11.2±2.4)分、(2.42±0.83)个、69.0％±18.0％、(57.5±21.9)个月.不稳定组较稳定组的病程长、术前JOA评分低、临床体征数目多、术后JOA评分改善率低、再次就诊时间短,两组差异均有统计学意义.(3)术后JOA评分改善率与术前JOA评分、病程和临床体征数目相关.结论单节段脊髓型颈椎病合并下颈椎不稳时,MRI T2WI上脊髓高信号的发生率高,患者病程长且临床体征多,术后疗效较差.
목적 탐토단절단척수형경추병반하경추불은적MRI신호개변급영향예후적상관인소.방법 회고성분석2005년1월지2008년6월채용전로감압식골융합내고정술치료적109례단절단척수형경추병환자적병례자료,근거시부존재하경추불은장환자분위불은정조、은정조.비교량조T2WI척수고신호적등급、발생솔급술후6개월일본골과학회(Japanese Orthopaedic Association,JOA)평분개선솔、유우증상반복혹출현신적척수압박증상량재차취진적례수화시간,기록환자병정화체정,포괄감각감퇴혹소실、Hoffmann정、Babinski정、건반사.응용다원선성회귀분석술후JOA평분개선솔여성별、년령、술전JOA평분、병정、림상체정수목、척수고신호등급적상관성.결과 불은정조화은정조환자성별、년령적차이무통계학의의.(1)불은정조T2WI척수고신호발생솔위74.3％,은정조위41.9％,량조차이유통계학의의.(2)불은정조적병정、술전JOA평분、림상체정수목、술후JOA평분개선솔、재차취진시간분별위(26.9±15.1)개월、(10.0±2.5)분、(2.91±0.91)개、55.6％±14.9％、(29.1±6.8)개월；은정조분별위(17.0±9.9)개월、(11.2±2.4)분、(2.42±0.83)개、69.0％±18.0％、(57.5±21.9)개월.불은정조교은정조적병정장、술전JOA평분저、림상체정수목다、술후JOA평분개선솔저、재차취진시간단,량조차이균유통계학의의.(3)술후JOA평분개선솔여술전JOA평분、병정화림상체정수목상관.결론 단절단척수형경추병합병하경추불은시,MRI T2WI상척수고신호적발생솔고,환자병정장차림상체정다,술후료효교차.
Objective To investigate the associated factors of MRI signal changes and prognosis in mono-segmental cervical spondylotic myelopathy (CSM) accompanied by instability of lower cervical spine.Methods In this retrospective study,data of 109 CSM patients who had undergone anterior cervical disectomy and fusion (ACDF) between January 2005 and June 2008 were analyzed.All patients were divided into unstable group and stable group,according to the stability of lower cervical spine.The two groups were compared in terms of spinal cord high signal on MRI T2WI and its incidence rate,JOA recovery rate six months after ACDF.The number of returned patients and the time they came back due to repeated symptoms or new symptoms caused by spinal cord compression were recorded.Besides,course of disease and physical signs including sensory hypoesthesia or disappearance,Hoffmann sign,Babinski sign and tendon reflexes were recorded.Multivariate linear regression was applied to analyze the correlation of postoperative JOA recovery rate with gender,age,preoperative JOA score,course of disease,the number of physical signs and high signal level of spinal cord.Results There was no significant difference in gender or age between the two groups.1) Occurrence rate of high signal in spinal cord was 74.3％ in unstable group,which was 41.9％ in stable group with significant difference.2) In unstable group,course of disease,preoperative JOA score,the numbers of physical signs and postoperative JOA recovery rate,and retreatment time were 26.9± 15.1 months,10.0±2.5 points,2.91±0.91,55.6％± 14.9％,29.1 ±6.8 months,respectively,and in stable group,17.0±9.9 months,11.2±2.4 points,2.42±0.83,69.0％± 18.0％,57.5±21.9 months,respectively.Significantly,the unstable group has longer course of disease,lower preoperative JOA score and postoperative JOA recovery rate,more physical signs,and shorter retreatment time,compared to stable group.3) Postoperative JOA recovery rate was correlated with preoperative JOA score,course of disease and the number of physical signs.Conclusion Patients suffering from cervical spondylotic myelopathy with lower cervical instability have higher incidence of high signal in spinal cord on MRI T2WI,longer course of disease,more physical signs,and poorer postoperative recovery rate.