剪切波弹性成像在颈椎病患者脊髓功能障碍评估中的价值

Value of shear wave elastography for evaluating the spinal cord dysfunction in patients with cervical spondylotic myelopathy

目的探讨剪切波弹性成像(SWE)技术评估脊髓型颈椎病患者脊髓功能障碍的价值。方法选择脊髓型颈椎病患者26例,术前行颈椎MRI检查测算病变节段脊髓的扁平率,并用日本骨科协会(JOA)评分对脊髓功能进行评价。患者均行棘突纵割式椎板成形术治疗,术中用Supersonic Imagine Aix Plorer型实时SWE超声诊断仪测量正常节段与病变节段脊髓的弹性模量,计算脊髓弹性模量下降比;分析患者年龄、病程、脊髓扁平率、JOA评分与脊髓弹性模量下降比间的关系,用组内相关系数(ICC)检验SWE技术的可重复性。结果患者病变节段脊髓的弹性模量低于正常节段脊髓的弹性模量(P<0.01)。脊髓弹性模量下降比为42.4%±23.5%。脊髓弹性模量下降比与患者年龄、病程、病变节段脊髓扁平率无相关性(r分别为0.147、0.268、0.262,P均>0.05),与术前JOA评分呈负相关(r=-0.426,P<0.05)。正常节段脊髓弹性模量的ICC为0.959(95%CI:0.912~0.982),病变节段脊髓弹性模量的ICC为0.832(95%CI:0.660~0.921),SWE测量脊髓弹性模量有很好的可重复性。结论 SWE检查可区分脊髓型颈椎病患者的正常与病变脊髓,其测算的弹性模量下降比可反映脊髓功能障碍程度。

Objective To evaluate the feasibility and diagnostic value of shear wave elastography（ SWE） in assessing spinal cord dysfunction in patients with cervical spondylotic myelopathy. Methods Twenty-six patients with myelopathy were included in our study,the cord compression rate was evaluated by preoperation MRI,and Japanese Orthropeadic Assocition（ JOA） scores were also evaluated. All patients were treated by cervical laminoplasty,the elastic modulus of normal segment and the compressed segment spinal cord were measured by Supersonic Imagine Aix Plorer real-time SWE,and the decline ratio of the elastic modulus was also calculated; the relationships between the age,duration of disease,cord compression rate,JOA scores and the decline ratio of elastic modulus were analyzed. Results The elastic modulus of compressive segment was significantly lower than those of normal spinal cord（ P〈0. 01）. The decline ratio of elastic modulus was 42. 4% ± 23. 5%. There was no significant correlation between the age,duration of disease,cord flattening rate and the decline ratio of elastic modulus（ r = 0. 147,0. 268,0. 262,all P〉0. 05）. There was a significant negative correlation between JOA scores and the decline ratio of elastic modulus（ r =-0. 426,P = 0. 03）. The ICC of the normal segment elastic modulus was 0. 959（ 95% CI： 0. 912-0. 982）,and the ICC of the compressed segment elastic modulus was 0. 832（ 95% CI： 0. 660-0. 921）. Conclusions SWE could distinguish the normal and compressed spinal cord and the decline ratio of elastic modulus could reflect the spinal cord dysfunction.