中重度颈脊髓压迫患者术前术后MRI研究

摘要

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。%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.