脊髓型颈椎病MRI T2信号变化与颈椎活动度的关系

Relationship between spinal cord T2 signals of MRI cervical changes and disease activity of cervical spondylotic myelopathy.

目的探讨脊髓型颈椎病患者MRI T2 WI病理信号变化的危险因素。MRI T2 WI信号变化在脊髓型颈椎病患者经常出现,信号强度的不同反映了脊髓的不同病理改变和颈椎病的发生和发展,但目前没有对引起MRI T2 WI信号变化的危险因素进行探讨,尤其是对颈椎病的发生和发展有着重要影响的颈椎动态特性。方法自2009年5月至2012年5月,符合研究纳入标准的71例脊髓型颈椎病患者纳入本研究。按MRI T2 WI信号强度分为三组:组1,信号无增强;组2,信号轻微增强;组3,信号明显增强。颈椎动态指标采用测量直立位颈椎过屈过伸侧位片Cobb角。结果各组间年龄、症状持续时间、术前JOA评分及性别比例差异无统计学意义(P>0.05)。各组间颈椎整体过屈、过伸弧度、活动度,颈椎节段过屈差异无统计学意义(P>0.05)。组1与组2、组3在节段过伸弧度与节段活动度差异有统计学意义(P<0.05),组2和组3在节段过伸弧度与节段活动度差异无统计学意义(P>0.05)。结论颈椎节段过伸弧度和活动度增加是脊髓型颈椎病MRI T2 WI出现高信号变化的危险因素。

Objective To determine the risk factors for high-intensity lesions observed on T2-weighted magnetic resonance images（T2WIs） in patients with cervical spondylotic myelopathy（CSM）.Intramedullary high signal intensity is frequently observed on MRI T2WIs from CSM patients and represents pathological changes in spinal cord.However few have attempted to identify the risk factors,especially cervical kinematics,for such changes in MRI signals.Methods This study included 71 CSM patients who were admitted to our hospital between May 2009 and May 2012（44 men,27 women;average age,52.5±11.7 years）.They were divided into three groups depending on T2WI data： group 1,no hyperintensity;group 2,slight hyperintensity;and group 3,bright hyperintensity.The Cobb angle in cervical flexion-extension radiography was measured as a parameter of cervical spine dynamics.Results Age,gender ratio,symptom duration and preoperative Japanese Orthopedic Association（JOA） score had no significant difference among the groups（P0.05）.Similarly,total hyperflexion,hyperextension curvatures,range of movement（ROM） and segmental hyperflexion curvature showed no significant difference among the groups（P0.05）.Segmental hyperextension curvature and ROM were significantly greater in groups 2 and 3 than in group 1（P0.05）,but there was no significant difference between groups 2 and 3（P0.05）.Conclusion Increased segmental hyperextension curvature and ROM are risk factors for high-intensity lesions on T2WIs in CSM patients.