【摘要】 目的：探究磁共振成像（MRI）T₂加权成像（T₂WI）矢状位预测脊髓型颈椎病（CSM）临床预后的价值。方法：选取100例在医院接受脊髓减压手术的CSM患者，根据患者颈椎MRIT₂WI矢状位脊髓受压部位形态情况将其分为正常信号组（32例）、点状信号组（34例）和片状信号组（34例）。分别于术前，术后3个月、6个月和12个月采用日本矫形科学协会（JOA）评分评估3组患者的神经功能情况；用Nurick步态分级评价患者术前和随访时行走功能；计算神经功能改善率；所有患者于术后6个月复查颈椎磁共振，评估3组患者脊髓的减压情况。结果：点状信号组和片状信号组与正常信号组相比，手术前及术后3个月、6个月和12个月JOA评分均有明显降低（F=64.86,F=61.09,F=96.54,F=113.19;P<0.05）；点状信号组和片状信号组术前，术后3个月、6个月和12个月Nurick步态分级均明显高于正常信号组（F=23.49,F=28.71,F=16.70,F=35.33;P<0.05）；正常信号组、点状信号组和片状信号组患者术后各时间点与术前JOA评分、Nurick步态分级比较，差异具有统计学意义(F_JOA评分=251.29,F=295.91,F=180.19;F_{Nurick步态分级}=55.90,F=71.52,F=72.81;P<0.05);3组间JOA改善率差异有统计学意义（F=12.75,P<0.05）。与正常信号组相比，片状信号组JOA改善率明显降低（t=5.12,P<0.05）；与点状信号组相比，片状信号组JOA改善率明显降低（t=3.34,P<0.05）；经受试者工作特征（ROC）曲线分析发现，正常信号、点状信号以及片状信号预测患者预后的ROC曲线下面积（AUC）分别为0.804、0.814及0.827。结论：MRI T₂WI矢状位脊髓受压部位内信号的形态与CSM患者预后具有密切的关系，可通过MRI T₂WI矢状位表现预测患者预后情况。更多还原

【Abstract】 Objective: To explore the value of magnetic resonance（MRI） t₂-weighted imaging（T₂WI） sagittal view in predicting the clinical prognosis of cervical myelopathy（CSM）. Methods: 100 patients with CSM who underwent spinal cord decompression in the hospital were selected and divided into normal signal group（n=32）, point signal group（n=34） and slice signal group（n=34） according to the morphology of the compressed part on sagittal view of T₂WI of cervical MRI. The neurological function of the patients was evaluated by Japanese Orthopaedic Association（JOA） before operation and 3, 6 and 12 months after operation; the walking function of patients was evaluated by gait classification before operation and during follow-up; the improvement rate of neurological function was calculated. All patients were reviewed by cervical magnetic resonance imaging at 6 months after the operation and the decompression of the spinal cord of the patients was assessed. Results: Compared with the normal signal group, the JOA scores of the point signal group and the slice signal group were significantly decreased preoperatively and postoperatively at 3,6 and 12 months（F=64.86, F=61.09, F=96.54, F=113.19; P<0.05）; the Nurick gait grade of the point signal group and the slice signal group were significantly higher preoperatively and postoperatively at 3, 6 and 12 months（F=23.49,F=28.71, F=16.70, F=35.33, P<0.05）; compared with the preoperative JOA score and Nurick gait classification at each time point after operation, the difference was statistically significant in the normal signal group, point signal group and slice signal group(F_{JOA score}=251.29, F=295.91, F=180.19, F_{Nurick gait grade}=55.90, F=71.52, F=72.81, P<0.05). There was a significant difference in the improvement rates of JOA among the three groups（F=12.75, P<0.05）. Compared with the normal signal group, the improvement rate of JOA in the slice signal group was significantly lower（t=5.12,P<0.05）; compared with the point signal group, the improvement rate of JOA in the slice signal group was significantly lower（t=3.34, P<0.05）. Receiver operating characteristic（ROC） curve analysis showed that area under curve（AUC）of normal signal, point signal and slice signal for predicting the prognosis of patients were 0.804, 0.814 and 0.827.Conclusion: On MRI T₂WI sagittal view, there is a close relationship between the shape of the signal in the area of spinal cord compression and the prognosis of CSM patients, which can be predicted by MRI T₂WI sagittal view.更多还原