【作者】 王凯；

【导师】 夏磊；

【作者基本信息】 郑州大学 ， 外科学， 2011， 硕士

【摘要】 研究背景：胸椎管狭窄(thoracic spinal stenosis, TSS)是由于胸椎的关节囊增生,黄韧带、后纵韧带骨化及椎体增生,椎间盘突出等原因造成椎管狭窄和脊髓压迫症状。MRI检查能够清晰地显示出脊髓受损害的程度,成为胸椎管狭窄的一项重要的影像学检查方法。在临床工作中发现有一部分患者核磁共振检查T2W1像会出现脊髓高信号(Increased signal intensity, ISI)。脊髓内出现高信号是因为病变部位的组织长期压迫脊髓,造成局部缺血所致。高信号提示脊髓存在水肿、变性和坏死等病理性的损害改变。对于颈椎病患者术前的MRI检查中出现T2W1脊髓高信号与手术预后的关系,有很多学者在这方面做了研究,但仍然没有一致的结果。而对于胸椎管狭窄患者而言,术前影像学检查中MRI图像T2加权像上出现脊髓高信号对手术预后的影响,目前对该相关方面的研究相对较少。目的：通过观察胸椎管狭窄症的患者中术前MRI检查T2加权相出现脊髓内高信号的患者的手术疗效,进而探讨术前MRI髓内信号的改变对于TSS手术预后的影响。方法：本文旨在通过回顾性分析我科于2008年7月-2011年2月期间因TSS住院并且采用手术治疗,有比较完整的随访资料的29例患者,其中男21例,女8例,平均年龄：51.5±11.7岁(38-76岁)。病程6个月-8年。术后采取定期复查,电话随访及问卷调查的方式对患者进行资料搜集。根据术前病情严重程度及术后改善情况,应用日本矫形外科学会(JOA)制定的下肢运动功评分标准进行术前术后的评分。将所有的患者根据术前胸椎MRI图像T2像脊髓是否有高信号进行分组,分为T2像高信号组和T2像信号正常组,并对这两组的术后的症状恢复情况和这两组手术前的JOA评分情况进行比较。判断T2像脊髓内出现高信号对手术效果的影响程度。在出现脊髓高信号的病例中将患者分为单节段信号增高组和多节段信号增高组,通过对两组的术前JOA评分和术后改善率进行比较,观察出现脊髓高信号的范围的大小对手术治疗效果的影响程度。采用SPSS 10.0统计软件包进行统计学数据分析,手术前、后的对比采用t检验,P值<0.05为有统计学意义。结果：(1)所有病例中T2像高信号组术前JOA评分平均为4.6±1.3分,T2像信号正常组JOA评分平均为6.4±1.6分,将两者进行比较,t检验结果显示(表1)T2像正常信号组的评分高于信号增高组,比较的结果据有统计学意义(P<0.05),说明T2像出现脊髓高信号与脊髓受损害的程度有关系。(2)将T2像高信号组与T2像信号正常组的术后改善率进行t检验结果表明(表2)两者术后改善率比较的结果据有统计学意义(P<0.05),说明T2像脊髓内高信号对手术疗效也有一定程度上的影响。(3)比较单一节段信号增高组与多节段信号增高组术前的JOA评分,对两者进行t检验结果表明(表3)比较的结果据有统计学意义(P<0.05),说明T2脊髓高信号出现的范围越大,脊髓受损害的程度就越重。(4)单一节段信号增高组术后JOA评分为7.2±1.9,多节段信号增高组为6.1±1.5。将两组的术后改善率进行比较,t检验结果表明(表4)两者术后改善率比较的结果据有统计学意义(P<0.05),说明脊髓信号增高的范围对手术疗效也有一定程度上的影响。结论：在胸椎管狭窄的患者中,MRI检查T2加权像出现脊髓高信号是该处脊髓受损害的表现,并且还与脊髓信号增高的范围有关,高信号出现的范围越大说明脊髓受损害的程度越重。T2出现像脊髓内高信号对手术疗效也有一定程度上的的影响,高信号出现的范围越大手术疗效也越差。更多还原

【Abstract】 Research background:Thoracic spinal stenosis TSS is due to proliferation of the joint capsule thoracic Ossification of Ligmentum Flavum and Posterior vertebral Longitudinal Ligament, vertebral hyperplasia, slipped disc.Reasulting in spinal stenosis and spinal cord compression symptoms. MRI examination can clearly show the extent of damage to the spinal cord, thoracic spinal canal stenosis as an important imaging method. Found in daily clinical some patients the spinal cord appears as high signal (Increased signal intensity, ISI) on MRI T2W1. With high signal within the spinal cord lesion because the organization of long-term spinal cord compression, resulting in local ischemia. There is high signal suggest that spinal edema, degeneration and other pathological changes in the damage. For patients with preoperative cervical MRI examination of spinal cord high signal appears T2W1 and surgical prognosis, scholars around the world not yet have a unified point of view. Many scholars have done a study in the cervical spine, but still no consistent results. For the thoracic spinal stenosis patients, preoperative MRI imaging in the image of spinal cord on T2-weighted image high signal on the prognosis of surgery, So far the lack of relevant aspects of this.Objective:To investigate the thoracic spinal stenosis in patients with T2-weighted preoperative MRI examination phase appears high signal in patients with spinal cord surgery, and then discuss the preoperative intramedullary signal change on MRI TSS surgery prognosis.Methods:This retrospective analysis aims to our department in July 2008 February 2011 during the period of hospitalization and use of surgical treatment of TSS, a relatively complete follow-up data of 29 patients, including 21 males and 8females, average age:51.5±11.7 years (38 to 76 years). Duration of 6 months to 8 years. To take on a regular basis after review of all patients, telephone follow-up and questionnaire survey to collect data on patients. According to the severity of the preoperative and postoperative improvement, application of the Japanese Orthopaedic Association (JOA) score developed standards for lower extremity motor function scores before and after operation. All the patients according to preoperative MRI images of thoracic spinal cord is like a high T2 signal were grouped into T2 as T2 high signal as the signal group and the normal group, and the symptoms of these two groups of postoperative recovery, and these two groups The JOA score before surgery were compared. As in the spinal cord to determine with high T2 signal on the effect of extent of surgery. In the case of spinal cord high signal were divided into single segment will signal increased group and increased multi-segment signal group, the two groups by preoperative and postoperative improvement rate of JOA score were compared to observe the extent of spinal cord high signal The size of the degree of influence surgical treatment. Using SPSS 10.0 statistical package was used for statistical data analysis, before and after surgery using a paired t test comparison, (P value<0.05) was considered statistically significant. Results:(1) of all cases as high signal on T2 preoperative JOA score was 4.6±1.3 points, T2 signal the normal group as JOA score was 6.4±1.6 points, to compare the two, paired t test showed (Table 1) T2 Groups like the normal signal higher score than the signal group, compare the results statistically significant, according to (P <0.05), shows high T2 signal of spinal cord as the spinal cord between the degree of damage.(2) as high signal on T2 and the T2 group as the signal to improve the rate of the control group to compare the postoperative paired t test showed (Table 2) Comparison between the results of postoperative improvement rate was statistically significant, according to (P<0.05) shows high T2 signal within the spinal cord as the surgery has some degree of influence.(3) to compare the signal increased in a single segment and multi-segment signal groups increased the preoperative JOA score of the paired t test to compare the two results (Table 3) to compare the results statistically significant, according to (P<0.05) shows T2 hyperintense spinal cord appeared greater the scope, the extent of damage to the spinal cord more weight.(4) a single segment of the signal increased postoperative JOA score was 7.2±1.9, multi-segment signal group increased 6.1±1.5. The postoperative improvement rate of the two groups were compared, t test results showed that (Table 4) improvement rate after surgery compared between the two, according to statistically significant results (P<0.05), shows increased signal range of spinal surgery has some of the Degree of influence.Conclusion:In patients with thoracic spinal canal stenosis, MRI examination of spinal cord T2-weighted image high signal is where the performance of the injured spinal cord, and also increased the scope of the spinal cord signal related to the greater range of high signal appears that the injured spinal cord More severe. T2 appear as high signal within the spinal cord surgery there is a certain degree of influence, The greater the range of high signal appeared the worse surgery.更多还原