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目的使用过伸过屈位MRI评估脊髓型颈椎病严重退变节段临近节段稳定性及脊髓压迫程度的动态改变,为评估病情提供参考。方法选取2014年7月—2016年7月哈尔滨医科大学附属第一医院确诊为脊髓型颈椎病且中立矢状位MRI表现为Muhle分级2级以上的的患者95例,按照脊髓压迫所在最重节段分为C3/C4(16例),C4/C5(27例),C5/C6(34例),C6/C7(18例)4组,再按照脊髓压迫严重程度将病例分为2级组(31例),3级组(64例)均加拍过伸过屈位MRI片,并于所成MRI的T2矢状位下,以脊髓压迫加重病例数衡量评估退变节段头尾端节段脊髓压迫状态的动态变化,测量过伸过屈位下退变最严重节段临近头尾端各一个节段的椎间角位移,颈椎总体的角度位移,所测得角位移之和反映相应节段及颈椎总体活动功能,对于其节段稳定性及脊髓压迫程度的动态变化进行分析。结果颈椎总体活动度为(28.31±4.66)°,(35.29±3.65)°,(32.81±4.43)°,(27.08±5.64)°,该节段活动度为(9.96±5.78)°,(11.58±4.43)°,(7.08±2.69)°,(9.25±2.04)°,临近头端节段活动度为(3.16±2.16)°,(8.41±4.98)°,(10.98±2.44)°,(5.53±3.25)°,临近尾端节段活动度为(5.31±3.62)°,(4.08±3.28)°,(8.52±2.04)°,(2.15±3.44)°,其中颈椎总体活动度各组间差异无统计学意义,C5/6的本节段活动度,临近头端节段活动度以及临近尾端节段活动度同C3/4,C4/5以及C5/6组间差异均有统计学意义(P<0.05)。各组上下节段压迫提升率同相应节段活动度间缺乏相关性。结论过伸过屈位MRI可用于脊髓型颈椎病明显退变节段临近节段功能的评估,严重退变所在节段同临近节段功能变化有关,C5/6节段在颈椎临近节段退变过程中有重要意义。过伸过屈位MRI可用于脊髓型颈椎病明显退变节段临近节段功能的评估,严重退变所在节段同临近节段功能变化有关,C5/6节段在颈椎临近节段退变过程中有重要意义。
Objective To evaluate the dynamic changes of the adjacent segments of severe degenerative segments of cervical spondylotic myelopathy and the degree of spinal cord compression using hyperextension-flexion MRI to provide a reference for the assessment of the disease. Methods From July 2014 to July 2016, 95 patients with diagnosed cervical spondylotic myelopathy from the First Affiliated Hospital of Harbin Medical University who had grade 2 or higher Muhle MRI were selected according to the most severe spinal cord compression The patients were divided into 4 groups: C3 / C4 (16 cases), C4 / C5 (27 cases), C5 / C6 (34 cases) and C6 / C7 (18 cases). The patients were divided into two groups according to the severity of spinal cord compression (31 cases), grade 3 group (64 cases) were extrapolated flexion and extension of the MRI films, and in the MRI of the T2 sagittal, the severity of spinal cord compression to assess the number of head and tail degeneration segment end section evaluation Section of the spinal cord compression state of the dynamic changes measured over the extension of flexion degeneration of the most serious segments near the end of each segment of the intervertebral angle of displacement, the overall cervical spine displacement, the measured angular displacement and reflect the corresponding Segments and cervical spine general function, for its segmental stability and spinal cord compression changes in the dynamic analysis. Results The total activities of cervical spondylosis were (28.31 ± 4.66) °, (35.29 ± 3.65) °, (32.81 ± 4.43) ° and (27.08 ± 5.64 °), respectively. The segment activity was (9.96 ± 5.78) ° 4.43 °, 7.08 ± 2.69 °, and 9.25 ± 2.04 °, respectively. The activities of the proximal head segment were (3.16 ± 2.16) °, (8.41 ± 4.98) °, (10.98 ± 2.44) °, (5.53 ± 3.25) °, and the activities of the proximal end segment were (5.31 ± 3.62) °, (4.08 ± 3.28) °, (8.52 ± 2.04) ° and (2.15 ± 3.44 ° °, respectively. Statistically significant differences were observed in the activities of this segment of C5 / 6, the activities of adjacent segments and the activities of segments adjacent to C3 / 4, C4 / 5 and C5 / 6 P <0.05). There was no correlation between the lifting rate of compression in the upper and lower segments of each group and the corresponding segment activity. Conclusions Overexertion flexion and extension flexion MRI can be used to evaluate the function of adjacent segments of degenerative cervical spondylotic myelopathy. The degenerative segments are related to functional changes of adjacent segments. C5 / 6 segments degenerate near the cervical spine The process of great significance. Overexertion and flexion MRI can be used for cervical myelopathy obvious degeneration of the segment near the segment function assessment, severe degeneration of the segment with changes in the function of the adjacent segments, C5 / 6 segments near the cervical spondylolisthesis degeneration In the important significance.