脊髓型颈椎病MRI脊髓内异常信号分级系统与预后相关性研究

目的：将脊髓型颈椎病（CSM）患者的颈椎磁共振（MRI）上脊髓内异常信号进行分级，探讨颈椎MRI上脊髓内异常信号分级系统与手术减压后临床疗效之间的相关性。方法收集2005年2月~2010年2月在我院行颈椎后路单开门椎管扩大成形、内固定术的CSM患者213例临床资料，包括术前MRI、手术前后的JOA评分。将术前MRI脊髓内信号异常分为0～Ⅱ级：脊髓内T2WI 和 T1WI 无信号改变（0级）；脊髓内T2WI 局灶性高信号、T1WI 无信号改变（Ⅰ级）；脊髓内T2WI 广泛大片状高信号，伴 T1WI 低信号改变（Ⅱ级）。结果213例患者获随访，随访时间6~79个月，平均1年3个月。脊髓内信号异常0级共121例，平均年龄（49.3＆#177;6.3）岁，平均病程（15.6＆#177;14.8）月，术前JOA评分为（12.1＆#177;3.1）分，术后6个月JOA评分平均为（16.7＆#177;1.7）分，改善率为94.1%；Ⅰ级共67例，平均年龄（56.0＆#177;9.5）岁，平均病程（46.3＆#177;46.7）个月，术前JOA评分为（10.3＆#177;2.6）分，术后6个月 JOA 评分平均为（15.1＆#177;2.1）分，手术改善率为72.1%；域级共25例，平均年龄（62.0＆#177;10.7）岁，平均病程（106.2＆#177;85）个月，术前JOA评分平均为（8.4＆#177;3.3）分，术后6个月JOA评分平均为（12.5＆#177;3.2）分，手术改善率为47.7%。组间比较采用单因素方差分析Post Hoc多重比较，结果显示：改善率3组之间有显著性差异（P＜0.01），且0级组与Ⅰ级组之间、Ⅰ级组与Ⅱ级组之间均有显著性差异（P＜0.01）；年龄3组之间无显著性差异（P＞0.05），病程3组之间有显著性差异（P＜0.01）。结论 MRI可以清晰地显示CSM患者的脊髓髓内信号，术前对CSM的脊髓内异常信号进行分级，对评估和研究手术后治疗效果有一定的指导意义。在脊髓信号改变以前早期手术，可以提高手术疗效。

The study of the correlation between prognosis and spinal cord abnormal signal classification system of MRI in cervical spondylotic myelopathy patients

Objective To investigate the correlation between the clinical curative effects of decompression operation with abnormal signal on MRI in cervical spinal cord which were classificated in CSM patients. Methods Collected the data of 213 cases of CSM patients with cervical posterior single open-door laminoplasty internal fixation from Feb 2005 to Feb 2010 in our hospital, which including the preoperative MRI and the JOA scores before and after operation. The abnormal signal in spinal cord of preoperative MRI was divided into 0~IIlevels：T2WI and T1WI no signal change（level 0 ）, focal high signal in T2WI and no signal change in T1WI （level Ⅰ）,widely patchy high signal in T2WI and low signal in T1WI （level II）. Results 213 patients were followed up,follow-up time was 6~79 months, mean follow-up time was 1 years and 3 months. Level 0：a total of 121 cases, the mean age was （49.3＆#177;6.3）years, mean disease course was （15.6＆#177;14.8） months, preoperative JOA score was （12.1＆#177;3.1）points, and 6 months after surgery JOA score was（16.7＆#177;1.7） points which the improvement rate was 94.1%. LevelⅠ：a total of 67 cases,the mean age was （56.0＆#177;9.5） years, mean disease course was （46.3＆#177;46.7） months, preoperative JOA score was （10.3＆#177;2.6） points, and 6 months after surgery the JOA score was （15.1＆#177;2.1） points which the improvement rate was 72.1%. Level II：a total of 25 cases, the mean age was （62.0＆#177;10.7） years, mean disease course was （106.2＆#177;85） months, preoperative JOA score was （8.4＆#177;3.3） points, and 6 months after surgery the JOA score was （12.5＆#177;3.2） points which the improvement rate was 47.7%. Statistics with single factor analysis of variance , compared with single factor analysis of variance and Post Hoc mul-tiple comparison, the results showed：the improvement rates between the three groups had significant differences（P＆lt;0.01）, and there were significant differences between level 0 group and level Ⅰgroup, also there were significant differences between levelⅠandⅡgroup（P＆lt;0.01）;age between the three groups had no significant differences （P＆gt;0.01）, disease courses were significantly different be-tween the three groups （P＆lt;0.01）. Conclusion MRI can clearly display the signal of spinal cord in CSM patients, classificating the signal in spinal cord of MRI before surgery, has certain directive significance to evaluating and researching the curative effect of the operation, in the spinal cord signal change before early surgery can improve curative effect.