多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的手术入路选择及疗效分析

发布时间：2018-03-03 03:18

本文选题：脊髓型颈椎病　切入点：髓内高信号　出处：《中国脊柱脊髓杂志》2016年02期 　论文类型：期刊论文

【摘要】：目的 :比较不同手术入路治疗多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的手术疗效,为手术方案的选择提供理论依据。方法:收集2011年1月~2014年12月就诊于上海长征医院脊柱外科的45例多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的临床资料,根据手术入路的不同分为颈前路手术组(A组)和颈后路手术组(B组),其中A组男17例,女5例,年龄54.36±6.18岁;B组男19例,女4例,年龄58.09±8.83岁。在颈椎MRI T2WI上测量0.1cm2的高信号区与同一矢状面上0.1cm2正常颈髓内信号区的强度比值,比较两组患者末次随访时的JOA评分、神经功能改善率、髓内高信号强度比值及术后并发症的发生率。结果:所有患者均定期随访,随访时间为16.84±9.95个月。两组患者性别构成比、年龄、病程、病变节段数、术前JOA评分、术前髓内高信号强度比值、术后随访时间均无统计学差异(P0.05)。A组末次随访时JOA评分为14.64±1.09分,B组为13.09±1.56分,A组明显高于B组(P0.05);A、B组神经功能改善率分别为(64.14±12.76)%、(35.08±20.52)%,A组神经功能改善率明显优于B组(P0.05)。A组末次随访时髓内高信号强度比值为1.36±0.14,B组为1.53±0.15,A组显著低于B组(P0.05)。A组患者术后并发症发生率为13.64%,B组为13.05%,两组间比较差异无统计学意义(P0.05)。结论 :多节段脊髓型颈椎病伴髓内MRI T2WI高信号时,前、后路手术后患者的神经功能和髓内高信号强度均有改善,但前路手术能更好地提高术后神经功能,并降低髓内高信号强度比值。
[Abstract]:Objective: to compare the effect of different surgical approaches in the treatment of multilevel cervical Spondylotic myelopathy with intramedullary MRI T2WI hyperintensity. Methods: from January 2011 to December 2014, 45 patients with multilevel cervical Spondylotic myelopathy with intramedullary MRI T2WI hyperintensity changes were collected from January 2011 to December 2014 in Shanghai Changzheng Hospital. According to the different operative approaches, they were divided into two groups: anterior cervical approach group (n = 19) and posterior cervical approach group (n = 4). There were 17 males and 5 females in group A, with age of 54.36 卤6.18 years old, 19 males and 4 females. Age 58.09 卤8.83 years. The intensity ratio of the high signal area of 0.1 cm ~ 2 to the normal signal area of 0.1 cm ~ 2 on the same sagittal plane was measured on MRI T _ 2WI of cervical spine, and the JOA score and the improvement rate of nerve function were compared between the two groups at the last follow-up. Results: all the patients were followed up regularly, the follow-up time was 16.84 卤9.95 months. The sex composition ratio, age, course of disease, number of lesion segments and preoperative JOA score were measured in the two groups. Preoperative intramedullary high intensity ratio, There was no significant difference in postoperative follow-up time. The JOA score of group A was 14.64 卤1.09 minutes after the last follow-up. Group A was significantly higher than group B with 13.09 卤1.56 minutes. The improvement rate of nerve function in group A was significantly higher than that in group B (P 0.05 卤12.76). The improvement rate of nerve function in group A was significantly better than that in group B (P 0.05). The intramedullary high signal intensity ratio in group B was 1.36 卤0.14 and 1.53 卤0.15 in group A was significantly lower than that in group B (P 0.05). The incidence of postoperative complications in group B was 13.05. There was no significant difference between the two groups. Conclusion: multilevel cervical Spondylotic myelopathy with myelin is not significantly different between the two groups. When the signal intensity was high on MRI T2WI, The neurologic function and intramedullary hyperintensity were improved after anterior and posterior approaches, but anterior approach could improve the postoperative neurological function and reduce the ratio of intramedullary high signal intensity.
【作者单位】：第二军医大学附属长征医院脊柱外科;
【分类号】：R687.3

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