影像学评分对多节段脊髓型颈椎病术式选择的意义

The clinical significance of the imageologicai score for the choice of operative approach in the multilevel cervical spondylosis myelopathy

目的制定影像学评分标准,探讨其对多节段脊髓型颈椎病术式选择的指导意义。方法回顾性分析1998年1月至2005年6月行手术治疗的多节段脊髓型颈椎病226例资料。分为前路手术、前后联合及后路手术组,统计每组中六项影像学指标（颈椎稳定性、局限性骨化、脊髓受压程度、黄韧带肥厚、先天性颈椎管狭窄、后纵韧带连续性骨化）的频数,用判别分析最大似然法得出影像学指标的得分。应用回顾性研究得出的影像学评分方法前瞻性判断2005年8月至2006年2月收治的多节段脊髓型颈椎病65例的术式选择,各术式影像学总分最高者即为推荐术式。两组患者的术式选择均依据各术式的适应证,由同一组手术医生完成。比较两组术前、术后JOA评分及改善率。结果制定出的影像学评分标准对回顾性研究组的判别符合率为84.1%,对前瞻性研究组的判别符合率为80.0%。所有患者随访6～18个月,平均12.6个月。症状均有不同程度缓解,两组术前、术后JOA评分比较差异有统计学意义;其症状改善率分别为59.61%±8.06%和60.26%±6.40%,差异无统计学意义。结论该影像学评分标准对多节段脊髓型颈椎病术式的选择可能有一定的指导意义,使术式选择更加规范、量化。

Objective To institute the standard of imageologieal score and to explore its clinical significance for the choice of operative approach in the multilevel cervical spondylosis myelopathy （MCSM）. Methods 226 MCSM patients with different operations from January 1998 to June 2005 were retrospectively analyzed. The cases were divided into three groups： anterior approach, anterior-posterior united approach, and posterior approach. The six imageologieal pykno-indexes of every group were collected, which were： the stability of cervical vertebra, the existence of local ossification, the degree of spinal cord compression, the plumpness of ligamenta flava, the existence of inborn cervical spinal stenosis, and the continual ossification of posterior longitudinal ligament. The maximum likelihood method of discriminatory analysis was adopted to analyze the six imageological indexes. The scores of the imageology were got. The operative approachs of 65 cases from August 2005 to February 2006 were studied by the scores, and studied by prospective analysis. The imageologieal scores of each approach for every case were calculated respectively before operation, the one with the highest score was selected. The JOA before and after operation of retrospective and prospective cases were compared. Results The coincidence rate of the imageologieal score was 84.1% for retrospective, 80.0% for prospective discrimination. All the cases were followed up from 6 to 18 months, averaged 12.6 months. The symptoms of the cases were relieved by different degree and there were no other severe complications. The JOA before and after operation had statistical significance for the retrospective and also for prospective cases; while the improvement rate was 59.61%±8.06% for the retrospective, 60.26%±6.40% for prospective cases, without statistical significance. Conclusion The imageologieal score is able to direct the choice of operative approach in multilevel cervical spondylotie myelopathy, and make it standardize and quantization.