MRI下颈长肌容积测量在脊髓型颈椎病患者ACDF术后疗效预测中的意义

The significance of measuring the volume of the cervical longus muscle under MRI in predicting the postoperative efficacy of ACDF in patients with cervical spondylotic myelopathy

目的探讨磁共振成像(MRI)下颈长肌容积测量在脊髓型颈椎病(CSM)患者颈椎前路椎间盘切除融合术(ACDF)术后疗效预测中的应用价值。方法选取本院接受ACDF治疗的68例CSM患者的临床资料。所有患者均在手术前进行MRI检查,测量手术节段相对应的颈长肌肌肉截面积和层厚,计算患者的颈长肌容积,分析颈长肌容积预测术后疗效的价值。结果68例患者手术疗效优秀38例(为手术疗效优秀组),占55.88%(38/68),30例患者手术疗效良好(为手术疗效良好组),占44.12%(30/68);手术疗效优秀组术前颈长肌容积低于手术疗效良好组,术后15个月视觉模拟评分法(VAS)评分、颈部功能障碍指数(NDI)均低于手术疗效良好组,改良日本骨科协会评分(mJOA)高于手术疗效良好组,差异均有统计学意义(P<0.05);经双变量Pearson相关性分析,CSM患者ACDF术前颈长肌容积分别与VAS评分、NDI评分呈负相关关系(r=-0.482、-0.377,P<0.05),与mJOA评分无相关性(P>0.05);CSM患者ACDF术前颈长肌容积预测术后疗效的灵敏度为86.70%,特异度为78.90%,曲线下面积(AUC)为0.902,截断值为8525.70 mm^(3)。结论CSM患者ACDF术前颈长肌容积对术后疗效有一定预测价值,且其大小与VAS评分、NDI指数均呈负相关关系。

Objective To analyze the application value of magnetic resonance functional imaging(MRI)in measuring the volume of the cervical longus muscle in predicting the postoperative efficacy of anterior cervical discectomy and fusion(ACDF)in patients with cervical spondylotic myelopathy(CSM).Methods Clinical data of 68 CSM patients who received ACDF treatment were retrospectively collected.All patients underwent MRI examination before surgery to measure the cross-sectional area and layer thickness of the cervical longus muscle corresponding to the surgical segment,and to calculate the volume of the cervical longus muscle.And then,we analyzed the value of predicting postoperative efficacy by analyzing the volume of the cervical longus muscle.Results The surgical efficacy of 68 patients was excellent in 38 cases,accounting for 55.88%(38/68),and the other 30 patients had good surgical efficacy,accounting for 44.12%(30/68);the volume of longus colli muscle before operation in the excellent surgical efficacy group was lower than that in the good surgical efficacy group.The visual analogue scale(VAS)score and neck dysfunction index(NDI)at 15 months after operation were lower than those in the good surgical efficacy group,and the modified Japanese Orthopaedic Association score(mJOA)was higher than that in the good surgical efficacy group,with statistical significant differences(P<0.05).By bivariate Pearson correlation analysis,the volume of longus colli in CSM patients before ACDF was negatively correlated with VAS score and NDI score(r=-480,-0.377,P<0.05),but not with mJOA score(P>0.05).The sensitivity,specificity,area under the curve and cut-off value of cervical longus muscle volume before ACDF in CSM patients were 86.70%,78.90%,0.902 and 8525.70 mm^(3),respectively.Conclusion The volume of longus colli in CSM patients before ACDF has a certain predictive value for postoperative efficacy,and its size is negatively correlated with VAS score and NDI index.