颈椎椎管狭窄症前路手术后脑脊液带改变与手术疗效及预后的相关性

Correlation between changes of cerebrospinal fluid band and both surgical efficacy and prognosis after anterior surgery for cervical spinal stenosis

目的探讨颈椎椎管狭窄症(CSS)前路手术后脑脊液带的改变与手术疗效和预后的相关性。方法回顾性分析2016年1月—2019年11月在淮北矿工总医院接受前路手术治疗的57例CSS患者临床资料,测量术前和术后3个月MRI T2加权像上脊髓受压最严重节段的硬膜囊前后径(Ds)、脊髓前后径(Dc),采用二者比值(Ds/Dc)判断脑脊液带的连续性和充盈性。术前和术后3个月采用改良日本骨科学会(mJOA)评分评估患者脊髓功能,采用mJOA评分改善率评价手术效果。以mJOA评分改善率为因变量,以术后Ds、Dc、Ds/Dc及术前mJOA评分为自变量,作线性回归分析,评估脑脊液带变化对术后脊髓功能恢复的影响。结果57例患者脊髓受压1个节段18例,2个节段16例,3个节段14例,4个节段7例,5个节段2例。术前Ds、Dc和Ds/Dc分别为(8.92±2.09)mm、(6.02±2.83)mm和1.51±0.30,术后3个月Ds、Dc和Ds/Dc分别为(9.76±1.02)mm、(6.84±0.91)mm和1.43±0.14。术前mJOA评分为(11.95±2.47)分,术后3个月mJOA评分为(15.93±1.13)分,术后3个月mJOA评分改善率为(82.06±18.43)%。依据回归方程计算,mJOA评分改善率与术后Ds/Dc显著相关(r=0.842)。结论CSS患者前路手术后,MRI T2加权像上脑脊液带连续性恢复、充盈完全者疗效较好,预后佳。通过对MRI T2加权像上脑脊液带改变情况的观察可预判术后疗效。

Objective To investigate the correlation between the changes of cerebrospinal fluid band and both surgical efficacy and prognosis of anterior surgery for cervical spinal stenosis(CSS).Methods The clinical data of 57 patients with CSS who underwent anterior surgery in Huaibei Miners General Hospital from January 2016 to November 2019 were analyzed retrospectively.The anteroposterior diameter of dural sac(Ds),anteroposterior diameter of spinal cord(Dc)and their ratio(Ds/Dc)of the most severely compressed segment of spinal cord on T2 weighted MRI at pre-operation and postoperative 3 months were measured,and their changes after operation were measured to judge the continuity and filling of cerebrospinal fluid band.The spinal cord function was evaluated by the modified Japanese Orthopaedic Association(mJOA)score before and 3 months after operation,and the surgical effect was evaluated by the improvement rate of mJOA score.Taking the improvement rate of mJOA score as the dependent variable and postoperative Ds,Dc,Ds/Dc and preoperative mJOA score as the independent variables,linear regression analysis was performed to evaluate the effect of cerebrospinal fluid band changes on postoperative spinal cord function recovery.Results Of all the 57 patients,18 patients had spinal cord compression in 1 segment,16 in 2 segments,14 in 3 segments,7 in 4 segments and 2 in 5 segments.The preoperative Ds,Dc,Ds/Dc were(8.92±2.09)mm,(6.02±2.83)mm and 1.51±0.30,respectively.Ds,Dc,Ds/Dc at postoperative 3 months were(9.76±1.02)mm,(6.84±0.91)mm and 1.43±0.14,respectively.The preoperative mJOA score was 11.95±2.47 and mJOA score at postoperative 3 months was 15.93±1.13.The improvement rate of mJOA score 3 months after operation was(82.06±18.43)%.According to the regression equation,the improvement rate of mJOA score was significantly correlated with postoperative Ds/Dc(r=0.842).Conclusion After anterior surgery,CSS patients have better therapeutic effect and better prognosis when the continuity and filling of cerebrospinal fluid band on T2 weighted MRI are complete.The postoperative effect can be predicted by observing the changes of cerebrospinal fluid band on T2 weighted MRI.