本文選題：脊髓型頸椎病　切入點：髓內(nèi)高信號　出處：《中國脊柱脊髓雜志》2016年02期 　論文類型：期刊論文

【摘要】：目的 :比較不同手術(shù)入路治療多節(jié)段脊髓型頸椎病伴髓內(nèi)MRI T2WI高信號改變患者的手術(shù)療效,為手術(shù)方案的選擇提供理論依據(jù)。方法:收集2011年1月~2014年12月就診于上海長征醫(yī)院脊柱外科的45例多節(jié)段脊髓型頸椎病伴髓內(nèi)MRI T2WI高信號改變患者的臨床資料,根據(jù)手術(shù)入路的不同分為頸前路手術(shù)組(A組)和頸后路手術(shù)組(B組),其中A組男17例,女5例,年齡54.36±6.18歲;B組男19例,女4例,年齡58.09±8.83歲。在頸椎MRI T2WI上測量0.1cm2的高信號區(qū)與同一矢狀面上0.1cm2正常頸髓內(nèi)信號區(qū)的強度比值,比較兩組患者末次隨訪時的JOA評分、神經(jīng)功能改善率、髓內(nèi)高信號強度比值及術(shù)后并發(fā)癥的發(fā)生率。結(jié)果:所有患者均定期隨訪,隨訪時間為16.84±9.95個月。兩組患者性別構(gòu)成比、年齡、病程、病變節(jié)段數(shù)、術(shù)前JOA評分、術(shù)前髓內(nèi)高信號強度比值、術(shù)后隨訪時間均無統(tǒng)計學(xué)差異(P0.05)。A組末次隨訪時JOA評分為14.64±1.09分,B組為13.09±1.56分,A組明顯高于B組(P0.05);A、B組神經(jīng)功能改善率分別為(64.14±12.76)%、(35.08±20.52)%,A組神經(jīng)功能改善率明顯優(yōu)于B組(P0.05)。A組末次隨訪時髓內(nèi)高信號強度比值為1.36±0.14,B組為1.53±0.15,A組顯著低于B組(P0.05)。A組患者術(shù)后并發(fā)癥發(fā)生率為13.64%,B組為13.05%,兩組間比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論 :多節(jié)段脊髓型頸椎病伴髓內(nèi)MRI T2WI高信號時,前、后路手術(shù)后患者的神經(jīng)功能和髓內(nèi)高信號強度均有改善,但前路手術(shù)能更好地提高術(shù)后神經(jīng)功能,并降低髓內(nèi)高信號強度比值。
[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 鹵6.18 years old, 19 males and 4 females. Age 58.09 鹵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 鹵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 鹵1.09 minutes after the last follow-up. Group A was significantly higher than group B with 13.09 鹵1.56 minutes. The improvement rate of nerve function in group A was significantly higher than that in group B (P 0.05 鹵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 鹵0.14 and 1.53 鹵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.
【作者單位】： 第二軍醫(yī)大學(xué)附屬長征醫(yī)院脊柱外科;
【分類號】：R687.3

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