摘要
目的探讨术前MRI中的T_1倾斜角(T_1 slope,T_1S)是否可预测脊髓型颈椎病患者后路单开门椎管扩大成形术(expansive open-door laminoplasty,EOLP)后颈椎曲度变化,从而弥补在颈椎X线片中难以测量的缺点。方法回顾分析2012年1月—2016年10月行EOLP治疗的36例脊髓型颈椎病患者临床资料,其中男21例,女15例;年龄37~73岁,平均55.8岁。术后随访时间12~24个月,平均14.3个月。术前常规摄颈椎动力位X线片、CT及MRI,末次随访时摄颈椎正侧位X线片,测量以下颈椎矢状位参数:所有患者术前及末次随访时的C_2-C_7 Cobb角和C_2-C_7矢状位轴向距离(C_2-C_7 sagittal vertical axis,C_2-C_7 SVA);术前于MRI上测量T_1S,并根据T_1S中位数大小分为较大T_1S组(T_1S>19°,A组)和较小T_1S组(T_1S≤19°,B组),分别测量两组患者术前T_1S、C_2-C_7Cobb角、C_2-C_7 SVA,及末次随访时C_2-C_7 Cobb角、C_2-C_7 SVA、轴向距离之差(手术前后C_2-C_7 SVA差值)、术后曲度丢失(手术前后C_2-C_7 Cobb角差值)、术后曲度丢失>5°例数及后凸改变发生(术后C_2-C_7 Cobb角<0°)例数。结果患者末次随访时C_2-C_7 Cobb角较术前显著减小(t=8.000,P=0.000),而手术前后C_2-C_7 SVA比较差异无统计学意义(t=–1.842,P=0.074)。术前T_1S为(19.69±3.39)°,其中A组17例,B组19例,两组患者性别及年龄比较差异均无统计学意义(P>0.05)。B组患者术前C_2-C_7 Cobb角显著低于A组(t=–2.150,P=0.039),而两组术前C_2-C_7SVA比较差异无统计学意义(t=0.206,P=0.838)。末次随访时,除术后曲度丢失B组显著低于A组,差异有统计学意义(t=–2.723,P=0.010)外,其余各指标两组间比较差异均无统计学意义(P>0.05)。结论术前MRI中较大的T_1S(T_1S>19°)其术前有更大的生理前凸角度,但术后有更多的生理曲度丢失;术前T_1S并不能预测其术后曲度丢失大小,但推测术前较大的T_1S其术后可能更易发生后凸畸形变化。
Objective To investigate whether preoperative T_1 slope（T_1S） in MRI can predict the changes of cervical curvature after expansive open-door laminoplasty（EOLP） in patients with cervical spondylotic myelopathy, so as to make up for the shortcomings of difficult measurement in X-ray film. Methods The clinical data of 36 patients with cervical spondylotic myelopathy who underwent EOLP were retrospectively analysed. There were 21 males and 15 females with an average age of 55.8 years（range, 37-73 years） and an average follow-up time of 14.3 months（range, 12-24 months）. The preoperative X-ray films at dynamic position, CT, and MRI of cervical spine before operation, and the anteroposterior and lateral X-ray films at last follow-up were taken out to measure the following sagittal parameters. The parameters included C_2-C_7 Cobb angle and C_2-C_7 sagittal vertical axis（C_2-C_7 SVA） in all patients before operation and at last follow-up; preoperative T_1S were measured in MRI, and the patients were divided into larger T_1S group（T_1S19°, group A）and small T_1S group（T_1S≤19°, group B） according to the median of T_1S, and the preoperative T_1S, C_2-C_7 Cobb angle, C_2-C_7 SVA, and the C_2-C_7 Cobb angle and C_2-C_7 SVA at last follow-up, difference in axial distance（the difference of C_2-C_7 SVA before and after operation）, postoperative curvature loss（the difference of C_2-C_7 Cobb angle before and after operation）,the number of patients whose curvature loss was more than 5° after operation, and the number of patients whose kyphosis changed（C_2-C_7 Cobb angle was less than 0° after operation）. Results The C_2-C_7 Cobb angle at last follow-up was significantly decreased when compared with preoperative value（t=8.000, P=0.000）, but there was no significant difference in C_2-C_7 SVA between pre-and post-operation（t=–1.842, P=0.074）. The preoperative T_1S was（19.69±3.39）°; there were 17 cases in group A and 19 cases in group B with no significant difference in gender and age between 2 groups（P0.05）.The preoperative C_2-C_7 Cobb angle in group B was significantly lower than that in group A（t=–2.150, P=0.039）, while there was no significant difference in preoperative C_2-C_7 SVA between 2 groups（t=0.206, P=0.838）. At last follow-up,except for the curvature loss after operation in group B was significantly lower than that in group A（t=–2.723, P=0.010）,there was no significant difference in the other indicators between 2 groups（P0.05）. Conclusion Preoperative larger T_1S（T_1S19°） in MRI had a larger preoperative lordosis angle, but more postoperative physiological curvature was lost;preoperative T_1S in MRI can not predict postoperative curvature loss, but preoperative larger T_1S may be more prone to kyphosis.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第1期64-68,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
脊髓型颈椎病
单开门椎管扩大成形术
MRI
矢状位参数
颈椎曲度
Cervical spondylotic myelopathy
expansive open-door laminoplasty
MRI
sagittal parameter
cervical curvature
