合并后纵韧带退变的脊髓型颈椎病的临床及影像特征研究

目的:探讨合并后纵韧带退变(cervical posterior longitudinal ligament degeneration,CPLLD)的脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的临床及影像特征。方法:选取2013年1月至2015年12月因CSM在郑州大学第一附属医院行手术治疗,且临床和影像资料完整患者的病例资料进行研究。从患者的病例资料中提取性别、年龄、身高、体质量、术前颈椎功能障碍指数(neck disability index,NDI)、术前日本骨科学会(Japanese Orthopedic Association,JOA)颈椎病评分、术前疼痛视觉模拟量表(visual analogue scale,VAS)评分、有效椎管矢状径(space available for the cord,SAC)、椎管椎体矢状径比值(diameter of sagittal canal and vertebral body ratio,DSR)及合并CPLLD和颈脊髓内信号改变情况。结果:①临床数据分析结果。共纳入128例CSM患者,其中53例合并CPLLD(CPLLD组),其余75例未合并CPLLD(无CPLLD组)。合并颈脊髓内信号改变者49例,其中CPLLD组29例、无CPLLD组20例,CPLLD组颈脊髓内信号改变发生率高于无CPLLD组(χ^2=13.866,P=0.000)。合并CPLLD的CSM患者中51~60岁患者所占比例最高,性别分布无明显差异;55个节段CPLLD呈中央型、47个节段呈偏侧型,好发部位为C 4~C 6节段。术前CPLLD组患者的NDI高于无CPLLD组[(46.57±8.20)%,(36.60±7.01)%,t=1.783,P=0.000],JOA颈椎病评分低于无CPLLD组[(9.97±1.41)分,(12.60±1.25)分,t=-3.247,P=0.000];2组患者术前的疼痛VAS评分比较,差异无统计学意义[(5.47±2.12)分,(5.44±2.03)分,t=0.693,P=0.075]。②影像数据分析结果。CPLLD组术前颈椎SAC和DSR均小于无CPLLD组[(4.17±1.30)mm,(5.32±1.34)mm,t=-1.327,P=0.000;0.70±0.21,0.82±0.23,t=-3.733,P=0.000]。CPLLD组组内不同性别患者的术前颈椎SAC和DSR比较,差异均无统计学意义[(4.21±1.32)mm,(4.12±1.30)mm,t=0.149,P=0.795;0.67±0.15,0.75±0.19,t=0.328,P=0.602];无CPLLD组组内不同性别患者的术前颈椎SAC和DSR比较,差异均无统计学意义[(5.36±1.30)mm,(5.27±1.39)mm,t=0.187,P=0.753;0.81±0.22,0.83±0.23,t=0.739,P=0.072]。③临床数据和影像数据的相关性分析结果。CPLLD和颈脊髓内信号改变呈正相关(r s=0.317,P=0.000);SAC、DSR均与JOA颈椎病评分呈正相关(r=0.321,P=0.000;r=0.795,P=0.000),均与NDI呈负相关(r=-0.309,P=0.000;r=-0.432,P=0.000)。结论:CSM患者常合并CPLLD,其中以51~60岁者多见,好发于C 4~C 6节段;合并CPLLD的CSM患者更容易发生颈脊髓变性、DSR和SAC更小、患者生活质量更差,建议早期手术干预。

A study of clinical and imaging characteristics of cervical spondylotic myelopathy combined with cervical posterior longitudinal ligament degeneration

Objective:To explore the clinical and imaging characteristics of cervical spondylotic myelopathy(CSM)combined with cervical posterior longitudinal ligament degeneration(CPLLD).Methods:The medical records of patients who received surgical treatment for CSM in The First Affiliated Hospital of Zhengzhou University from January 2013 to December 2015 and had complete clinical and imaging data were selected for the study.The information about gender,age,height,body mass,preoperative neck disability index(NDI),preoperative Japanese Orthopedic Association(JOA)CSM scores,preoperative pain visual analogue scale(VAS)scores,space available for the cord(SAC),diameter of sagittal canal and vertebral body ratio(DSR),CPLLD and signal changes in cervical spinal cord were extracted from medical records for analysis.Results:One hundred and twenty-eight patients were included in the study.CPLLD were found in 53 patients(CPLLD group)and unfound in 75 patients(non-CPLLD group).The signal changes in cervical spinal cord were found in 49 patients,in which 29 patients in CPLLD group and 20 patients in non-CPLLD group.The incidence rate of signal changes in cervical spinal cord was higher in CPLLD group compared to non-CPLLD group(χ^2=13.866,P=0.000).The majority of patients with CSM and CPLLD ranged in age from 51 to 60 years and there was no significant difference in gender distribution.The CPLLD belonged to central type at 55 cervical vertebral segments and asymmetrical type at 47 cervical vertebral segments and was commonly found at C4-6 segments.The preoperative NDI was higher and the preoperative JOA CSM scores were lower in CPLLD group compared to non-CPLLD group(46.57+/-8.20 vs 36.60+/-7.01%,t=1.783,P=0.000;9.97+/-1.41 vs 12.60+/-1.25 points,t=-3.247,P=0.000).There was no statistical difference in preoperative pain VAS scores between the 2 groups(5.47+/-2.12 vs 5.44+/-2.03 points,t=0.693,P=0.075).The preoperative cervical SAC and DSR were smaller in CPLLD group compared to non-CPLLD group(4.17+/-1.30 vs 5.32+/-1.34 mm,t=-1.327,P=0.000;0.70+/-0.21 vs 0.82+/-0.23,t=-3.733,P=0.000).There was no statistical difference in preoperative cervical SAC and DSR between males and females in CPLLD group(4.21+/-1.32 vs 4.12+/-1.30 mm,t=0.149,P=0.795;0.67+/-0.15 vs 0.75+/-0.19,t=0.328,P=0.602).There was no statistical difference in preoperative cervical SAC and DSR between males and females in non-CPLLD group(5.36+/-1.30 vs 5.27+/-1.39 mm,t=0.187,P=0.753;0.81+/-0.22 vs 0.83+/-0.23,t=0.739,P=0.072).The results of correlation analysis of the relationship between clinical data and imaging data showed that CPLLD was positively correlated with signal changes in cervical spinal cord(r s=0.317,P=0.000);SAC and DSR were positively correlated with JOA CSM scores(r=0.321,PV=0.000;r=0.795,P=0.000)and were negatively correlated with NDI(r=-0.309,P=0.000;r=-0.432,P=0.000).Conclusion:CSM often combines with CPLLD and often occurs at C4-6 segments in persons aged from 51 to 60 years.More cervical spinal degeneration,smaller DSR and SAC and poorer quality of life can be found in patients with CSM and CPLLD,and early surgical intervention is recommended.