| Objective:By measuring the imaging changes in the cervical magnetic resonance imaging(MRI)of patients with cervical spondylotic myelopathy(CSM),including the transverse diameter,sagittal diameter,transverse diameter/sagittal diameter,cross-sectional area of the mri cross section,the cumulative number of segments of the compressed spinal cord,T2W2 image height signal change and T2W2 high signal combined with T1W1 low The signal changes.To investigate the magnetic resonance imaging of patients with cervical spondylotic myelopathy the correlation between the clinical improvement rate of postoperative neurological function in patients with CSM was improved,and the prognosis of patients with clinical csm preoperative was better evaluated.Methods:For the normal physical examination of the undergraduate department of the Second Affiliated Hospital of Kunming Medical College from October 2013 to November 2017,there were 12 males,including 7 males and 5 females,aged 38-69 years old,and 12 normal physical examinations.The age is 51.4 years old.Selected from October 2013 to 2017 11 Among the 32 patients with cervical spondylotic myelopathy who were treated with undergraduate treatment,21 of them were male and 11 were female.The average age was 58.88±10.49,and the course ranged from February to October.Seven of them were included.The patient was involved in a single stage,and the two segments were involved in 14 cases,1 For patients with multiple segments,19 patients underwent anterior cervical approach,11 patients had posterior approach,and 2 patients underwent combined anterior and posterior approaches.All patients underwent MRI examination of the head and neck.All 32 patients with cervical spondylotic myelopathy underwent preoperative MRI examination in our hospital,and a detailed medical history was asked for all patients.A detailed physical examination was performed on japanese orthopaedic association score(JOA)before and after surgery,and the clinical recovery rate(RR)of the patient's,Clinical improvement rate=|postoperative JOA score-preoperative mJOA score |/| 17-preoperative JOA score |×100%.The method of this study is mainly divided into four steps.the first step is to measure the normal value of cervical spinal cord in normal subjects without cervical spinal cord compression.The transverse diameter,sagittal diameter,transverse diameter/sagittal diameter and cross section area of C1?2?C2?3?C3?4?C4?5?C5?6?C6?7 spinal cord segments in normal subjects were measured with spinal pia mater as the boundary.Because under physiological conditions,C1?2 have dentate processes in front and are relatively stable,and spinal cord compression is rarely caused by factors related to cervical degeneration.Therefore,C1?2 were used as relatively fixed segments.Calculate the segments C2?3?C3?4?C4?5?C5?6?C6?7 and C1?2 transverse diameter,sagittal diameter,cross-sectional area ratio,multiple measurements were taken to establish the standard morphology values of cervical spinal cord morphology based on C1?2.Secondly,image processing and data collection of 32 preoperative MRI of cervical spondylotic myelopathy were performed.The transverse diameter,sagittal diameter and cross-sectional area of the spinal cord of C1?2 segments were measured,and the values of the compressed segment were calculated according to the ratio.And calculate the transverse diameter,sagittal diameter,transverse diameter/sagittal diameter,and cross-sectional area change rate.Compression ratio(CR)=|normal shape cross-sectional area-cross-sectional area of spinal cord after compression|/normal shape cross-sectional area×100/%,of which the double-segment and multi-stage affected patients selected the largest section of area change.Third,according to the preoperative MRI images of all patients,the involved segments of cervical spinal cord were divided into single-stage,double-segment,and multi-stage(three or more).Fourth,32 patients with cervical Spondylotic myelopathy(CSM)were divided into three groups:no signal change group,T2W1 high signal group and T2W1 high signal combined with T1W1 low signal group.Using the SPSS 22.0 statistical software package,correlation analysis was used to examine the correlation between transverse diameter change rate,sagittal diameter change rate,transverse diameter/sagittal diameter,spinal cord area,number of compression segments,spinal cord signal changes and cervical spinal cord neurological function improvement rate.Results:The number of segments of C1?2?C2?3?C3?4?C4?5?C5?6?C6?7 of 12 physical examinations was calculated and measured.The transverse diameter,sagittal diameter and transverse diameter of each cervical segment were calculated.The sagittal diameter and spinal cord area were:C1?2:11.36±0.58mm,8.14±0.84mm,1.40,69.28±6.35mm2,C2?3:11.59±0.98mm,7.98±0.67mm,1.45,69.97±6.94mm2;C3?4:11.93‘0.78mm,7.82±0.72mm,1.53,73.44±8.51mm2;C4?5:12.38±0.64mm,7.57±0.65mm,1.64,76.21±7.14mm2;C5?6:11.81±0.75mm,7.41±0.78mm,1.9,70.67±9.22 mm2;C6?7:10.91±0.81 mm,6.51±0.66 mm,1.68,61.66±7.57 mm2.The average diameter of the C1?C7 spinal cord is 11.67mm,the average sagittal diameter is 7.57mm,and the average cross-sectional area is 70.21 mm2.Calculate the ratios of the values of the transverse diameter,the sagittal diameter and the cross-sectional area of C2?3?C3?4?C4?5?C5?6?C6?7 and C1?2 respectively,1.02,0.98,1.01;1.05,0.96,1.06;1.09,0.93,1.10;1.04,0.91,1.02;0.96,0.80,0.89.The data of 32 patients with cervical spondylotic myelopathy were measured and found:The minimum change rate of transverse diameter is 2.17%,the maximum transverse diameter change rate is 47.26%,the average is 27.11±8.54%;the minimum change rate of sagittal diameter change rate is 10.22%,the maximum change rate is 42.53%,and the average is 24.25±8.23%;transverse diameter/vector Minimum change in path change rate 13.81,the maximum change rate is 132.81%,the average is 71.52±27.89%;the minimum change rate of cross-sectional area change rate is 13.63,the maximum change rate is 38.24%,the average is 25.11±5.96%;the preoperative joa score is minimum 6,the maximum is 13 points,the average is 9.75±1.89 points;postoperative joa score of 9,maximum 16 points,average 13.69 ±2.07 points;neurological clinical improvement rate of 27.27%,maximum improvement rate of 83.33%,average 57.69± 16.34%.7 patients were single-segment involvement,14 patients were affected by two segments,and 11 patients were involved in multiple stages.Thirty-two patients with cervical spondylotic myelopathy had no signal change in preoperative MRI in 11 cases,T2W1 high signal change in 21 cases,T2W1 high signal combined with T1W1 low signal change in 10 cases.Statistical analysis of the change rate of transverse diameter,sagittal diameter change rate and transverse diameter of MRI images of spinal cord in patients with cervical spondylotic myelopathy There was no significant correlation between the rate of change of path and the clinical improvement rate of postoperative neurological function(p>0.05)The rate of change of cross-sectional spinal cord area was significantly correlated with the clinical improvement rate of neurological function(p<0.05);T2W1 high signal There was no significant correlation between changes and postoperative neurological improvement rate(p>0.05);T2W1 high signal combined with T1W1 low signal change was associated with postoperative neurological improvement rate(p<0.05);spinal cord involvement segment number was significantly associated with clinical improvement rate of neurological function(p<0.05).Conclusion:There is no significant correlation between the changes of transverse diameter,sagittal diameter and transverse diameter/sagittal diameter in patients with cervical spondylotic myelopathy before operation and the clinical prognosis of patients with cervical spondylotic myelopathy.The change of diameter,transverse diameter and sagittal diameter was used as an indicator to evaluate the prognosis of patients.Cross section of the spinal cord There was a significant correlation between the number of changes and the number of cervical spinal cord compression segments and the clinical improvement rate of postoperative spinal cord function.The more the spinal cord area was reduced,the worse the postoperative neurological function recovery.In this study,the average spinal cord area lost 25.11%,indicating that when the spinal cord area is greater than 25.1 1%,the recovery of postoperative neurological function will have a significant impact.The number of affected segments is negatively correlated with the rate of improvement in postoperative neurological function.The more the patient's cervical spinal cord was subjected to compression,the worse the postoperative recovery.Preoperative T2W1 with high signal has no guiding significance for patient prognosis evaluation.Preoperative T2W1 with high signal and T1W1 low signal change can be used as an indicator to evaluate prognosis,and suggest that patients have poor prognosis. |
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