中国医药科学
中國醫藥科學
중국의약과학
CHINA MEDICINE AND PHARMACY
2015年
15期
168-172
,共5页
曹凯%马迅%冯皓宇%陈辉%席镭民%郭永明
曹凱%馬迅%馮皓宇%陳輝%席鐳民%郭永明
조개%마신%풍호우%진휘%석뢰민%곽영명
颈脊髓压迫%颈椎MRI%脊髓型颈椎病
頸脊髓壓迫%頸椎MRI%脊髓型頸椎病
경척수압박%경추MRI%척수형경추병
Cervical spinal cord compression%Cervical spine MRI%Cervical spondylotic myelopathy(CSM)
目的：探讨中重度颈脊髓压迫患者术前术后MRI变化，指导颈椎病的治疗及疗效评价。方法收集山西医学科学院、山西大医院骨科2011年11月21日~2014年5月15日525例颈椎手术患者和38例体检中心健康人群一般资料、术前术后JOA评分及颈椎MRI资料，并根据颈脊髓受压程度及影像学表现选取中重度颈脊髓受压患者221例，其中中度受压组168例，重度受压组53例，观察颈脊髓形态并测量C3~7脊髓及椎管矢状径。结果（1）中度组术前JOA评分为（7.96±2.54）分，术后JOA评分为（12.42±2.18）分；重度组术前JOA评分为（6.88±2.57）分，术后JOA评分为（12.31±2.24）分。两组术后JOA评分较术前明显改善（P＜0.05）。中、重度颈脊髓受压组JOA评分改善率分别为（65.45%±2.01%）、（44.60%±1.17%）。受压程度越小，JOA评分改善率越好（P＜0.05）。（2）正常人群脊髓矢状径（6.68±0.80）mm，椎管矢状径为（16.27±0.35）mm；中度组术前脊髓矢状径（5.81±0.41）mm，椎管矢状径为（12.30±0.32）mm，术后脊髓矢状径（6.77±0.65）mm，椎管矢状径为（15.05±0.61）mm；重度组术前脊髓矢状径（5.01±0.65）mm，椎管矢状径为（11.40±0.44）mm，术后脊髓矢状径（6.64±0.71）mm，椎管矢状径为（14.95±0.77）mm。与正常人群相比，中重度颈脊髓受压患者的脊髓矢状径、椎管矢状径明显狭窄（P＜0.05）。中、重组术前术后矢状径改变均有统计学意义（P＜0.05），术后椎管狭窄程度明显改善。（3）中重度颈脊髓受压患者颈椎MRI中T2节段高信号术前共181例；术后T2高信号好转101例。结论（1）术前颈椎MRI可较清晰的显示颈椎、椎间盘及周围组织的病变程度；术后颈椎MRI为评价颈椎手术疗效、患者症状改善程度及康复锻炼的指导等提供科学客观的影像学资料。（2）中重度脊髓压迫患者术前术后的MRI脊髓矢状径、椎管矢状径改变与JOA改善率密切相关，脊髓受压越轻，术后改善率越高。
目的：探討中重度頸脊髓壓迫患者術前術後MRI變化，指導頸椎病的治療及療效評價。方法收集山西醫學科學院、山西大醫院骨科2011年11月21日~2014年5月15日525例頸椎手術患者和38例體檢中心健康人群一般資料、術前術後JOA評分及頸椎MRI資料，併根據頸脊髓受壓程度及影像學錶現選取中重度頸脊髓受壓患者221例，其中中度受壓組168例，重度受壓組53例，觀察頸脊髓形態併測量C3~7脊髓及椎管矢狀徑。結果（1）中度組術前JOA評分為（7.96±2.54）分，術後JOA評分為（12.42±2.18）分；重度組術前JOA評分為（6.88±2.57）分，術後JOA評分為（12.31±2.24）分。兩組術後JOA評分較術前明顯改善（P＜0.05）。中、重度頸脊髓受壓組JOA評分改善率分彆為（65.45%±2.01%）、（44.60%±1.17%）。受壓程度越小，JOA評分改善率越好（P＜0.05）。（2）正常人群脊髓矢狀徑（6.68±0.80）mm，椎管矢狀徑為（16.27±0.35）mm；中度組術前脊髓矢狀徑（5.81±0.41）mm，椎管矢狀徑為（12.30±0.32）mm，術後脊髓矢狀徑（6.77±0.65）mm，椎管矢狀徑為（15.05±0.61）mm；重度組術前脊髓矢狀徑（5.01±0.65）mm，椎管矢狀徑為（11.40±0.44）mm，術後脊髓矢狀徑（6.64±0.71）mm，椎管矢狀徑為（14.95±0.77）mm。與正常人群相比，中重度頸脊髓受壓患者的脊髓矢狀徑、椎管矢狀徑明顯狹窄（P＜0.05）。中、重組術前術後矢狀徑改變均有統計學意義（P＜0.05），術後椎管狹窄程度明顯改善。（3）中重度頸脊髓受壓患者頸椎MRI中T2節段高信號術前共181例；術後T2高信號好轉101例。結論（1）術前頸椎MRI可較清晰的顯示頸椎、椎間盤及週圍組織的病變程度；術後頸椎MRI為評價頸椎手術療效、患者癥狀改善程度及康複鍛煉的指導等提供科學客觀的影像學資料。（2）中重度脊髓壓迫患者術前術後的MRI脊髓矢狀徑、椎管矢狀徑改變與JOA改善率密切相關，脊髓受壓越輕，術後改善率越高。
목적：탐토중중도경척수압박환자술전술후MRI변화，지도경추병적치료급료효평개。방법수집산서의학과학원、산서대의원골과2011년11월21일~2014년5월15일525례경추수술환자화38례체검중심건강인군일반자료、술전술후JOA평분급경추MRI자료，병근거경척수수압정도급영상학표현선취중중도경척수수압환자221례，기중중도수압조168례，중도수압조53례，관찰경척수형태병측량C3~7척수급추관시상경。결과（1）중도조술전JOA평분위（7.96±2.54）분，술후JOA평분위（12.42±2.18）분；중도조술전JOA평분위（6.88±2.57）분，술후JOA평분위（12.31±2.24）분。량조술후JOA평분교술전명현개선（P＜0.05）。중、중도경척수수압조JOA평분개선솔분별위（65.45%±2.01%）、（44.60%±1.17%）。수압정도월소，JOA평분개선솔월호（P＜0.05）。（2）정상인군척수시상경（6.68±0.80）mm，추관시상경위（16.27±0.35）mm；중도조술전척수시상경（5.81±0.41）mm，추관시상경위（12.30±0.32）mm，술후척수시상경（6.77±0.65）mm，추관시상경위（15.05±0.61）mm；중도조술전척수시상경（5.01±0.65）mm，추관시상경위（11.40±0.44）mm，술후척수시상경（6.64±0.71）mm，추관시상경위（14.95±0.77）mm。여정상인군상비，중중도경척수수압환자적척수시상경、추관시상경명현협착（P＜0.05）。중、중조술전술후시상경개변균유통계학의의（P＜0.05），술후추관협착정도명현개선。（3）중중도경척수수압환자경추MRI중T2절단고신호술전공181례；술후T2고신호호전101례。결론（1）술전경추MRI가교청석적현시경추、추간반급주위조직적병변정도；술후경추MRI위평개경추수술료효、환자증상개선정도급강복단련적지도등제공과학객관적영상학자료。（2）중중도척수압박환자술전술후적MRI척수시상경、추관시상경개변여JOA개선솔밀절상관，척수수압월경，술후개선솔월고。
Objective To explore MRI changes of patients with moderate and severe cervical cord compression before and after the operation so as to guide the treatment and curative effective evaluation of cervical spondylosis. Methods Basic data, JOA scores before and after operation and MRI data of cervical spine of 525 patients who were admitted to department of orthopedics in Shanxi Academy of Medical Sciences, Shanxi DAYI Hospital to receive cervical operation from November 21, 2011 to May 15, 2014 and 38 healthy people in Medical Examination Center were collected. 221 patients with moderate to severe cervical cord compression were selected according to degrees of cervical cord compression and imaging findings, of which, 168 patients were in the moderate cervical cord compression group and 53 patients were in severe cervical cord compression group. Morphology of cervical cord was observed, in addition, sagittal diameter of spinal cord and spinal canal were measured.Results (1) JOA scores before and after operation of the moderate group were (7.96±2.54) and (12.42±2.18) respectively while JOA scores before and after operation of the severe group were (6.88±2.57) and (12.31±2.24) respectively. JOA scores after operation were significantly improved than that before treatment in two groups (P<0.05). The improvement rates of the moderate group and the severe group were (65.45%±2.01%) and (44.60%±1.17%) respectively. The smaller the degree of compression was, the better the JOA improvement rates were (P<0.05). (2) Sagittal diameter of normal cervical cord was (6.68±0.80)mm and sagittal diameter of normal spinal canal was (16.27±0.35)mm. Sagittal diameters of cervical cord and spinal canal before operation of patients in the moderate group were (5.81±0.41)mm and (12.30±0.32) mm respectively. Sagittal diameters of cervical cord and spinal canal after operation of patients in the moderate groupwere (6.77±0.65)mm and (15.05±0.61)mm respectively. Sagittal diameters of cervical cord and spinal canal before operation of patients in the severe group were (5.01±0.65)mm and (11.40±0.44)mm respectively. Sagittal diameters of cervical cord and spinal canal after operation of patients in the severe group were (6.64±0.71)mm and (14.95±0.77)mm respectively. Sagittal diameters of cervical cord and spinal canal of patients with moderate to severe cervical cord compression were significantly narrow compared with normal people (P<0.05). Changes of sagittal diameters before and after operation had statistically significance. Narrow degree of spinal canal after the operation was significantly improved. 3. 181 patients with moderate to severe cervical cord compression had MRI T2 high signal before operation while 101 patients had a better MRI T2 high signal after operation.Conclusion (1)The Preoperative cervical spine MRI can clearly show the lesion degree of cervical spine, intervertebral disc and the surrounding tissues. The post-operative cervical spine MRI can provide scientific and objective image information for evaluating curative effects of operation, degree of symptoms improvement and guidance for the rehabilitation exercises. (2) Changes of sagittal diameters of MRI cervical cord and spinal canal before and after operation of patients with moderate and severe cervical cord are closely related to the JOA improvement rate. The smaller the degree of compression is, the higher the improvement rates are.
