不同影像学特点的脊髓型颈椎病的手术治疗

Surgical treatment for cervical spondylotic myelopathy with different characteristics in imaging examinations

目的：探讨不同影像学特点的脊髓型颈椎病的临床特点、手术方法和临床疗效。方法回顾性分析2011年11月至2013年10月手术治疗并获得半年以上随访的221例脊髓型颈椎病患者资料，按照影像学评价标准即颈椎退变的程度和形式分成轻度、中度、重度三组。轻度组79例，男48例，女31例；年龄37～74岁，平均（54.9±10.2）岁；病程6～250个月，平均（26.1±37.2）个月。中度组89例，男61例，女28例；年龄31～82岁，平均（59.7±9.2）岁；病程6～250个月，平均（36.7±42.7）个月。重度组53例，男36例，女17例；年龄33～88岁，平均（62.9±12.1）岁；病程6～240个月，平均（43.5±47.8）个月。比较三组患者的一般资料、影像学特点、手术选择、不同术式比率和末次随访的日本骨科协会（Japanese Ortho-paedic Association，JOA）评分及其改善率；应用单因素卡方检验或方差分析对三组间JOA改善率、年龄、性别、病程、脊髓受压程度、脊髓受压节段数、颈椎退变程度、颈椎不稳、T2高信号、发育性椎管狭窄、后纵韧带骨化等进行统计学分析。结果三组患者性别无差异；轻度和重度组病程有差异；三组的平均年龄、术前JOA评分和术后JOA评分改善率有差异，轻度和中度、轻度和重度之间有差异，中度和重度组无差异。所有病例均采用前路或后路手术完成减压和重建，轻、中、重度组前路手术比率分别是91.1%（72/79）、79.8%（71/89）、35.8%（18/53）。影像学特点复杂程度越低，前路手术的比例越高，影像学特点的复杂程度越高，后路手术的比例越高。轻、中、重度组末次随访的平均改善率分别是75.4%±6.4%、67.7%±8.7%、62.8%±10.4%。年龄、病程、术前JOA评分、脊髓受压程度、受压节段数、颈椎退变程度、T2WI髓内高信号、后纵韧带骨化、发育性椎管狭窄和改善率相关。结论脊髓型颈椎病依据不同影像学标准分组，选择适当术式，临床疗效良好。

Objective To investigate the clinical features, operation procedures and clinical outcomes of cervical spondy-lotic myelopathy with different imageological characteristics. Methods Two hundred and twenty one cervical myelopathy with different imageological characteristics patients between November 2011 and October 2013 were involved in this retrospective study. Patients were distributed into three groups, namely mild group （A）, moderate group （B） and severe group（C）, based on severi-ty of complexity by imageological variables （severity of cervical spine degeneration, the number of spinal cord compression, severi-ty of spinal cord compression and difficulty in operation）. Preoperative and postoperative Japanese Orthopaedic Association （JOA） score and mean recovery rate were collected to evaluate the postoperative clinical effects. Demographic data and imageological characteristics were recorded;Univariate analysis or analysis of variance was conducted to analyze the correlation between post-operative JOA recovery rate with gender, age, course of disease, severity of spinal cord compression, the number of segment with spinal cord compression, severity of disc degeneration, MRI T2 increased signal intensity, cervical instability, cervical kyphosis, developmental cervical spinal stenosis and ossification of posterior longitudinal ligament. Results There was no significant differ-ence in gender between three groups. There was significant difference in age, preoperative JOA score and improvement rate be-tween group A and group B （C）. All patients received decompression and reconstruction by anterior or posterior approach. The ra-tio of anterior approach in group A, B and C was 91.1%（72/79）, 79.8%（71/89）, 35.8%（18/53）. The last follow-up JOA recovery rate of group A, B and C was 75.4%±6.4%、67.7%±8.7%、62.8%±10.4%. The last follow-up JOA recovery rate was correlated with duration of disease, the number of spinal cord compression and severity of spinal cord compression. Age, duration of course, preop-erative JOA score, degree of cord compression, the number of segment with cord compression, degree of disc degeneration, MRI T 2 increased signal intensity, cervical instability, cervical kyphosis, developmental cervical spinal stenosis and OPLL. Conclusion Patients suffering from cervical myelopathy with different imageological have good prognosis by appropriate operation procedure.