颈椎管狭窄症的影像学所见与临床表现的对照研究

Image and clinical correlative studies on cervical spinalcanal stenosis

作者对４７例经手术证实颈椎管狭窄症患者的临床、ＭＲＩ和Ｘ线资料作对照研究。采用日本矫形外科协会用ＪＯＡ标准评定，最低６分，最高１４分，平均１０．１３分。Ｔｏｒｇ指数均小于正常值，以Ｃ＿４为最小。ＭＲＩ示颈髓前后代偿间隙，颈髓矢状径均减少，以病变节段最为明显。Ｔｏｒｇ指数、ＭＲＩ的脊髓矢状径与ＪＯＡ评分密切相关（Ｐ＜０．０１，相关系数分别为０．０９９３和０．４８１５，其中ＭＲＩ明显优于Ｘ线（Ｐ＜０．０１）。ＭＲＩ的特征变化为正中矢状面上蛛网膜下腔减少或消失、和／或伴有脊髓的压迫形变、髓内改善。进而对ＭＲＩ表现以：（１）狭窄范围；（２）狭窄方向；（３）狭窄程度和（４）髓内改变四方面行详尽分类。此分类较准确地联系临床，对颈椎管狭窄症的准确诊断和术式选择有指导意义。

AbstractClinical finding,X-ray and MR imagings in 47 pa-tients who underwent operation for degenerative cervi-cal stenosis were correalatively studied.JOA score wasused for evaluation and it varied from 6 to 14 points,with an average of 1 0.13 points.All Torg ratios weresmaller than normal value and that of C_4 was the small-est.The reserve space,sagittal diameter of spinal corddecreased, especially in the diseased segments.Sagittaldiameter of spinal cord showed on T_2 weighted imagingand Torg ratio were in good correiation with JOA score(P<0.01,r=0. 4815,r=0. 0993),MRI being superiorto X-ray (P<0.01). The MRI characteristic changesof degenerative cervical stenosis were subarachnoidspace decrease or vanish , compression deformation ofspinal cord and abnormal signal in spinal cord. MRIclassification was established according to the segmentsinvolved, compression direction. Compression degreeand abnormal changes in spinal cord, can indicate clin-cal changes and guide diagnosis and operation.