多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的手术入路选择及疗效分析

Analysis on the choice of surgical approaches and clinical effect on multilevel cervical spondylotic myelopathy with MRI T2WI intramedullary high signal

目的 ：比较不同手术入路治疗多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的手术疗效,为手术方案的选择提供理论依据。方法：收集2011年1月~2014年12月就诊于上海长征医院脊柱外科的45例多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的临床资料,根据手术入路的不同分为颈前路手术组（A组）和颈后路手术组（B组）,其中A组男17例,女5例,年龄54.36±6.18岁;B组男19例,女4例,年龄58.09±8.83岁。在颈椎MRI T2WI上测量0.1cm2的高信号区与同一矢状面上0.1cm2正常颈髓内信号区的强度比值,比较两组患者末次随访时的JOA评分、神经功能改善率、髓内高信号强度比值及术后并发症的发生率。结果：所有患者均定期随访,随访时间为16.84±9.95个月。两组患者性别构成比、年龄、病程、病变节段数、术前JOA评分、术前髓内高信号强度比值、术后随访时间均无统计学差异（P〉0.05）。A组末次随访时JOA评分为14.64±1.09分,B组为13.09±1.56分,A组明显高于B组（P〈0.05）;A、B组神经功能改善率分别为（64.14±12.76）%、（35.08±20.52）%,A组神经功能改善率明显优于B组（P〈0.05）。A组末次随访时髓内高信号强度比值为1.36±0.14,B组为1.53±0.15,A组显著低于B组（P〈0.05）。A组患者术后并发症发生率为13.64%,B组为13.05%,两组间比较差异无统计学意义（P〉0.05）。结论 ：多节段脊髓型颈椎病伴髓内MRI T2WI高信号时,前、后路手术后患者的神经功能和髓内高信号强度均有改善,但前路手术能更好地提高术后神经功能,并降低髓内高信号强度比值。

Objectives： To analyze the clinical effect of different surgical approaches on multilevel cervical spondylotic myelopathy with MRI T2 WI intramedullary high signal, and to provide guidance for clinical surgical strategy. Methods： The clinical data from 45 patients who had multilevel cervical spondylotic myelopathy with MRI T2 WI intramedullary high signal from January 2011 to December 2014 were retrospectively selected.The patients were divided into two groups based on the surgical approaches： group A comprised 17 men and5 women（average age, 54.36±6.18 years） who underwent anterior approach surgery, and group B comprised 19 men and 4 women（average age, 58.09 ±8.83 years） who underwent posterior approach surgery. The intramedullary high signal intensity ratio was defined as the ratio of the signal intensity of 0.1cm2 zone in high signal zone and normal signal zone in cervical MRI T2 WI. The JOA score, improvement rate of neurological function, change of intramedullary high signal intensity ratio and the incidence rate of complications were assessed in both groups. Results： All patients were followed up regularly, and the average follow-up period was16.84±9.95 months. There were no significant differences with regard to gender, age, duration of disease,number of lesion segments, preoperative JOA score, preoperative intramedullary high signal intensity ratio and the follow-up time between two groups（P〉0.05）. The average of final postoperative follow-up JOA score in group A was 14.64±1.09 and that in group B was 13.09±1.56, and the average of final postoperative followup JOA score in group A was significantly higher than that in group B（P〈0.05）. The improvement rate of neurological function of two groups was（64.14±12.76）% and（35.08±20.52）%, respectively, which showed significant difference（P〈0.05）. The average of intramedullary high signal intensity ratio was 1.36±0.14 in group A and 1.53±0.15 in group B. The average of high signal intensity ratio in group A was significantly lower than that in group B（P〈0.05）. The incidence rate of complications was 13.64% in group A and 13.05% in group B, which showed no difference between two groups（P〉0.05）. Conclusions： When confronting patients of multilevel cervical spondylotic myelopathy with MRI T2 WI intramedullary high signal, both anterior and posterior surgical approaches can improve the neurological function and intramedullary high signal intensity.But the anterior approach can better improve the neurological function and decrease intramedullary high signal intensity ratio.