过伸性颈椎颈髓损伤严重程度影响因素分析  

FACTORS TO AFFECT SEVERITY OF HYPEREXTENSION INJURY OF CERVICAL SPINAL CORD

作　　者：刘培太[1,2] 廖文波[1] 

机构地区：[1]遵义医学院附属医院骨二科,贵州遵义563003 [2]河南大学第一附属医院骨科

出　　处：《中国修复重建外科杂志》2009年第11期1338-1342,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨影响过伸性颈椎颈髓损伤严重程度的因素。方法对2005年12月-2008年9月收治的45例急性过伸性颈椎颈髓损伤患者进行回顾分析。男35例,女10例;年龄27～67岁,平均48.2岁。病程30min～16d。脊髓损伤采用ASIA改良Frankel分级标准:A级6例,B级8例,C级16例,D级15例。根据神经平面结合髓内高信号征判定脊髓损伤节段,凡神经平面下整个节段或节段内大部分呈高信号改变者为主要受损脊髓节段,节段内呈断续或斑片状高信号改变者为一般受损脊髓节段。规定头面部受力较大、在高速移动中受力或伤后头面部有较重挫裂伤体征者为重伤力,反之为轻伤力。根据颈椎MRIT2加权像椎间盘信号强度判定颈椎间盘退变程度,并以C3、4～C6、7退变最严重的椎间盘分级代表整体颈椎退变分级,由轻到重分为0～4级。依据颈椎MRI正中矢状面T2加权像脊髓前后脑脊液层厚薄和T1加权像脊髓受压程度,将椎管狭窄由轻到重分为0～4级。研究外伤力、颈椎退变及椎管狭窄与受损脊髓节段的关系。结果轻伤力引起者12例,重伤力引起者33例,轻伤力组较重伤力组脊髓损伤轻、年龄大(P<0.05)。主要受损脊髓节段见于40例45节,其中C3、4最多(25节);一般受损脊髓节段21例39节。45例患者颈椎均有退变,3级最多(22例),退变最重节段位于C5、6最多(35例)。不同级别退变椎间盘处发生的主要受损脊髓节段数为0级0节,1级9节,2级20节,3级14节,4级2节。各级别椎管狭窄节段处受损节段数与椎管狭窄节段数的比值依次是:0级1/62节,1级2/11节,2级27/52节,3级33/33节,4级21/22节。结论创伤力大小、颈椎节段性不稳定程度和椎管狭窄程度是影响颈脊髓过伸性损伤发生发展的3个主要因素。Objective To explore the factors to affect severity of hyperextension injury of the cervical spinal cord （HEICSC）. Methods Forty-five patients with HEICSC, 35 males and 10 females, aged 27-67 years old （mean 48.2 years old）, were retrospectively analyzed. The disease course was 30 minutes to 16 days. According to modified Frankel grading, there were 6 cases of grade A, 8 cases of grade B, 16 cases of grade C and 15 cases of grade D. Spinal cord injuries （SCI） segments were determined according to SCI plane and high signal change （HSC） in spinal cord on MR images. The whole or large part of HSC segments were supposed to be main injured spinal cord segments （MISCSs） and the staccato or patchy HSC ones were supposed to be common injured spinal cord segments （CISCSs）. When the external force acting on head or face suffered was larger, the force produced during high-speed movement or forehead and/or face had severe contused and/or） lacerated wound, the force was defined severe traumatic strength, whereas the reverse was true for slight traumatic strength. According to signal magnitude of the cervical discs on T2-weighted MR images, degeneration of cervical discs and cervical vertebras were classified into 5 grades： grade 0-4. Cervical spinal stenosis were graded to 5 grades according to the width of anterior or posterior cerebrospinal fluid layer to spinal cord on T2-weighted MR images and compressed degree of spinal cord on T1-weighted MR images. The influence of traumatic strength, cervical spinal degeneration or cervical spinal stenosis on SCI were explored. Results Among the 45 cases, 12 cases were caused by slight traumatic strength, 33 cases were caused by severe one. The cervical spinal cord was injuried more slightly and the patients were older in the slight traumatic strength cases than in the severe ones （P 〈 0.05）. The number of MISCSs were 45 in 40 cases and the 25 segments were located at C3.4 level. The number of CISCSs were 39 in 21 cases. All the cerv/cal vertebraes of

关 键 词：颈椎 颈髓 过伸性损伤 脊髓损伤 MRI 

分 类 号：R651.2[医药卫生—外科学]