脊髓型颈椎病合并椎体分节不良的临床及影像学的特点分析

doi:10.3760/cma.j.issn.2095-7041.2016.04.002

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摘要目的探讨脊髓型颈椎病合并椎体分节不良的临床及影像学特点。方法回顾性分析2004年2月—2013年7月河北医科大学第三医院脊柱外科收治的2 981例脊髓型颈椎病患者的临床资料,其中合并椎体分节不良患者71例纳入观察组,随机选取其中住院号尾数为单号的、无分节不良的单节段颈椎病患者80例为对照组。两组患者均采用前路手术完成减压和脊柱重建,观察颈椎分节不良的分布特点。比较两组患者术前颈椎活动度、颈椎曲度值、病变节段及相邻节段椎间盘退变程度、MRI T₂WI髓内高信号。采用术后6个月的JOA评分及其改善率评价临床效果。结果脊髓型颈椎病合并椎体分节不良发生率为2.4%(71/2 981),分节不良椎体为上位椎间隙8例、下位椎间隙53例、远隔椎间隙10例。观察组术前颈椎活动度(35.2°±6.5°)较对照组(47.3°±8.8°)低,差异有统计学意义(t=9.509,P<0.01);观察组和对照组术前颈椎曲度分别为24.3°±3.8°和25.8°±5.6°,差异无统计学意义(t=1.901, P>0.05)。观察组MRI T₂WI髓内高信号发生率为39.4%(28/71)显著高于对照组22.5%(18/80),差异有统计学意义(χ²=4.823,P<0.05)。观察组病变椎间盘平均退变分级高于对照组(Z=5.273, P<0.01),而颈椎分节不良椎体下位邻近节段椎间盘与上位邻近椎间盘分级差异均无统计学意义(P值均>0.05)。术后观察组及对照组患者平均JOA评分改善率分别为64.24%±9.49%和61.78%±11.48%,差异无统计学意义(t=1.388, P>0.05)。结论脊髓型颈椎病合并椎体分节不良影像学上表现椎间盘突出多发生于分节不良节段下位椎间隙,退变严重,颈椎活动度变小,但相邻节段和颈椎整体曲度影响不大。此类临床表现与脊髓型颈椎病相似,选择适当术式治疗,预后良好。

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	张旭
	丁文元
	王辉
	杨大龙
	白智龙
	王海莹
	魏海鲲

关键词 ：颈椎病, 椎体分节不良, 颈椎曲度, 活动度, 磁共振成像

Abstract：Objective To investigate the clinical and imaging characteristics of cervical spondylotic myelopathy with cervical fusion deformity.Methods From February 2004 to July 2013, 2 981 patients with cervical spondylotic myelopathy were involved in this retrospective study. The patients with cervical spondylotic myelopathy that combined with cervical fusion deformity were placed in the cervical fusion deformity group (n=71), and 80 patients, the hospital number mantissa were odd numbers,without cervical fusion deformity were included as control group. All patients received decompression and reconstruction by anterior approach. The distribution characteristics of cervical fusion deformity were recorded. The cervical spine activity, cervical spine curvature, the number of pathological segments and severity of adjacent segments disc degeneration, T₂WI increased signal intensity were then analyzed. Preoperative and postoperative Japanese Orthopaedic Association (JOA) score and mean recovery rate were collected to evaluate the postoperative clinical effects.Results Cervical disc herniation in the most of cervical spondylotic myelopathy patients with cervical fusion deformity, occured in a total of 8 patients in the upper intervertebral space of the cervical fusion deformity, 53 patients in the lower intervertebral space, and 10 cases in the adjacent segment intervertebral space.The mean cervical spine activity in the cervical fusion deformity group (35.2°±6.5°) was significantly lower than that in the controls (47.3°±8.8°) , the difference was statistically significant(t=9.509, P<0.01), while the average cervical spine curvature showed no significant difference (t=1.901, P>0.05). The prevalence of MRI T₂WI increased signal intensity was substantially higher in the cervical fusion deformity group (39.4%, 28/71) than that in control group (22.5%, 18/80), the difference was statistically significant(χ²=4.823, P<0.05). There was a significant increase in the severity of disc degeneration in the cervical fusion deformity group as compared with control individuals (Z=5.273, P<0.01), whereas the adjacent segment intervertebral space showed no significant difference (all P values>0.05). There was no significant difference in preoperative JOA score and improvement rate between the cervical fusion deformity group (64.24%±9.49%) and control group (61.78%±11.48%) (t=1.388, P>0.05).Conclusions The cervical disc herniation in cervical spondylotic myelopathy patients with cervical fusion deformity, occurs mostly in the lower intervertebral space in the imageology,and more serious degeneration than the controls. These patients have a lower spinal activity, but have no difference in the average cervical spine curvature and adjacent segment degeneration. Cervical spondylotic myelopathy with cervical fusion deformity is similar to the cervical spondylotic myelopathy in clinical manifestation while has good prognosis by appropriate operation procedure.

Key words： Cervical spondylosis Cervical fusion deformity Cervical spine activity Cervical spine curvature Magnetic resonance imaging

收稿日期: 2015-10-01

通讯作者: 丁文元, Email: dingwenyuan2012@126. com

引用本文:

张旭,丁文元,王辉,杨大龙,白智龙,王海莹,魏海鲲. 脊髓型颈椎病合并椎体分节不良的临床及影像学的特点分析[J]. 中华解剖与临床杂志, 2016, 21(4): 286-290.
Zhang Xu, Ding Wenyuan, Wang Hui, Yang Dalong, Bai Zhilong, Wang Haiying, Wei Haikun. The imaging and clinical features of cervical spondylotic myelopathy with cervical fusion deformity. Chinese Journal of Anatomy and Clinics, 2016, 21(4): 286-290.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2016.04.002 或 http://www.cjac.com.cn/CN/Y2016/V21/I4/286

[1]	Sharan AD, Krystal JD, Singla A, et al. Advances in the understanding of cervical spine deformity[J]. Instr Course Lect, 2015, 64: 417-426
[2]	Gallagher MJ, Chavredakis E, Carter D, et al. Cervical vertebral fusion with anterior meningocele[J]. Neuroradiol J, 2015, 28(2): 205-208. DOI:10.1177/1971400915576308.
[3]	Guan X, Fan G, Wu X, et al. Diffusion tensor imaging studies of cervical spondylotic myelopathy: a systemic review and meta-analysis[J]. PLoS One, 2015, 10(2): e0117707. DOI:10.1371/journal.pone.0117707.
[4]	Lawrence BD, Jacobs WB, Norvell DC, et al. Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: a systematic review[J]. Spine (Phila Pa 1976), 2013, 38(22 Suppl 1): S173-S182. DOI:10.1097/BRS.0b013e3182a7eaaf.
[5]	Harrison DE, Harrison DD, Cailliet R, et al. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis[J]. Spine (Phila Pa 1976), 2000, 25(16): 2072-2078
[6]	Ganju A, Ondra SL, Shaffrey CI. Cervical kyphosis[J]. Techniques in Orthopaedics, 2002, 17(3):345-354
[7]	Yukawa Y, Kato F, Yoshihara H, et al. MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes[J]. Spine (Phila Pa 1976), 2007, 32(15): 1675-1678. DOI:10.1097/BRS.0b013e318074d62e.
[8]	Miyazaki M, Hong SW, Yoon SH, et al. Kinematic analysis of the relationship between the grade of disc degeneration and motion unit of the cervical spine[J]. Spine (Phila Pa 1976), 2008, 33(2): 187-193. DOI:10.1097/BRS.0b013e3181604501.
[9]	方加虎, 贾连顺. 颈椎后凸畸形的影像学测量和诊断的研究进展[J]. 中国矫形外科杂志, 2008, 16(19): 1477-1479
[10]	陈雄生, 贾连顺, 袁文, 等. 脊髓型颈椎病自然史规律研究[J]. 中国矫形外科杂志, 2002, 10(13): 1301-1304. DOI doi:10.3969/j.issn.1005-8478.2002.z1.016.
[11]	Uchida K, Nakajima H, Takeura N, et al. Prognostic value of changes in spinal cord signal intensity on magnetic resonance imaging in patients with cervical compressive myelopathy[J]. Spine J, 2014, 14(8): 1601-1610. DOI:10.1016/j.spinee.2013.09.038.
[12]	沈惠良, 曹立, 张庆明, 等. 一期后、前路手术治疗发育性颈椎管狭窄症合并巨大椎间盘突出[J]. 中国脊柱脊髓杂志, 2007, 17(10): 761-764. DOI:10.3969/j.issn.1004-406X.2007.10.014.
[13]	莫新发, 郑晓林, 李佛保, 等. 脊髓型颈椎病患者术前MRI表现与术后神经功能恢复的相关性初探[J]. 中国脊柱脊髓杂志, 2004, 14(9): 61-62. DOI:10.3969/j.issn.1004-406X.2004.09.019.
[14]	马迅, 陈辉, 曹凯, 等. 不同影像学特点的脊髓型颈椎病的手术治疗[J]. 中华骨科杂志, 2014, 34(10): 983-991. DOI:10.3760/cma.j.issn.0253-2352.2014.10.001.
[15]	申勇, 张英泽, 吴华荣, 等. 退行性下颈椎不稳症的早期手术治疗[J]. 中华骨科杂志, 2005, 25(5): 297-300. DOI: 10.3760/j.issn:0253-2352.2005.05.011.
[16]	Cao JM, Zhang YZ, Shen Y, et al. Selection of operative approaches for multilevel cervical spondylotic myelopathy by imageological score[J]. J Spinal Disord Tech, 2012, 25(2): 99-106. DOI:10.1097/BSD.0b013e318211fc1d.