潘细根　　邵阳通　潘玲玲　　李正祥

[關键词] 神经根型颈椎病;中医康复治疗;核磁共振成像;弥散张量成像

[中图分类号] R445.2          [文献标识码] B          [文章编号] 1673-9701（2021）21-0096-04

Application value of MRI diffusion tensor imaging in evaluation of curative effect of traditional Chinese medicine rehabilitation for cervical spondylotic radiculopathy

PAN Xigen1   SHAO Yangtong1   PAN Lingling1   LI Zhengxiang2

1.Department of Radiology，Wenling Hospital of Traditional Chinese Medicine，Zhejiang Province，Wenling   317500，China;2.Department of Acupuncture and Massage，Wenling Hospital of Traditional Chinese Medicine，Zhejiang Province，Wenling   317500，China

[Abstract] Objective To explore the application value of MRI diffusion tensor imaging （DIT） in evaluation of curative effect of traditional Chinese medicine rehabilitation for cervical spondylotic radiculopathy. Methods A total of 86 patients with cervical spondylotic radiculopathy admitted to our hospital from June 2018 to June 2020 were selected and randomly divided into the observation group and the control group.The two groups were both treated with conventional cervical traction，and the observation group was additionally treated with traditional Chinese medicine rehabilitation.The changes of diffusion tensor imaging （DTI） analysis indexes [apparent diffusion coefficient （ADC），vertical diffusion rate （VD），fraction anisotropy rate （FA） and axial dispersion rate （AD）] in magnetic resonance imaging （MRI） were evaluated and compared between the two groups before and after treatment，and the clinical efficacy was compared. Results After one month of treatment，the total clinical effective rate of observation group （93.02%） was significantly better than that of control group （76.74%） （χ2=4.440， P<0.05）.The ADC and VD indexes in both groups were significantly lower after treatment [（1.46±0.26），（1.33±0.23），（0.94±0.18），（0.83±0.19）] than before treatment [（1.64±0.24），（1.62±0.20），（1.01±0.22），（1.02±0.24）]，while the FA and AD indexes after treatment [（0.54±0.08），（0.59±0.09），（1.88±0.35），（2.12±0.47）] were significantly higher than before treatment [（0.49±0.11），（0.50±0.09），（1.76±0.34），（1.79±0.41）] （P<0.05 or P<0.01）， and the change range of observation group was more obvious than that of control group （P<0.05）. Conclusion Traditional Chinese medicine rehabilitation treatment can effectively improve the curative effect of cervical spondylotic radiculopathy.MRI examination and DTI can be used to accurately evaluate the therapeutic effect，providing a basis for clinical practice.

[Key words] Cervical spondylotic radiculopathy;Traditional Chinese medicine rehabilitation treatment;Magnetic Resonance Imaging （MRI）;Diffusion tensor imaging （DTI）

神经根型颈椎病是骨科好发的疾病之一，由于单侧或双侧的神经根会被挤压或刺激造成感觉、运动或反射性障碍，因此患者会出现麻木、疼痛等严重影响生活质量[1-2]。神经根型颈椎病治疗方式较多，包括牵引治疗、手术治疗等，近年来，中医康复治疗较多的应用于临床，取得患者的认可[3-4]。早期的诊断和治疗对于改善患者的预后事关重要，核磁共振成像（Magnetic Resonance Imaging，MRI）是诊断颈椎病重要辅助检查手段，但其在治疗后疗效评价时存在敏感性、特异性不高等缺点，弥散张量成像（Diffusion tensor imaging，DTI）是MRI的特殊模式，能够量化的反应颈椎的微观结构，因此可以将DTI应用于疗效评价中[5-6]。本研究将MRI的DTI量化指标应用于中医康复治疗神经根型颈椎病疗效评价中，现报道如下。

1资料与方法

1.1 一般资料

选取2018年6月至2020年6月期间在我院就诊的神经根型颈椎病患者共86例。纳入标准[7]：（1）年龄18～75岁;（2）符合1992年全国颈椎病专题研讨会制定的颈椎病诊断标准，经CT或MRI证实存在神经压迫，并有相应的临床症状;排除标准[6]：（1）伴有其他颈椎疾病，如：颈椎肿瘤、结核、感染等;（2）治疗后不愿接受MRI检查;采用随机数字表法分为观察组和对照组。两组性别、年龄、病程时间等情况比较差异无统计学意义（P>0.05），具有可比性。见表1。本研究方案经医院伦理委员会审批通过，纳入患者均签署了知情同意书。