术中剪切波弹性成像测量脊髓弹性模量的初步研究

Preliminary study of spinal cord elastic modulus evaluated by intraoperative shear wave elastography

目的 :探讨术中剪切波弹性成像(shear wave elastography,SWE)测量脊髓型颈椎病患者脊髓弹性模量变化的可行性与应用价值。方法:对17例行颈椎后路椎管扩大成形术的脊髓型颈椎病患者行术中SWE。其中男11例,女6例;年龄58.18±11.49岁(37~78岁);病程2~180个月(62.06±52.54个月);4例C3/4,4例C4/5,5例C5/6,2例C3/4、C4/5,1例C4/5、C5/6,1例C5/6、C6/7;术前JOA评分为6.5~15分(10.74±2.62分),身体质量指数(BMI)为26.02±3.15kg/m2(19.33~30.76kg/m2),病变节段脊髓扁平率为(40.07±9.43)%(24.14%~52.93%)。术中定量测量正常节段和受压节段脊髓弹性模量的均值(Mean)、最大值(Max)、最小值(Min)及标准差(SD),并重复操作两次,对前后两次测量的数据结果使用组内相关系数(ICC)检验其重测信度。应用配对t检验分析两组弹性模量的差异,使用t检验分析不同性别正常脊髓弹性模量的差异,应用Pearson相关分析患者年龄及BMI与正常节段脊髓弹性模量的关系,应用Pearson相关分析患者病程、脊髓扁平率及JOA评分与受压节段脊髓弹性模量的关系。结果:正常节段脊髓弹性模量ICC为0.964(95%CI:0.902~0.987),受压节段脊髓弹性模量的ICC为0.842(95%CI:0.564~0.943)。受压节段脊髓弹性模量的均值、最大值和最小值均显著低于正常脊髓(P<0.01)。患者BMI与正常节段脊髓弹性模量间呈正相关(R^2=0.39,P=0.005),年龄与正常脊髓弹性模量无显著相关性(P=0.88)。男性与女性间正常脊髓弹性模量无显著性差异(P=0.68)。病程、脊髓扁平率、JOA评分与受压节段脊髓弹性模量均无显著相关性(分别为:R^2=0.001,P=0.89;R^2=0.004,P=0.80;R^2=0.11,P=0.19)。结论:术中SWE测量脊髓型颈椎病患者脊髓的弹性模量具有可行性,并发现病变脊髓的弹性模量会有所下降。

Objectives： To investigate the clinical value and the feasibility of intraoperative shear wave elastography（SWE） in cervical spondylotic myelopathy by measuring spinal cord elastic modulus. Methods： 17 patients undergoing cervical laminoplasty for cervical spondylotic myelopathy in our hospital were evaluated spinal cord elastic modulus by using SWE. There were 11 males and 6 females, aged 58.18±11.49 years old（range, 37-78）, duration of disease was from 2 to 180 months（62.06±52.54）. There were 4 cases of C3/4, 4 cases of C4/5, 5 cases of C5/6, 2 cases C3/4, C4/5, 1 case of C4/5, C5/6, 1 case of C5/6, C6/7. Preoperative JOA score was averaged 10.74±2.62（6.5-15）, BMI was 26.02±3.15kg/m2（range, 19.33-30.76kg/m2）, compressed spinal cord flattening rate was （40.07±9.43）%（range, 24.14%-52.93%）. Mean, max, min and standard deviation of normal segment and lesion compression segment spinal cord elastic modulus were measured twice. Paired t-test was used to analyze the difference of elastic modulus between the normal and compressed segment spinal cord. t-test was used to analyze the difference of the normal spinal cord elastic modulus between male and female. Pearson correlation was used to analyze the relationship between age, BMI and the elastic modulus of normal segment spinal cord. Pearson correlation was also used to analyze the relationship between the duration of disease, cord flattening rate, JOA scores and elastic modulus of the compressed segment spinal cord. The retest reliability was tested by using the intra-group correlation coefficient（ICC）. Results： The mean, max and min values of the elastic modulus of compressed segment were significantly lower than those of normal spinal cord （P〈0.01）. There was a positive correlation between BMI and normal segment spinal cord elastic modulus（R2=0.39,P=0.005）. There was no significant correlation between age and normal segment spinal cord elasticity（P=0.88）. There was no significant difference in spinal cord elastic modulus between male and female（P=0.68）. There was no significant correlation between the duration of disease（R2=0.001, P=0.89）, cord flattening rate（R2=0.004, P=0.80）, JOA scores（R2=0.11, P=0.19） and elastic modulus of the compressed segment spinal cord. The ICC of the elastic modulus in normal segment spine cord was 0.964（95%CI, 0.902-0.987）, and which of compressed segment spine cord was 0.842（95%CI, 0.564-0.943）. Conclusions： The spinal cord elastic modulus in patients with cervical spondylotic myelopathy measured by SWE is feasible. The elastic modulus will decrease in lesion spinal cord.