MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病的治疗

Treatment of mild cervical spondylotic myelopathy with increased signal intensity on T2-weighted magnetic resonance imaging

目的分析比较MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者行手术治疗和非手术治疗的临床效果,初步探讨可能影响预后的相关因素。方法 2008年7月年-2011年6月,收治轻度脊髓型颈椎病患者91例符合纳入标准,进行回顾性研究,以日本骨科学会（Japanese Orthapaedic Association,JOA）评分改善率作为治疗后临床效果的评估指标,比较手术治疗和非手术治疗的情况。进一步将JOA评分改善率与治疗方式、性别、年龄、病程、节段性前凸角、C2-7活动度、脊髓受压程度进行相关及多元线性回归分析,筛选影响疗效的相关因素,并进一步明确其与治疗后临床效果的关系。结果根据治疗方法不同将本组病例分为2组,A组53例,采用颈前路减压植骨融合钢板内固定手术进行治疗,平均随访30.68个月。B组38例采用非手术治疗,平均随访34.68个月。对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,手术治疗与非手术治疗相比,两者临床疗效差异无统计学意义。病程（P〈0.01）、节段性前凸角（P〈0.01）2个因素与JOA评分改善率之间存在显著相关性。多元线性回归结果表明,病程较短、节段性前凸角较大的患者治疗后效果较好。结论对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,其手术治疗和非手术治疗并无显著差异,然而病程较短、节段性前凸角较大的患者治疗的效果优于病程较长、节段后凸的患者。

Objective To compare clinical outcomes of surgery or conservative treatment for patients with mild cervical spondylotic myelopathy（ CSM） and intramedullary increased signal intensity（ ISI） on T2-weighted imaging（ T2WI） of magnetic resonance imaging（ MRI）. Related factors that may affect prognosis were explored. Methods Data of 91 patients treated from July 2008 to June 2011 were retrospectively analyzed. The Japanese Orthopaedic Association（ JOA） improvement rate was used to compare outcomes of surgery and conservative treatment. Correlation and multiple linear regression analyses were performed between JOA improvement rate and age,disease course,segmental lordosis,C2-7range of motion（ ROM）,or extent of spinal cord compression. Results Patients were divided into 2 groups by therapy methods： Group A（ n = 53）underwent anterior cervical decompression and fusion surgery,average followed-up was 30. 68 months; Group B（ n = 38）received conservative treatment,average followed-up was 30. 68 months. There were no significant differences in clinical outcomes between the 2 groups. There were significant correlations between JOA improvement rate and clinical course（ P〈0. 01） or segmental lordosis（ P〈0. 01）. Patients with shorter disease course and larger segmental lordosis have better clinical outcomes as showed by multiple linear regression analysis. Conclusion For mild CSM patients with high ISI on T2WI-MRI,there are no significant differences in clinical outcome between surgery and conservative treatment. Patients with shorter disease course and larger segmental lordosis have better clinical outcomes than those with longer course and segmental kyphosis.