【作者】 刘伟；

【导师】 程雷；

【作者基本信息】 山东大学 ， 外科学（专业学位）， 2023， 硕士

【摘要】 目的:脊髓型颈椎病(Cervical spondylotic myelopathy,CSM)是脊柱外科的一种常见疾病,是引起成年人脊髓功能障碍的主要病因。在对CSM患者进行影像学检查时,常常在病变节段发现MRI-T2WI脊髓高信号。本研究通过探讨MRI-T2WI脊髓高信号与脊髓型颈椎病患者手术预后的关系,同时筛选脊髓高信号的独立危险因素,为伴有脊髓高信号的CSM患者的个体化诊疗提供理论指导。方法:本研究收集了 2020年1月至2022年9月期间就诊于山东大学齐鲁医院符合纳入与排除标准的206例接受手术治疗的CSM患者,根据MRI-T2WI脊髓高信号等级分为3组,其中0级高信号组96例,1级高信号组65例,2级高信号组45例。依据临床病例、影像学资料及随访结果,收集统计患者性别、年龄、病程、个人史、既往史、椎间盘退变程度、颈椎曲度、颈椎活动度、脊髓受压程度、术前术后日本骨科协会(Japanese orthopaedic association,JOA)评分等指标,对比分析不同高信号等级组患者的手术预后,并通过倾向得分匹配法(Propensity score matching,PSM)加以验证。同时运用有序Logistic回归分析,筛选脊髓高信号的独立危险因素。结果:PSM前三个高信号等级组的基线资料中,病程、颈椎活动度和脊髓受压程度具有统计学差异(P<0.05),而性别、年龄、个人史、既往史、椎间盘退变程度、颈椎曲度、手术方式等指标不具有统计学差异(P>0.05)。0级、1级和2级高信号等级组的术后6个月、末次随访的JOA改善率分别为62.30±17.74%和68.66±16.19%、62.81±17.34%和68.98±15.41%、53.61±13.90%和61.73±13.86%,2级高信号组的JOA改善率显著低于0级、1级高信号组,差异具有统计学意义(P<0.05)。经过PSM处理后,三个高信号等级组各有19例匹配成功,组间基线资料均衡,不具有统计学差异(P>0.05),0级、1级和2级高信号等级组的术后6个月、末次随访的JOA改善率分别为61.20±15.22%和64.76±14.48%、62.05±14.40%和65.91±11.24%、50.62±11.05%和55.22±11.65%,2级高信号组的JOA改善率同样低于0级、1级高信号组,差异具有统计学意义(P<0.05)。有序Logistic回归分析显示,病程(P<0.05)、颈椎活动度(P<0.05)和脊髓受压程度(P<0.001)为脊髓高信号的独立危险因素。结论:MRI-T2WI脊髓高信号与脊髓型颈椎病患者手术预后显著相关,2级高信号患者手术预后较差,0级高信号和1级高信号患者手术预后无明显差异。病程越长、颈椎活动度越大、脊髓受压程度越重,CSM患者脊髓出现较高等级高信号的可能性越大。更多还原

【Abstract】 Purpose:Cervical spondylotic myelopathy(CSM)is a common disease in spinal surgery and a major cause of spinal dysfunction in adults.In the imaging examination of patients with CSM,an increased signal intensity is often found in the spinal cord at the diseased segment on MRI-T2WI.This study aims to explore the relationship between intramedullary hyperintensity and surgical prognosis of patients with CSM on MRI-T2WI,and at the same time investigate independent risk factors of intramedullary hyperintensity,so as to provide theoretical guidance for individualized diagnosis and treatment of patients with CSM and intramedullary hyperintensity.Methods:In this study,206 CSM patients admitted to Qilu Hospital of Shandong University from January 2020 to September 2022 who met the inclusion and exclusion criteria for surgical treatment were divided into 3 groups according to MRI-T2WI hyperintensity grade of spinal cord,including 96 patients in grade 0 hyperintensity group,65 patients in grade 1 hyperintensity group,and 45 patients in grade 2 hyperintensity group.According to clinical cases,imaging data and follow-up results,gender,age,duration of the disease,personal history,past history,degree of intervertebral disc degeneration,cervical curvature,cervical range of motion,spinal cord compression,preoperative and postoperative JOA score of patients were collected and analyzed.The surgical prognosis of patients in different hyperintensity grade groups was compared and verified by propensity score matching(PSM).At the same time,ordered Logistic regression analysis was used to investigate independent risk factors of intramedullary hyperintensity.Results:In the baseline data of the first three high-signal grade groups before PSM treatment,there were statistically significant differences in the duration of disease,cervical range of motion and spinal cord compression(P<0.05),while there were no statistically significant differences in gender,age,personal history,past history,degree of intervertebral disc degeneration,cervical curvature and surgical method(P>0.05).The JOA improvement rates at 6 months after surgery and at the last follow-up were 62.3 00±17.74%and 68.66±16.19%,62.81±17.34%and 68.98±15.41%,53.61±13.90%and 61.73±13.86%in grade 0,Grade 1 and grade 2 hyperintensity groups.The improvement rate of JOA in grade 2 hyperintensity group was significantly lower than that in grade 0 and grade 1 hyperintensity group,and the difference was statistically significant(P<0.05).After PSM treatment,19 cases in each of the hyperintensity groups were matched successfully,and baseline data between groups was balanced without statistical difference(P>0.05).The JOA improvement rates at 6 months after surgery and at the last follow-up were 61.20±15.22%and 64.76±14.48%,62.05±14.40%and 65.91±11.24%,50.62±11.05%and 55.22±11.65%in grade 0,1 and 2 hyperintensity groups.The JOA improvement rate of Grade 2 hyperintensity group was also lower than that of grade 0 and grade 1 hyperintensity group,and the difference was statistically significant(P<0.05).Ordered Logistic regression analysis showed that disease duration(P<0.05),cervical range of motion(P<0.05)and spinal cord compression(P<0.01)were independent risk factors for intramedullary hyperintensity.Conclusion:preoperative hyperintensity grade of spinal cord is significantly correlated with the surgical prognosis of patients with CSM.The surgical prognosis of grade 2 hyperintensity patients is poor,and there is no significant difference between grade 0 hyperintensity patients and grade 1 hyperintensity patients.The longer the duration of the disease,the greater the cervical range of motion,and the greater the degree of spinal cord compression,the greater the likelihood of higher-grade hyperintensity in the spinal cord of patients with CSM.更多还原