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作 者:戴宇森[1] 陈毕 滕红林[1] 黄克伦 王靖[1] 朱旻宇[1] 李驰[1]
机构地区:[1]温州医科大学附属第一医院脊柱外科,浙江温州325000
出 处:《中国骨伤》2015年第8期686-689,共4页China Journal of Orthopaedics and Traumatology
摘 要:目的 :探讨成人无骨折脱位型颈椎过伸伤患者MRI椎前高信号、椎管矢状径与神经功能的相关性。方法:回顾性分析2010年9月至2013年12月收治的无骨折脱位型颈椎过伸伤患者病例资料100例,根据MRI T2序列有无椎前高信号分为椎前高信号组和无椎前高信号组,其中椎前高信号组39例,男31例,女8例,年龄21~83岁,平均(58.10±14.78)岁;无椎前高信号组61例,男49例,女12例,年龄32~77岁,平均(55.05±10.36)岁。通过MRI正中矢状面测量下颈椎各椎间盘层面椎管矢状径,并记录年龄、性别、受伤原因及椎管狭窄节段数;采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经功能分级及运动评分对神经功能进行评价。结果 :ASIA运动评分椎前高信号组为52.56±31.97,无椎前高信号组为67.70±22.83,两组差异有统计学意义(P=0.013);椎前高信号组患者的髓内高信号发生率明显高于无椎前高信号组(P=0.006);两组患者ASIA运动评分与损伤节段椎间盘层面椎管矢状径存在正相关(P=0.003),且椎管狭窄节段越多,ASIA分级越差。结论:成人无骨折脱位颈椎过伸伤MRI椎前高信号、椎管矢状径均与伤后神经功能相关,而存在多节段椎管狭窄的患者更易遭受严重的颈髓损伤。Objective:To explore the correlation among prevertebral hyperintensity(PVH),sagittal canal diameter on MRI and neurologic function of patients after cervical vertebral hyperextension injury without fracture and dislocation. Methods:The clinical data of 100 patients with cervical vertebral hyperextension injury without fracture and dislocation were retrospectively analyzed from September 2010 to December 2013. The patients were divided into PVH group and non-PVH group according to the presence of PVH on T2-weighted magnetic resonance imaging. There were 39 patients in PVH group,including 31 males and 8 females,aged from 21 to 83 years old with an average of(58.10±14.78) years;and the other 69 patients in non-PVH group,including 49 males and 12 females,aged from 32 to 77 years old with an average of(55.05±10.36) years. The sagittal disc level canal diameters of subaxial cervical spine were measured on mid sagittal magnetic resonance imaging. The age,sex,cause of injury,and the segments of spinal stenosis were recorded. American Spinal Injury Association(ASIA) impairment scale and motor score were used to evaluate the neurological status. Results:The ASIA motor score of the group with PVH was 52.56±31.97 while the ASIA motor score was 67.70±22.83 in non-PVH group(P=0.013). More patients with intramedullary hyperintensity signal on MRI were observed in the PVH group than in non-PVH group(P=0.006). There was a significant positive correlation between ASIA motor score and sagittal disc level canal diameter of injury segment(P=0.003).The neurological status was worse in patients with multi level sagittal canal diameters below 8 mm. Conclusion:The PVH and the disc level canal sagittal diameter of the injury segment are associated with neurological status. The patients with multi level sagittal canal stenosis are vulnerable to severe cervical spinal cord injury.
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