MRI在无骨折脱位型颈脊髓损伤诊断和预后分析中的作用  

Effects of MRI in the diagnosis and prognosis of cervical spinal cord injury without fracture or dislocation

作　　者：刘新阁 李涛[2] 陈方民 韩敦富[2] 时明 

机构地区：[1]滨州医学院,山东省淄博市255400 [2]淄博市中心医院骨科,山东省淄博市256600 [3]滨州医学院烟台附属医院,山东省烟台市264100

出　　处：《中国组织工程研究》2017年第31期5037-5042,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:中老年人的颈椎可因不同原因导致不同程度的椎管狭窄,在受伤时发生无骨折脱位颈髓损伤概率也相对较高,有文献报道可占颈段脊髓损伤的3%-16%。目的:探讨MRI在诊断和预测无骨折脱位型颈脊髓损伤预后中的作用,并分析手术效果的影响因素。方法:回顾分析2014年8月至2016年6月就诊于淄博市中心医院的51例成人无骨折脱位型颈脊髓损伤患者,根据影像学资料,分别采取前路、后路或前-后路联合手术,将术中所见颈椎骨韧带损伤与MRI表现对比。使用单因素和多因素Logistic回归分析患者的年龄、外伤类别、脊髓损伤MRI类型、受伤到就诊时间、脊髓损伤信号长度、脊髓损伤ASIA分级、颈椎管狭窄程度、伤后8 h内是否使用激素治疗、受伤至手术的时间、手术方式等10个因素对预后的影响。结果与结论:(1)颈椎MRI较术中所见更全面显示了脊髓及椎间盘韧带复合体损伤(χ~2=5.966,P<0.05),且颈脊髓损伤与相应椎间隙平面椎间盘韧带复合体损伤有关(χ~2=1.53,P<0.05);(2)单因素分析结果表明,脊髓损伤MRI类型、脊髓损伤信号长度、脊髓损伤ASIA分级、颈椎管狭窄程度、伤后8 h内是否使用激素治疗、受伤至手术时间与脊髓神经功能恢复相关(P<0.1);(3)再经多因素Logistic回归分析,脊髓损伤MRI类型、脊髓损伤信号长度、颈椎管狭窄程度、受伤至手术时间与脊髓神经功能恢复有明显相关性(P<0.05);(4)结果提示,颈椎MRI因其组织分辨优势,在诊断无骨折脱位型颈脊髓损伤及预测其预后中具有重要作用;脊髓损伤程度、颈椎管狭窄程度及手术时机是影响术后疗效的主要因素。BACKGROUND： In the elderly, the cervical vertebrae will appear with different degrees of spinal stenosis caused byvarious factors. Notably, the incidence of cervical spinal cord injury without fracture or dislocation is high, accounting for3%-16% of cervical spinal cord injury.OBJECTIVE： To explore the efficacy of MRI in the diagnosis and prognosis of cervical spinal cord injury without fractureor dislocation, and to analyze the influencing factors for surgical effectiveness.METHODS： Fifty-one patients with cervical spinal cord injury without fracture or dislocation in Zibo Central Hospital fromAugust 2014 to June 2016 were analyzed retrospectively. All the patients underwent anterior, posteror, oranterior-posterior fusion, respectively, and then the intraoperative ligament injury and MRI images were compared. Theage, injury type, spinal cord injury type revealed on MRI, time from injury to hospital, signal length of spinal cord injury,American Spinal injury Association grade, degree of cervical stenosis, whether hormone used or not within 8 hours afterinjury, time from injury to surgery, and surgical approaches were analyzed based on univariate analysis and multivariateanalysis by Logistic regression analysis.RESULTS AND CONCLUSION： （1） MRI showed more comprehensive damage of the spinal cord and intervertebral discligament complex than the intraoperative findings （χ2=5.966,P 〈 0.05）, and the cervical spinal cord injury was related tothe injury of the corresponding intervertebral disc ligament complex （χ2=1.53, P 〉 0.05）. （2） Univariate analysis resultsshowed that the spinal cord injury type revealed on MRI, signal length of spinal cord injury, American Spinal injuryAssociation grade, degrees of cervical stenosis, whether hormone used or not within 8 hours after injury, and time frominjury to surgery were related to the functional recovery of spinal cord （P 〈 0.01）. （3） Multivariate analysis resultsindicated that the type revealed on MRI, signal length of spinal cord injury

关 键 词：骨科植入物 脊柱植入物 无骨折脱位型颈脊髓损伤 手术 MRI 回归分析 因素分析 

分 类 号：R318[医药卫生—生物医学工程]