颈段脊柱外伤的MRI评价与预后  

The MRI Appearances and its Relationship with Clinical Prognosis in Cervical Spine Trauma

作　　者：叶彩林 张婧婧[1] 陆璐[1] 钱银锋[1] 余永强[1] 

机构地区：[1]安徽医科大学第一附属医院放射科,230022

出　　处：《临床放射学杂志》2015年第9期1453-1458,共6页Journal of Clinical Radiology

摘　　要：目的探讨颈段脊柱外伤患者的MRI表现及其与临床预后的关系。方法回顾性分析106例颈段脊柱外伤患者的MRI资料,从椎体、椎间小关节、椎间盘、脊髓、韧带、血肿和椎动脉共7个方面进行评价,根据出院时患者的综合状况将预后分为完全恢复、明显好转、好转、无变化、恶化5个等级,分析不同MRI表现对预后的影响。结果 106例颈部外伤患者中,上颈段椎体骨折18例共23个椎体,下颈段椎体骨折58例共83个椎体,其中C5-C7椎体占96.4%。椎体滑脱伴椎间小关节脱位26例,最常见为C5椎体向前滑脱。椎间盘损伤99例179个,其中71例140个椎间盘突出,28例共39个椎间盘破裂;椎间盘突出患者与椎间盘破裂者预后存在统计学差异（P〈0.01）。脊髓内水肿67例,脊髓内血肿20例,脊髓水肿患者与脊髓血肿患者预后存在统计学差异（P〈0.01）。98例患者共有231处韧带损伤,其中韧带剥离138处,韧带撕裂93处,所有韧带损伤患者均有不同程度运动和感觉障碍,韧带剥离患者与韧带撕裂患者预后存在统计学差异（P〈0.01）。95例患者可见椎旁血肿,包括椎体前缘血肿79处,椎体后方血肿73处,椎管后部硬膜外血肿68处。椎动脉损伤24例,除5例有心血管基础疾病外,19例患者治疗后相关症状均消失。结论 MRI可全面评估颈段脊柱外伤,对指导临床治疗、判断预后具有重要作用。Objective To explore the MRI appearances of the cervical spine trauma and its relationship with prognosis.Methods Retrospectively analysis 106 cervical spine trauma patients performed with MRI examination,evaluating content contained vertebral body,facet joints,intervertebral discs,spinal cord,ligaments,hematoma and vertebral arteries. According to the comprehensive status when the patients out of the hospital,the clinical outcomes were classified as five levels： fully restored,significantly improved,improved,unchanged and deterioration; the relationship of MRI appearances with prognosis was evaluated. Results Among 106 cases with cervical spine trauma,18 cases had 23 upper cervical vertebral fractures,58 cases had 83 lower cervical vertebral fractures,in which C5- C7 vertebrae accounted for 96. 4%.Twenty six cases with spondylolisthesis associated with facet joint dislocation,among which C5 spondylolisthesis forward was the most common. There were 179 intervertebral discs changes in 99 cases,including 140 discs herniation in 71 cases and39 disc rupture in 28 cases. The prognosis of the patients with disc herniation was superior to the patients with disc rupture（ P 〈 0. 01）. Spinal cord edema was found in 67 cases,and spinal cord hematoma was found in 20 cases,the prognosis was significant difference between two groups（ P 〈 0. 01）. Ninety eight cases had total of 231 places ligament injury,contained 138 places ligament detachment and 93 places ligament rupture. All patients with ligament damage have varying degrees of movement and sensory disorders,and the prognosis of the patients with ligament detachment was superior to the patients with ligament rupture（ P 〈 0. 01）. Ninety five cases had paraspinal hematoma,included prevertebral hematoma in 79 places,postvertebral hematoma in 73 places and epidural hematoma posterior to the spinal cord in 68 places. Among the 24 cases with vertebral artery injury,except five cases with fundamental cardiovascular disease,19 cases with symptoms associated wit

关 键 词：颈椎 外伤 磁共振成像 预后 

分 类 号：R681.5[医药卫生—骨科学] R445.2[医药卫生—外科学]