轻中度颈脊髓压迫患者产生脊髓损害症状与体征的危险因素

The risk factors inducing spinal cord injury in cervical myelopathy patients with mild to moderate cervical cord compression

中文关键词:  颈椎  脊髓压迫  症状与体征  影像学  危险因素

英文关键词:Cervical vertebra  Spinal cord compression  Symptoms and signs  Imaging  Risk factors

中文摘要:

  【摘要】 目的：探讨轻中度颈脊髓压迫患者产生脊髓损害症状与体征的危险因素。方法：回顾性分析我院脊柱外科2008年11月~2011年11月门诊诊治的68例轻、中度颈脊髓压迫患者的病例资料。男37例，女31例。单节段32例，两节段22例，三节段14例。患者均有颈椎正侧位和过伸过屈位X线平片和颈椎CT及MRI检查图片。根据有无脊髓损害症状与体征，将其分为两组，无脊髓损害症状与体征的30例患者为A组，有脊髓损害症状与体征的38例患者为B组，比较两组患者年龄、性别、病程、病变节段数目，以及最大受压节段颈椎管比率、整体活动范围、节段不稳发生率、C2～C7 Cobb角、脊髓受压方向及脊髓高信号发生率。结果：两组患者年龄、性别、病程、病变节段数目差异均无统计学意义；平均最大受压节段颈椎管比率，A组为90.3%，B组为83.6%（P＜0.05）；平均颈椎整体活动范围A组为47.5°，B组为44.1°（P＞0.05）；颈椎节段不稳发生率，A组为23.3%，B组为65.8%（P＜0.05）；平均C2～C7 Cobb 角A组为14.1°，B组为14.1°（P＞0.05）；脊髓受压方向，A组中央型19例，旁中央型11例，B组中央型17例，旁中央型21例（P＞0.05）；颈椎MRI T2加权像高信号发生率，A组为13.3%，B组为86.9%（P＜0.05）。结论：对于轻、中度颈脊髓压迫患者，颈椎节段不稳和脊髓高信号是导致出现脊髓损害症状与体征的危险因素，而颈椎管比率较大是一种保护因素，尚不能认为脊髓受压方向、颈椎整体曲度和活动范围对出现脊髓损害症状与体征产生影响。

英文摘要:

  【Abstract】 Objectives: To investigate the risk factors inducing spinal cord injury in cervical myelopathy patients with mild to moderate cervical cord compression. Methods: From November 2008 to November 2011， 68 patients(male∶female=37∶31) with mild to moderate cervical cord compression were included in this retrospective analysis. There were 32 single-segment cases, 22 double-segment cases and 14 three-segment cases. All of these cases underwent anterior-posterior， lateral， excessive flexion and extension cervical spine X-ray, CT and MRI. All patients were divided into two groups according to the symptoms and signs of myelopathy. Group A included 30 patients without clinical features of myelopathy. Group B included 38 patients with cervical spondylotic myelopathy. Age, gender, duration of disease, the number of segments involved, the Torg ratio at the most severe cord compression level, the ROM of cervical spine, cervical segmental instability, C2-C7 lofrdosis angle, the direction of spinal cord compression and high signal incidence were compared between the two groups. Results: No differences were found in terms of age, gender, duration of disease, the number of segments involved between the two groups. The mean Torg ratio at the most severe cord compression level was 90.3% and 83.6%, respectively(P＜0.05); the mean ROM of cervical spine was 47.5° and 44.1°, respectively(P＞0.05); the cervical segmental instability was 23.3% and 65.8%, respectively(P＜0.05); the mean C2-C7 lordosis was 14.1° and 14.1°, respectively(P＞0.05); the central type cord compression was observed in 19 patients of group A and 17 patients of group B, whereas the imcomplete central type cord compression was observed in 11 patients of group A and 21 patients of group B(P＞0.05); the high signal incidence was 13.3% and 86.9%, respectively(P＜0.05). Conclusions: Cervical segmental instability and spinal cord high intensity signal are the risk factors in cervical myelopathy with mild to moderate cervical cord compression, but a larger Torg ratio is a protective factor. It is still remained unclear that the direction of spinal cord compression, cervical total curvature and range of motion affect the appearance of spinal cord injury.