脊髓型颈椎病手术疗效与MRI的相关性研究.doc

脊髓型颈椎病手术疗效与MRI的相关性研究 ??????? 作者：陈刚，杜斌，茆军，夏建龙，严培军，薛锦标\ 【摘要】? 目的 探讨高龄脊髓型颈椎病手术疗效与MRI所见的关系。方法 回顾研究行颈前路或后路减压的脊髓型颈椎病37 例，平均随访16.4个月(6～55个月)。大于60 岁为观察组(A组)，小于60 岁为对照组(B组)，评估比较两组术前术后JOA评分、术前术后MRI影像。结果 颈椎病术后改善率A组(47.4±13.5)％，B组(65.6±15.8)％；MRI脊髓横截面积，术前A组(38.5±11.5) mm2，B组(48.3±12.8) mm2，术后A组(47.9±12.6) mm2，B组(61.6±11.4) mm2，A、B两组数据均有显著性差异。术后脊髓高信号不变比例，A组为83.3％，B组为20.0％，A组信号不变比例高。平均患病时间A组(15.2±11.8)个月，B组(7.7±6.17)个月，二者有显著性差异。结论 高龄脊髓型颈椎病预后与颈髓最明显受压处的横截面积关系密切，面积越小，预后则越差；高龄患者疗效较年轻人差，与病程长、脊髓压迫重、脊髓变性等因素有关。 【关键词】? 老年人；颈椎病；手术；MRI ??? Correlation between the Surgical Effect and MR Imaging on Cervical Spondylotic Myelopathy in the Aged ????? Abstract： Objective? To investigate correlation between the surgical effect and MR imaging on cervical spondylotic myelopathy in the aged. Methods? 37 cases with Cervical Spondylotic Myelopathy(CSM) underwent anterior or posterior surgical decompression. The average followup was 16.4 months(range， 6 to 55 months). According to age， the cases were divided into two groups. Group A： The age was more than 60 years old. Group B： The age was less than 60 years old. Two groups cases were evaluated and compared with preoperational and postoperational JOA scores， preoperational and postoperational MR imaging. Results? According to JOA score system， the excellent results were obtained in (47.4±13.5)％ Group A and (65.6±15.8)％ in Group B. The area of spinal cord in Group A was average (38.5±11.5) mm2 in preoperation and (47.9±12.6) mm2 in postoperation， While， Group B was average (48.3±12.8) mm2 in preoperation and (61.6±11.4) mm2 in postoperation. We compared high signal intensity on MRI of spinal cord between preoperation and postoperation. 83.3％ high signal of MRI were the same in Group A and 20.0％ high signal of MRI were the same in Group B. There was statistically significant difference between Group A and B. Average time of disease was (15.2±11.8) months in Group A and (7.7±6.17) months in Group B. Conclusion? Surgical effect on CSM in the aged was rel