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[1]王玉強,王利民,劉屹林,等.合并后縱韌帶退變的脊髓型頸椎病的臨床及影像特征研究[J].中醫(yī)正骨,2020,32(07):6-11.
　WANG Yuqiang,WANG Limin,LIU Yilin,et al.A study of clinical and imaging characteristics of cervical spondylotic myelopathy combined with cervical posterior longitudinal ligament degeneration[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(07):6-11.
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合并后縱韌帶退變的脊髓型頸椎病的臨床及影像特征研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年07期
頁碼:
6-11
欄目:
臨床研究
出版日期:
2020-07-20

文章信息/Info

Title:
A study of clinical and imaging characteristics of cervical spondylotic myelopathy combined with cervical posterior longitudinal ligament degeneration
作者:
王玉強; 王利民; 劉屹林; 劉宏建; 趙耀; 張書豪; 張敏; 王衛(wèi)東; 譚洪宇
鄭州大學第一附屬醫(yī)院,河南 鄭州 450052
Author(s):
WANG Yuqiang; WANG Limin; LIU Yilin; LIU Hongjian; ZHAO Yao; ZHANG Shuhao; ZHANG Min; WANG Weidong; TAN Hongyu
The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China
關鍵詞:
頸椎;  脊髓型頸椎病;  后縱韌帶退變
Keywords:
cervical vertebrae;  cervical spondylotic myelopathy;  cervical posterior longitudinal ligament degeneration
摘要:
目的:探討合并后縱韌帶退變(cervical posterior longitudinal ligament degeneration,CPLLD)的脊髓型頸椎病(cervical spondylotic myelopathy,CSM)的臨床及影像特征。方法:選取2013年1月至2015年12月因CSM在鄭州大學第一附屬醫(yī)院行手術治療,且臨床和影像資料完整患者的病例資料進行研究。從患者的病例資料中提取性別、年齡、身高、體質量、術前頸椎功能障礙指數(shù)(neck disability index,NDI)、術前日本骨科學會(Japanese Orthopedic Association,JOA)頸椎病評分、術前疼痛視覺模擬量表(visual analogue scale,VAS)評分、有效椎管矢狀徑(space available for the cord,SAC)、椎管椎體矢狀徑比值(diameter of sagittal canal and vertebral body ratio,DSR)及合并CPLLD和頸脊髓內信號改變情況。結果:①臨床數(shù)據(jù)分析結果。共納入128例CSM患者,其中53例合并CPLLD(CPLLD組),其余75例未合并CPLLD(無CPLLD組)。合并頸脊髓內信號改變者49例,其中CPLLD組29例、無CPLLD組20例,CPLLD組頸脊髓內信號改變發(fā)生率高于無CPLLD組(χ2=13.866,P=0.000)。合并CPLLD的CSM患者中51～60歲患者所占比例最高,性別分布無明顯差異; 55個節(jié)段CPLLD呈中央型、47個節(jié)段呈偏側型,好發(fā)部位為C4～C6節(jié)段。術前CPLLD組患者的NDI高于無CPLLD組[(46.57±8.20)%,(36.60±7.01)%,t=1.783,P=0.000],JOA頸椎病評分低于無CPLLD組[(9.97±1.41)分,(12.60±1.25)分,t=-3.247,P=0.000]; 2組患者術前的疼痛VAS評分比較,差異無統(tǒng)計學意義[(5.47±2.12)分,(5.44±2.03)分,t=0.693,P=0.075]。②影像數(shù)據(jù)分析結果。CPLLD組術前頸椎SAC和DSR均小于無CPLLD組[(4.17±1.30)mm,(5.32±1.34)mm,t=-1.327,P=0.000; 0.70±0.21,0.82±0.23,t=-3.733,P=0.000]。CPLLD組組內不同性別患者的術前頸椎SAC和DSR比較,差異均無統(tǒng)計學意義[(4.21±1.32)mm,(4.12±1.30)mm,t=0.149,P=0.795; 0.67±0.15,0.75±0.19,t=0.328,P=0.602]; 無CPLLD組組內不同性別患者的術前頸椎SAC和DSR比較,差異均無統(tǒng)計學意義[(5.36±1.30)mm,(5.27±1.39)mm,t=0.187,P=0.753; 0.81±0.22,0.83±0.23,t=0.739,P=0.072]。③臨床數(shù)據(jù)和影像數(shù)據(jù)的相關性分析結果。CPLLD和頸脊髓內信號改變呈正相關(rs=0.317,P=0.000); SAC、DSR均與JOA頸椎病評分呈正相關(r=0.321,P=0.000; r=0.795,P=0.000),均與NDI呈負相關(r=-0.309,P=0.000; r=-0.432,P=0.000)。結論:CSM患者常合并CPLLD,其中以51～60歲者多見,好發(fā)于C4～C6節(jié)段; 合并CPLLD的CSM患者更容易發(fā)生頸脊髓變性、DSR和SAC更小、患者生活質量更差,建議早期手術干預。
Abstract:
Objective:To explore the clinical and imaging characteristics of cervical spondylotic myelopathy(CSM)combined with cervical posterior longitudinal ligament degeneration(CPLLD).Methods:The medical records of patients who received surgical treatment for CSM in The First Affiliated Hospital of Zhengzhou University from January 2013 to December 2015 and had complete clinical and imaging data were selected for the study.The information about gender,age,height,body mass,preoperative neck disability index(NDI),preoperative Japanese Orthopedic Association(JOA)CSM scores,preoperative pain visual analogue scale(VAS)scores,space available for the cord(SAC),diameter of sagittal canal and vertebral body ratio(DSR),CPLLD and signal changes in cervical spinal cord were extracted from medical records for analysis.Results:One hundred and twenty-eight patients were included in the study.CPLLD were found in 53 patients(CPLLD group)and unfound in 75 patients(non-CPLLD group).The signal changes in cervical spinal cord were found in 49 patients,in which 29 patients in CPLLD group and 20 patients in non-CPLLD group.The incidence rate of signal changes in cervical spinal cord was higher in CPLLD group compared to non-CPLLD group(χ2=13.866,P=0.000).The majority of patients with CSM and CPLLD ranged in age from 51 to 60 years and there was no significant difference in gender distribution.The CPLLD belonged to central type at 55 cervical vertebral segments and asymmetrical type at 47 cervical vertebral segments and was commonly found at C4-6 segments.The preoperative NDI was higher and the preoperative JOA CSM scores were lower in CPLLD group compared to non-CPLLD group(46.57+/-8.20 vs 36.60+/-7.01%,t=1.783,P=0.000; 9.97+/-1.41 vs 12.60+/-1.25 points,t=-3.247,P=0.000).There was no statistical difference in preoperative pain VAS scores between the 2 groups(5.47+/-2.12 vs 5.44+/-2.03 points,t=0.693,P=0.075).The preoperative cervical SAC and DSR were smaller in CPLLD group compared to non-CPLLD group(4.17+/-1.30 vs 5.32+/-1.34 mm,t=-1.327,P=0.000; 0.70+/-0.21 vs 0.82+/-0.23,t=-3.733,P=0.000).There was no statistical difference in preoperative cervical SAC and DSR between males and females in CPLLD group(4.21+/-1.32 vs 4.12+/-1.30 mm,t=0.149,P=0.795; 0.67+/-0.15 vs 0.75+/-0.19,t=0.328,P=0.602).There was no statistical difference in preoperative cervical SAC and DSR between males and females in non-CPLLD group(5.36+/-1.30 vs 5.27+/-1.39 mm,t=0.187,P=0.753; 0.81+/-0.22 vs 0.83+/-0.23,t=0.739,P=0.072).The results of correlation analysis of the relationship between clinical data and imaging data showed that CPLLD was positively correlated with signal changes in cervical spinal cord(rs=0.317,P=0.000); SAC and DSR were positively correlated with JOA CSM scores(r=0.321,PV=0.000; r=0.795,P=0.000)and were negatively correlated with NDI(r=-0.309,P=0.000; r=-0.432,P=0.000).Conclusion:CSM often combines with CPLLD and often occurs at C4-6 segments in persons aged from 51 to 60 years.More cervical spinal degeneration,smaller DSR and SAC and poorer quality of life can be found in patients with CSM and CPLLD,and early surgical intervention is recommended.

參考文獻/References:

[1] 何少奇,湯呈宣,唐小君,等.頸后路單開門椎管擴大成形跳躍式與連續(xù)式微型鈦板內固定術治療多節(jié)段脊髓型頸椎病的對比研究[J].中醫(yī)正骨,2019,31(4):8-16.
[2] JOAQUIM A F,BAUM G,TAN L A,et al.Dynamic cord compression causing cervical myelopathy[J].Neurospine,2019[2020-02-01].https://www.e-neurospine.org/journal/view.php?doi=10.14245/ns.1938202.101.
[3] 宋卿鵬,田偉,何達,等.頸椎人工椎間盤置換術治療脊髓型頸椎病的長期療效[J].中國脊柱脊髓雜志,2018,28(2):144-150.
[4] 陳振,陳欣,孫宇,等.家族聚集性頸椎后縱韌帶骨化的影像學特征[J].中國脊柱脊髓雜志,2016,26(11):972-976.
[5] 張競,張穎,王良哲,等.伴肌動蛋白相關錨定蛋白(N-RAP)在頸椎后縱韌帶骨化中的表達及意義[J].中國脊柱脊髓雜志,2013,23(9):833-836.
[6] 馬鶴成,夏燕妮,司萌,等.頸椎全椎間盤置換術后異位骨化的研究進展[J].中醫(yī)正骨,2019,31(8):38-41.
[7] 綦珂,何平,沈洪興.頸椎后縱韌帶骨化自然史及手術治療進展[J].中國矯形外科雜志,2013,21(13):1321-1323.
[8] SHIMOKAWA N,SATO H,MATSUMOTO H,et al.Review of radiological parameters, imaging characteristics,and their effect on optimal treatment approaches and surgical outcomes for cervical ossification of the posterior longitudinal ligament[J].Neurospine,2019,16(3):506-516.
[9] 雷濤,申勇,王林峰,等.節(jié)段型嚴重頸椎后縱韌帶骨化癥前路、后路手術的療效比較與選擇策略[J].中華骨科雜志,2013,33(2):117-122.
[10] 張頡鴻,劉洋,袁文.遺傳因素在后縱韌帶骨化癥發(fā)生機制中的作用[J].脊柱外科雜志,2013,11(5):314-317.
[11] 李會明,夏剛,田融.兩種頸前路減壓重建術治療多節(jié)段脊髓型頸椎病的療效比較[J].中華實驗外科雜志,2016,33(5):1409-1411.
[12] KANG M S,KIM K H,JY P,et al.Progression of cervical ossification of posterior longitudinal ligament after laminoplasty or laminectomy with posterior fixation[J].Clinical spine surgery,2019,32(9):363-368.
[13] 中華外科雜志編輯部.頸椎病的分型、診斷及非手術治療專家共識(2018)[J].中華外科雜志,2018,56(6):401-402.
[14] BADHIWALA J H,WILSON J R.The natural history of degenerative cervical myelopathy[J].Neurosurg Clin N Am,2018,29(1):21-32.
[15] XU Y,CHEN F,WANG Y,et al.Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI:a meta-analysis[J].J Orthop Surg Res,2019,14(1):224.
[16] 卓大宏.中國殘疾預防學[M].北京:華夏出版社,1998:407-408.
[17] 劉云鵬,劉沂.骨與關節(jié)損傷和疾病的診斷分類及功能評定標準[M].北京:清華大學出版社,2002:243-244.
[18] 周英杰.頸椎前路融合與非融合手術在脊髓型頸椎病治療中的合理選擇[J].中醫(yī)正骨,2019,31(8):1-5.
[19] LIAO X,TANG D,YANG H,et al.Long non-coding rna xist may influence cervical ossification of the posterior longitudinal ligament through regulation of mir-17-5p/ahnak/bmp2 signaling pathway[J].Calcif Tissue Int,2019,105(6):670-680.
[20] BERNSTEIN D N,PRONG M,KURUCAN E,et al.National trends and complications in the surgical management of ossification of the posterior longitudinal ligament(OPLL)[J].Spine(Phila Pa 1976),2019,44(22):1550-1557.
[21] MOON B J,KIM D,SHIN D A,et al.Patterns of short-term and long-term surgical outcomes and prognostic factors for cervical ossification of the posterior longitudinal ligament between anterior cervical corpectomy and fusion and posterior laminoplasty[J].Neurosurg Rev,2019,42(4):907-913.
[22] SHIN J,JY C,KIM Y W,et al.Quantification of risk factors for cervical ossification of the posterior longitudinal ligament in korean populations:a nationwide population-based case-control study[J].Spine(Phila Pa 1976),2019,44(16):E957-E964.
[23] DAVIES B,MOWFORTH O,SADLER I,et al.Recovery priorities in degenerative cervical myelopathy:a cross-sectional survey of an international,online community of patients[J].BMJ Open,2019,9(10):e031486.
[24] 關曉明,馬迅.脊髓型頸椎病手術入路及減壓融合方式的選擇策略[J].中華骨科雜志,2019,39(23):1478-1484.
[25] 邊帥,唐成林,柳萬國.脊髓型頸椎病脊髓MRI信號改變與臨床預后關系的研究進展[J].中國脊柱脊髓雜志,2013,23(1):66-69.
[26] MACHINO M,ANDO K,KOBAYASHI K,et al.Postoperative resolution of Mr T2 increased signal intensity in cervical spondylotic myelopathy:the impact of signal change resolution on the outcomes[J].Spine(Phila Pa 1976),2019,44(21):E1241-E1247.
[27] WEI L,CAO P,XU C,et al.Comparison of three anterior techniques in the surgical treatment of Three-Level cervical spondylotic myelopathy with intramedullary T2-Weighted increased signal intensity[J].World Neurosurg,2019,126:e842-e852.
[28] WEI L,CAO P,XU C,et al.Clinical and radiologic results of anterior cervical discectomy and fusion for cervical spondylotic myelopathy in elderly patients with T2-Weighted increased signal intensity[J].World Neurosurg,2018,112:e520-e526.

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備注/Memo

備注/Memo:
基金項目:河南省醫(yī)學科技攻關計劃普通項目(201503017) 通訊作者:張敏 E-mail:[email protected]
更新日期/Last Update: 2020-07-20