脊髓型颈椎病MRI表现和病理分型的关联性

Association between MRI manifestations and pathological types of cervical spondylotic myelopathy

目的:通过对脊髓型颈椎病MRI影像表现和病理分型间的关系进行对比分析,以明确其关联性。方法:于2001-01/2003-12选择第二军医大学上海长征骨科医院脊髓型颈椎病住院患者120例为观察对象。根据脊髓型颈椎病病理阶段的特点,结合临床症状将脊髓型颈椎病的病理分型细分为5期即椎间盘变性/膨隆期,椎间盘突出症期,椎间盘脱出症期,椎间盘脱出合并有骨赘形成期,椎间盘脱出合并脊髓损害。通过对120例不同病理分型的脊髓型颈椎病患者的椎间盘MRI影像表现在T1、T2加权像上进行信号分析,将MRI影像表现特点进行归纳分类,确定为12个观察指标为:①椎板间平行结构消失呈楔形变。②椎间高度变低,椎间隙变窄。③椎间盘夹层样结构消失。④纤维环出现裂隙呈条状高信号。⑤纤维环完整髓核膨隆。⑥髓核信号强度的变化。⑦髓核突出为孤立团块。⑧髓核突出有狭颈相连。⑨椎间盘压迫脊髓或神经根。⑩骨赘的形成及其对脊髓的压迫。黄韧带肥厚并对脊髓的压迫。脊髓信号的改变及其变性程度。以得出规律性的结果。统计学设计采用回顾性、成组设计的方法。结果:脊髓型颈椎病的12个MRI观察指标在不同的临床分期中都有各自的出现率。①椎板间平行结构消失呈楔形变在椎间盘变性/膨隆期,椎间盘突出症期,椎间盘脱出症期,椎间盘脱出合并有骨赘形成期,椎间盘脱出合并脊髓损害的出现率依次为53.3%,73.3%,80.0%,90.0%,90.0%。②椎间高度变低,椎间隙变窄在5期病理分型的出现率依次为76.7%,90.0%,90.0%,90.0%,93.3%。③椎间盘夹层样结构消失的出现率依次为73.3%,80.0%,86.7%,93.3%,93.3%。④纤维环出现裂隙呈条状高信号的出现率为43.3%,66.7%,76.7%,80.0%,86.7%。⑤纤维环完整髓核膨隆在椎间盘变性/膨隆期的出现率为53.3%。⑥髓核信号强度的变化在5期的出现率为73.3%,80.0%,86.7%,93.3%,90.0%。⑦髓核突出为孤立团块在椎间盘脱出症期,椎间盘脱出合并有骨赘形成期,椎间盘脱出合并脊髓损害的出现率为86.7%,93.3%,93.3%。⑧髓核突出有狭颈相连在椎间盘突出症期的出现率为86.7%。⑨椎间盘压迫脊髓或神经根在5期的出现率为40.0%,90.0%,96.7%,100.0%,100.0%。⑩骨赘的形成及其对脊髓的压迫在椎间盘脱出合并有骨赘形成期,椎间盘脱出合并脊髓损害的出现率依次为100.0%,86.7%。黄韧带肥厚并对脊髓的压迫在后4期的出现率为20.0%,30.0%,46.7%,60.0%。脊髓信号的改变及其变性程度在椎间盘脱出合并脊髓损害的出现率为100.0%。作者对每1个观察指标在各个临床分期中的出现率进行χ2检验,P=0.0～0.3。结论:①在脊髓型颈椎病不同的病理分型中,有其相对应的脊髓型颈椎病的MRI观察指标出现,其改变和病理分期间具有紧密的关联性。②由MRI影像表现可以判断脊髓型颈椎病患者的病理分型,对治疗方法的11121112选择和预后的判断具有重要作用。

AIM： To comparatively analyze the correlation between the MRI manifestations and pathological types of cervical spondylotic myelopathy, so as to make clear their association. METHODS： Totally 120 inpatients with cervical spondylotic myelopathy were selected from Shanghai Changzheng Orthopaedic Hospital between January 2001 and December 2003. According to the pathological characteristics of cervical spondylotic myelopathy and clinical symptoms, the pathological types of cervical spondylotic myelopathy were divided into 5 stages： intervertebral disc degeneration/expending stage, intervertebral disc protrusion stage, intervertebral disc extrusion stage, intervertebral disc protrusion plus osteophyte formation stage, intervertebral disc protrusion plus spinal cord lesion stage. The signal analysis was applied to the T1- and T2-weighted MRI manifestations of the 120 patients with cervical spondylotic myelopathy of different pathological stages, and then the MRI manifestations of the 120 patients with cervical spondylotic myelopathy of different pathological stages, and then the characteristics of the MRI manifestations were sorted and classified, 12 observational indexes were made： （1） disappearance and wedging of the parallel structure between lamina of vertebra; （2） lowered vertebral height, narrowed intervertebral space; （3） disappearance of dissecting structure of intervertebral disc; （4） crevice and strip-like high signal of fibrous rings; （5） complete fibrous rings and expending of nucleus pulposus; （6） changes of the signal intensity of nucleus pulposus; （7） protrusion to isolated block of nucleus pulpous; （8） protrusion and linked narrow neck of nucleus pulposus; （9） intervertebral disc compressed spinal cord or nerve root; （10） formation of osteophyte and its compression on spinal cord; （11） hypertrophy of yellow ligament and its compression on spinal cord; （12） changes of spinal signal and its degenerated severity. Retrospection and grouped design were used in the statistical analysis. RESULTS： The 12 MR1 observational indexes of cervical spondylotic myelopathy all had their own incidence rates at different clinical stages. （1） The incidence rates of the disappearance and wedging of the parallel structure between lamina of vertebra at the intervertebral disc degeneration/expending stage, intervertebral disc protrusion stage, intervertebral disc extrusion stage, intervertebral disc protrusion plus osteophyte formation stage and intervertebral disc protrusion plus spinal cord lesion stage were 53.3%, 73.3%, 80.0%, 90.0%, 90.0% respectively. （2） The incidence rates of lowered vertebral height and narrowed intervertebral space at the 5 pathological stages were 76.7%, 90.0%, 90.0%, 90.0%, 93.3% respectively. （3） The incidence rates of the disappearance of dissecting structure of intervertebral disc were 73.3%, 80.0%, 86.7%, 93.3%, 93.3% respectively. （4） The incidence rates of crevice and strip-like high signal of fibrous rings were 43.3%, 66.7%, 76.7%, 80.0%, 86.7% respectively. （5） The incidence rate of complete fibrous rings and expending of nucleus pulposus at the intervertebral disc degeneration/expending stage was 53.3%. （6） The incidence rates of changes of the signal intensity of nucleus pulposus at the 5 pathologcal stages were 73.3%, 80.0%, 86.7%, 93.3%, 90.0% respectively.（7） The incidence rates of protrusion to isolated block of nucleus pulpous at the intervertebral disc extrusion stage, intervertebral disc protrusion plus osteophyte formation stage and intervertebral disc protrusion plus spinal cord lesion stage were 86.7%, 93.3%, 93.3% respectively.（8） The incidence rate of protrusion and linked narrowneck of nucleus pulposus at the intervertebral disc protrusion stage was 86.7%. （9） The incidence rates of intervertebral disc compressed spinal cord or nerve root at the 5 pathological stages were 40.0%, 90.0%, 96.7%, 100.0%, 100.0% respectively.（10） The incidence rates of formation of osteophyte and its compression on spinal cord at the intervertebral disc protrusion plus osteophyte formation stage and intervertebral disc protrusion plus spinal cord lesion stage were 100.0% and 86.7%. （11） The incidence rates of hypertrophy of yellow ligament and its compression on spinal cord at the latter 4 pathological stages were 20.0%, 30.0%, 46.7%, 60.0% respectively. （12） The incidence rate of changes of spinal signal and its degenerated severity at intervertebral disc protrusion plus spinal cord lesion stage was 100.0%. The chi-square test was applied to the incidence rate of each observational index at each clinical stage （P=-0.0-0.3）. CONCLUSION： ① In the different pathological types of cervical spondylotie myelopathy, there are occurrences of corresponding MRI obser- vational indexes of cervical spondylotie myelopathy, and the MRI changes are closely associated with the pathological stages. ② The pathological types of patients cervical spondylotic myelopathy can be judged from the MRI manifestations, which are significant for the choice of therapeutic methods and the judgement of prognosis.