摘要
目的 探讨颈椎病患者手术治疗前后的多模态影像学参数变化及与临床疗效的关系.方法 选择2020年1月至2022年10月在河北中石油医院治疗的颈椎病患者260例,其中男性153例,女性107例;年龄44～69岁,平均年龄51.02岁;身体质量指数22.5～32.7 kg/m2,平均身体质量指数24.21 kg/m2;高血压121例,糖尿病71例;颈椎病类型,神经根型颈椎病168例,脊髓型颈椎病92例.根据手术治疗效果分为不良组(改善率＜25％)和优良组(改善率≥ 25％).分析比较不良组与优良组治疗前后Cobb角、C2～C7矢状位轴向垂直距离、T1倾斜角、颈椎倾斜角、椎管最大狭窄程度、脊髓最大受压程度、表观扩散系数(ADC)值等差异,同时分析X射线及MRI参数术后-术前差值与日本骨科协会(JOA)评估治疗分数评分改善率相关性.结果 根据手术治疗效果分为不良组72例和优良组188例.优良组术后Cobb角及术后-术前差值、C2～C7矢状位轴向垂直距离术后-术前差值分别为(16.22±4.10)°、(4.03±1.03)°和(5.50±1.10)mm,明显高于不良组[(14.35±4.10)°、(1.94±0.78)°和(2.56±0.86)mm](P＜0.05),而术后C2～C7矢状位轴向垂直距离为(18.87±4.26)mm,明显低于不良组[(21.54±4.12)mm](P＜0.05).优良组术后椎管最大狭窄程度、脊髓最大受压程度、ADC 值分别为(36.69±7.54)％、(27.78±5.88)％和(1.06±0.29)× 10-3 mm2/s,明显低于不良组[(40.49±7.19)％、(32.21±6.10)％和(1.15±0.30)× 10-3 mm2/s](P＜0.05),而椎管最大狭窄程度术后-术前差值、脊髓最大受压程度术后-术前差值、ADC值术后-术前差值分别为(8.82±1.59)％、(7.91±1.18)％和(0.21±0.06)× 10-3 mm2/s,明显高于不良组[(6.15±1.44)％、(4.44±1.07)％和(0.11±0.05)× 10-3 mm2/s](P＜0.05).Cobb 角术后-术前差值与 JOA 评分改善率呈正相关(r=0.411,P＜0.05);椎管最大狭窄程度术后-术前差值、脊髓最大受压程度术后-术前差值和ADC值术后-术前差值与JOA评分改善率呈负相关(r=-0.463、-0.442、-0.398,P＜0.05).结论 颈椎病患者手术治疗前后X射线及MRI参数与临床疗效有关,值得进一步分析研究.
Abstract
Objective To explore the changes of multimodal imaging parameters before and after operative treatment in pa-tients with cervical spondylosis and its correlation with clinical efficacy.Methods From January 2020 to October 2022,a to-tal of 260 patients with cervical spondylosis were enrolled,which included 153 males and 107 females,aged 44-69 years old with mean age of 51.02 years old;body mass index(BMI)was 22.5-32.7 kg/m2 with mean BMI of 24.21 kg/m2.There were 121 cases of hypertension and 71 of diabetes;there were 168 cases of nerve root type cervical spondylosis and 92 cases of cervical spondylotic myelopathy.According to operative efficacy,all of them were divided into poor group(improvement rate＜25％)and excellent group(improvement rate ≥ 25％).The differences of Cobb angle,C2-C7 sagittal axial vertical distance,T,inclination angle,cervical spine inclination angle,maximum spinal canal stenosis,and maximum spinal cord compression,apparent diffu-sion coefficient(ADC)value before and after treatment between 2 groups were analyzed and compared.The correlation between improvement rate of Japanese Orthopaedic Association(JOA)score and the postoperative-preoperative difference of X-ray and MRI parameters was analyzed.Results According to operative efficacy,all of them were divided into poor group(n=72)and excellent group(n=188).The postoperative Cobb angle,postoperative-preoperative difference and postoperative-preoperative difference of C2-C7 sagittal axial vertical distance in excellent group[(16.22±4.10)°,(4.03±1.03)° and(5.50±1.10)mm]were significantly higher than those in poor group[(4.35±4.10)°,(1.94±0.78)° and(2.56±0.86)mm](P＜0.05),while postoperative C2-C7 sagittal axial vertical distance in excellent group[(18.87±4.26)mm]was significantly lower than that in poor group[(21.54±4.12)mm](P＜0.05).The maximum spinal canal stenosis,maximum spinal cord compression and ADC value in excellent group[(36.69±7.54)％,(27.78±5.88)％ and(1.06±0.29)×10-3 mm2/s]were significantly lower than those in poor group[(40.49±7.19)％,(32.21± 6.10)％ and(1.15±0.30)×10-3 mm2/s](P＜0.05).The postoperative-preoperative difference of the maximum spinal canal stenosis,the postoperative-preoperative difference of the maximum spinal cord compression,and postoperative-preoperative dif-ference of ADC value[(8.82±1.59)％,(7.91±1.18)％and(0.21±0.06)x 10-3 mm2/s]were significantly higher than those in poor group[(6.15±1.44)％,(4.44±1.07)％ and(0.11±0.05)×10-3 mm2/s](P＜0.05).The postoperative-preoperative difference of Cobb angle was positively correlated with improvement rate of JOA score(r=0.411,P＜0.05).The postoperative-preoperative dif-ference of the maximum stenosis spinal canal,the postoperative-preoperative difference of the maximum compression spinal cord and postoperative-preoperative difference of ADC value were negatively correlated with improvement rate of JOA score(r=-0.463,-0.442,-0.398,P＜0.05).Conclusion It is demonstrated that the X-ray and MRI parameters of patients with cervical spondylosis before and after operative treatment are related to the clinical efficacy,which is worthy of further analysis and research.
基金项目
河北省廊坊市科学技术研究与发展计划(2022013021)
NETL
NSTL
万方数据