髓内MRI T2WI信号强度对多节段脊髓型颈椎病手术治疗方案的指导意义

Significance of intramedullary MRI T2WI signal intensity in surgical treatment of multilevel cervical spondylotic myelopathy

目的探究颈脊髓内磁共振成像(magnetic resonance imaging,MRI)T2加权像(T2WI)信号强度对多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM)手术治疗方案的指导意义。方法回顾性分析2017年4月-2019年4月秦皇岛市第一医院收治的131例MCSM患者的临床资料,术前所有患者行高分辨率1.5 T MR成像并量化髓内MRIT2WI信号强度比值,依据该比值数据大小将患者分为低信号强度比值组(n=60)、中信号强度比值组(n=42)、高信号强度比值组(n=29),分析各组患者在颈前路、颈后路手术治疗方法下的日本整形外科协会(JOA)评分、改善率及术后并发症发生率,并分析髓内MRI T2WI信号强度与MCSM患者手术治疗改善率的相关性。结果不同术式的低信号强度比值组患者术前JOA评分、术后JOA评分、改善率及术后并发症发生率差异无统计学意义(P>0.05);不同术式的中信号强度比值组患者术前JOA评分差异无统计学意义(P>0.05);不同术式的中信号强度比值组患者术后JOA评分、改善率及术后并发症发生率差异具有统计学意义(P<0.05);不同术式的高信号强度比值组患者术后JOA评分、改善率及术后并发症发生率差异具有统计学意义(P<0.05);各信号等级组患者术前JOA评分、术后JOA评分、改善率及术后并发症发生率差异具有统计学意义(P<0.05);髓内MRI T2WI信号强度与MCSM患者手术治疗改善率呈负相关(P<0.05)。结论颈前、后入路2种术式在不同T2WI信号强度下均显示出不同手术疗效,因此量化颈脊髓内MRIT2WI信号强度等级有助于指导临床多节段脊髓型颈椎病手术治疗方案的选择,建议在临床推广应用。

Objective To investigate the value of intramedullary MRI T2WI signal intensity in surgical treatment of multilevel cervical spondylotic myelopathy(MCSM). Methods The clinical data on 131 MCSM patients admitted to our hospital between April 2017 and April 2019 was analyzed retrospectively. All the patients received the 1.5 T MRI examination before surgery. According to the signal intensity ratio, these patients were divided into three groups: the low signal intensity ratio group(n=60), middle signal intensity ratio group(n=42), and high signal intensity ratio group(n=29). The JOA score, improvement rate and incidence of complications after anterior and posterior cervical surger y were compared between the three groups. Results The difference in the preoperative JOA score, post-operative JOA score, improvement rate and incidence of complications was not statistically significant between patients treated with different surgical approaches in the low signal intensity ratio group(P>0.05). Preoperative JOA scores in the middle signal intensity ratio group were not significantly different between recipients of different surgery(P>0.05), but postoperative JOA scores, improvement rates and the incidence of postoperative complications were significantly different(P<0.05). The difference in the preoperative JOA score, postoperative JOA score, improvement rate and incidence of postoperative complications was statistically significant between patients treated with different surgical approaches in the high signal intensity ratio group(P<0.05). The difference in the preoperative JOA score, postoperative JOA score, improvement rate and incidence of postoperative complications was statistically signif icant between the three groups(P<0.05).There was a negative correlation between intramedullary MRI T2WI signal and the improvement rate of operation in patients with MCSM(P<0.05). Conclusion The anterior and posterior approaches to the cer vical spine lead to different surgical outcomes under different signal intensities of T2 WI. Therefore, quantifying the signal intensities of T2WI in the cervical spinal cord can help the selection of surgical approaches for MCSM patients.