胸椎黄韧带骨化症患者髓内MRI高信号与手术疗效的关系

The relationship between single-segment increased signal intensity on T2WI and the surgical results of thoracic ossification of the ligamentum flavum

中文关键词:  胸椎黄韧带骨化症  MRI T2WI高信号  手术疗效

英文关键词:Thoracic ossification of the ligamentum flavum  MRI T2WI  Increased signal intensity  Surgical results

中文摘要:

  【摘要】 目的：探讨胸椎黄韧带骨化症患者髓内单节段MRI T2WI高信号改变与手术疗效的关系。方法：选取2010年1月～2013年12月在我院行后路减压内固定手术治疗的胸椎黄韧带骨化症患者59例，其中合并髓内单节段高信号患者28例（高信号组），男18例，女10例；年龄43～63岁，平均52.8±1.8岁；病程11～38个月（20.1±3.7个月）；脊髓受压节段：单节段11例，双节段7例，三节段6例，三节段以上4例；术前JOA评分为3～7分，平均4.8±1.6分；ASIA分级：B级2例，C级11例，D级15例。髓内信号正常患者31例（正常信号组），男20例，女11例，年龄38～66岁，平均53.7±2.4岁；病程5～38个月（18.7±4.3个月）；脊髓受压节段：单节段15例，双节段9例，三节段5例，三节段以上2例；术前JOA评分为3～8分，平均4.9±1.8分，ASIA分级：B级1例，C级14例，D级16例。所有患者均行后路椎板薄化分解揭盖减压、植骨融合术。随访两组患者术后JOA评分及改善率、神经功能ASIA分级，观察内固定位置及植骨融合情况。结果：所有患者均获得随访，随访时间为6～54个月，平均23.7个月。术后6个月均获得骨性融合，无内固定松动、移位、断裂等并发症。两组术后均有神经功能恶化者，其中高信号组2例，正常信号组1例，经对症处理后均好转。末次随访时高信号组和正常信号组的JOA评分分别为6～10分（平均7.0±1.5分）、8～10分（平均8.9±1.1分），改善率分别为28.3%～78.9%[平均（40.0±12.4）%]、38.7%～83.1%[平均（53.7±15.4）%]，与术前比较均有明显改善（P<0.05），高信号组术后JOA评分和改善率均明显低于信号正常组（P<0.05）。末次随访时，两组共有37例神经功能好转，其中髓内高信号组16例，正常信号组21例， ASIA分级改善1~2个等级。结论：胸椎黄韧带骨化症伴髓内MRI T2WI高信号患者手术治疗可取得一定疗效，但效果较正常信号者差。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between single-segment intramedullary increased signal intensity(ISI) on T2-weighted imaging(T2WI) and the surgical results of thoracic ossification of the ligamentum flavum. Methods: From January 2010 to December 2013, 59 patients with thoracic ossification of the ligamentum flavum underwent posterior decompression surgery with thinned-segmented decompression technique. ISI group included 28 patients, there were 18 males and 10 females with an average age of 52.8±1.8 years old(range, 43-63 years old). The average course of disease was 20.1±3.7 months(range, 11-38 months). 11 cases had spinal cord compression at single level, 7 cases at two levels, 6 cases at three levels, 4 cases at more than three levels. The average pre-operative JOA score was 4.8±1.6(range, 3-7). 2 cases were in ASIA grade B, 11 cases in grade C, 15 cases in grade D. Normal group included 31 patients, there were 20 males and 11 females with an average age of 53.7±2.4 years old(range, 38-66 years old). The average course of disease was 18.7±4.3 months(range, 5-38 months). 15 cases had spinal cord compression at single level, 9 cases at two levels, 5 cases at three levels, 2 cases at more than three levels. The average preoperative JOA score was 4.9±1.8(range, 3-8). 1 case was in ASIA grade B, 14 cases in grade C, 16 cases in grade D. The preoperative, postoperative JOA score, JOA score improvement rate and ASIA grade of each patient was evaluated. Results: All patients were followed up with an average time of 23.7 months (range from 6 to 54 months). All patients got bony fusion 6 months after operation. There was no internal fixation loosen and displacement. 2 patients suffered from neurological deterioration in ISI group, while 1 patient suffered from neurological deterioration in normal group. All of them healed after treatment. At last follow-up, the average JOA score of ISI group and normal group was 7.0±1.5(range, 6-10) and 8.9±1.1(range, 8-10), the average JOA improvement rate of two groups was (40.0±12.4)%(range, 28.3%-78.9%) and (53.7±15.4)%(range, 38.7%-83.1%). The last follow-up JOA score of two groups significantly improved compared with those of preoperative(P<0.05). The postoperative JOA score and improvement rate of ISI group were significantly lower than those of normal group(P<0.05). At last follow-up, ASIA grade of most patients in two groups improved compared with the preoperatives. Conclusions: For thoracic ossification of the ligamentum flavum with high signal intensity on T2W1, surgical treatment is a effective method, but less than that with normal signal intensity.