多节段脊髓型颈椎病在不同MRI T2信号强度下三种手术方法疗效的回顾性研究

Comparison of three surgical approaches for multilevel cervical spondylotic myelopathy by classification of quantifying MRI T2 signal intensity ratio

目的探讨多节段脊髓型颈椎病量化MRI T2信号强度等级后，不同手术方法选择的临床应用价值。方法 2000年12月至2007年11月，共116例多节段脊髓型颈椎病患暂，分别接受不同术式治疗。男86例，女30例；年龄31-78岁，平均58．73岁，术前所有患耆均行高分辨率1．5TMR成像并量化脊髓信号强度比值．将患者按比值大小平均分为三组，重点分析各信号等级组内患者及全体患者在三种手术治疗方法下的JOA评分改善率。结果所有患者获得至少12个月随访，最长随访5年，中位随访14．5个月，术前JOA评分为（8．68±2．26）分，术后1年为（12．16±3．07）分，改善率为55．13％±15．27％。经秩和检验，在低信号强度比值组．改善率于三组间差异无统计学意义。在中信号强度比值组，改善率于三组间差异有统计学意义；进一步两两比较显示，前路手术组（71％）与后路手术组（47％）、后路手术组与前后路手术组（64％）改善率差异有统计学意义。在商信号强度比值组，改善率于三组间差异有统计学意义；进一步两两比较显示，前路手术组（20％）与后路手术组（36％）、前路手术组与前后路手术组（28%）改善率差异有统计学意义。结论手术是治疗多节段颈椎病的有效方法，区分颈脊髓MRIR信号强度等级后，不同术式的疗效显示出相直差异。

Objective To assess the clinical value of three approaches for muhilevel cervical spondylotic myelopathy according to classification of quantifying MRI T2 signal intensity ratio. Methods From December 2000 to November 2007, 116 patients treated with anterior, posterior, or posterior-anterior combined surgery for multilevel cervical myelopathy were enrolled retrospectively in this study. There were 86 males and 30 females, with the mean age of 58.73 years. Each patient underwent 1.5 T MRI examination before surgery. All patients were divided into three groups by signal intensity ratio. The improvement rate of JOA score were studied in groups according to classification with signal intensity ratio or different surgical approach. Results All patients were followed up for 1-5 years, with the median of 14.5 months. The JOA score in 116 patients was 8.68±2.26 preoperatively, and 12.16±3.07 twelve months postoperatively. The mean recovery rate was 55.13%±15.27% at final follow-up. With the Kruskal-Wallis test for recovery rate, in the group of low signal intensity ratio, there were no significant difference among three surgical approaches. In the group of middle signal intensity ratio, there showed significant difference among three surgical approaches. The SNK test showed significant difference between groups of anterior （71%） and posterior （47%） decompression, posterior and posterior-anterior combined（64%） decompression for recovery rate. In the group of high signal intensity ratio, there also showed significant difference among three surgical approaches. The SNK test showed significant difference between groups of anterior （20%） and posterior （36%） decompression, anterior and posterior-anterior combined （28%） decompression for recovery rate. Conclusion Surgical decompression for multilevel cervical spondylotie myelopathy can significantly improve the neurological function, and the classification of quantifying MRI T2 signal intensity ratio can discriminate the outcome of differ- ent surgical approach.