摘要:
目的：探究功能性核磁成像技术在脊髓型颈椎病患者中应用及其临床意义。方法：选择2014年1月至2014年6月我院骨科收治的脊髓型颈椎病患者为观察对象，选择同期10例健康志愿者为对照组对象。在术前、术后6周、3月及其6月分别进行一次fMRI脑功能成像并根据日本骨科学会评分系统(JOA scores)对术后恢复情况进行评估。对照组对象同期行脑fMRI功能成像。比较两组不同时间点脑fMRI功能成像、JOA 评分和术后恢复(步长，动作完成时间)。结果：对照组健康对象在完成指定动作时，在对侧脑部主要运动区都有局部有限的皮质激活区域。脊髓型颈椎病患者fMRI图像表明激活的皮质映射区域与健康对照组相比有所扩大。脊髓减压术后皮质激活映射区有所缩小并接近健康组激活区域范围。与对照组比较，枕叶、额叶及其边缘系统是观察组患者ReHo显著降低的脑区；小脑及其边缘叶是观察组ReHo显著升高的脑区。JOA评分和术后恢复观察组患者明显(P < 0.05)。结论：fMRI可作为脊髓型颈椎病患者术前和术后皮质投射区变化的有效评定方法，通过此FMRI的评估可以有效的进行患者术后评估和术后恢复指导。
Abstract:
Objective: To explore the functional magnetic resonance imaging application and its clinical significance in the spondylotic myelopathy. Methods: 10 cases spondylotic myelopathy patients treated in the orthopaedic department of our hospital from January 2014 to June 2014 were selected as the observation objects, and 10 cases healthy volunteers were selected as the control objects in the same period. Functional magnetic resonance imaging and the Japanese orthopaedic society of scoring system (JOA scores) evaluating the postoperative recovery were measured in the preoperative and postoperative 6 weeks, 3 months and 6 months, respectively. The control objects in the same period were measured by functional magnetic resonance imaging. Functional magnetic resonance imaging and JOA score and postoperative recovery (time step, action) were compared between two groups at different time points. Results: The limited areas of the cortex were activated at main motor areas on the side of the brain after completing the action in the control objects. Activation of cortical map area in functional magnetic resonance imaging of the spondylotic myelopathy patients widened compared with the healthy controls. Cortical activation mapping area reduced activation area and close to the healthy group after the spinal cord decompression. Compared with the control group, the occipital lobe, the frontal lobe and the limbic system were the areas of the brain that ReHo of the observation group patients significantly reduced. The cerebellum and the edge of leaf were the areas of the brain that ReHo of the observation group patients significantly increased. The JOA score and post-operation of the observation group are more significant than those of the control group (P < 0.05). Conclusion: Functional magnetic resonance imaging can be effective evaluation methods for the preoperative and postoperative cortical projection area changes in the spondylotic myelopathy patients’ cerebral cortex. We can evaluate the postoperative recovery and give positive postoperative rehabilitation guidance effectively with the functional magnetic resonance imaging assessment.