过伸性颈脊髓损伤影像学分型及其临床指导价值  

Radiological classification of hyperextension cervical spinal cord injury and its clinical guiding value

作　　者：王建杰[1] 程黎明[1] 曾至立[1] 谢宁 麻彬 于研[1] 朱睿[1] 崔志明[2] 海涌[3] 罗卓荆 王哲 周许辉 陈雄生 贾连顺 Wang Jianjie;Cheng Liming;Zeng Zhili;Xie Ning;Ma Bin;Yu Yan;Zhu Rui;Cui Zhiming;Hai Yong;Luo Zhuojing;Wang Zhe;Zhou Xuhui;Cheng Xiongsheng;Jia Lianshun(Department of Orthopedics,Tongji Hospital Affiliated to Tongji University&Key Lciboratory of Spine and Spinal Cord Injury Repair and Regeneration,Ministry of Education,Shanghai 200065,China;Department of Orthopedics,Second Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Orthopedics,Beijing Chao-Ying Hospital,Capital Medical Unirersity,Beijing 100020,China;Department of Orthopedics,Xijing Hospital of Airforce Medical University,Xi'an 710032,China;Department of Orthopedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China)

机构地区：[1]同济大学附属同济医院骨科,脊柱脊髓损伤再生修复教育部重点实验室,上海200065 [2]南通大学第二附属医院骨科,226001 [3]首都医科大学附属北京朝阳医院骨科,100020 [4]空军军医大学西京医院骨科,西安710032 [5]海军军医大学长征医院骨科,上海200003

出　　处：《中华创伤杂志》2020年第12期1109-1117,共9页Chinese Journal of Trauma

基　　金：上海市重中之重重点学科建设计划(2017ZZ02004);上海市临床重点专科项目(shslczdzk05503);上海市卫生计生系统重要薄弱学科建设计划(2016ZB0204);上海市中西医临床协作试点项目[ZY(2018-2020)-FWTX-1005];上海市卫生和计划生育委员会科研课题青年项目(20154Y0071)。

摘　　要：目的基于过伸性颈脊髓损伤的影像学特征建立新的临床分型并验证其临床指导意义。方法采用回顾性病例系列研究分析2009年4月至2016年12月同济大学附属同济医院收治的88例过伸性颈脊髓损伤患者临床资料,其中男68例,女20例;年龄18~87岁[(52.9±14.8)岁]。根据颈椎椎管退变状态将过伸性颈脊髓损伤进行分型(Cheng氏分型):无退变性椎管狭窄为A型,单纯椎间盘突出为B型,椎间盘突出合并骨赘增生为C型,椎管内韧带骨化为D型。根据脊髓信号改变和椎间盘韧带复合体(DLC)损伤情况各型又分为3个亚型:无脊髓信号改变或DLC损伤为A1、B1、C1、D1型,伴脊髓信号改变但无DLC损伤为A2、B2、C2、D2,伴脊髓信号改变及DLC损伤为A3、B3、C3、D3型。分析不同分型的基本特征及脊髓信号改变与DLC损伤节段的一致率。A1、A2型采用非手术治疗(非手术组,22例),A3型与B、C、D型采用手术治疗(手术组,66例)。比较两组治疗前和末次随访时美国脊髓损伤协会(ASIA)评分、ASIA损伤分级(AIS)和日本骨科学会(JOA)评分。根据是否有颈椎椎管退变,将患者分为无退变类(A型)和退变类(B、C、D型),比较两类患者的年龄及治疗前和末次随访时ASIA评分和JOA评分。结果本组A型24例,B型22例,C型34例,D型8例,其中退变性患者占73%(64/88),以B、C、D型为主。B、C型占退变患者的88%(56/64),并以中老年患者为主。脊髓信号改变与颈椎退变状态有关,而与DLC损伤节段的一致率为40%。所有患者随访1~9.1年[4(1,6)年]。非手术组治疗前与末次随访时ASIA运动评分为90(88,96)分、100(100,100)分,感觉评分为216(212,221)分、224(224,224)分;AIS治疗前22例均为D级,末次随访时均为E级;治疗前与末次随访时JOA评分分别为13(12,14)分、17(17,17)分。手术组治疗前与末次随访时ASIA运动评分为76(62,86)分、98(94,100)分,感觉评分为204(191,212)分、220(212,224)分;AIS治疗前A级4例、Objective To innovate a classification of hvperextensioii cen ical spinal cord injuiy according to the radiological characteristics and to verify its clinical significance.Methods A retrospective case series study was performed to analyze the clinical(lata of 88 patients with hyperextension cervical spinal cord injury admitted to Tongji Hospital Affiliated to Tongji University between April 2009 and December 2016.The patients included 68 mules and 20 females,aged 18-87 years[(52.9±14.8)years].Hyperextension cervical spinal cord injiuy was classified by the degree of degeneration(Cheng's classification):type A(nou-degenerative spinal stenosis),type B(disc herniation alone),type C(disc herniation along with osteophyte)and type D(ossification of posterior longitudinal ligament).Further,all types were divided into 3 subtypes based on disc-ligmentous complex(DLC)injury and intramedullary signal in tensity change:without high-intensity intramedullary signal or DLC injury as subtypes Al,Bl,Cl and DI),with liigh-intensity intramedullary signal but without DLC injury as subtypes A2,B2,C2 and D2,with high-intrnsity intramedulkiry signal and DLC injuiy as subtypes A3,B3,C3 and D3.The concordance rate between intramedullary signal intensity change and DLC injury segment as well as the basic chaiacteristics of different types were analyzed.Types Al and A2 were treated with non-surgical treatment(22 patients,non-surgical group).Types A3,B,C and D were treated operatively(66 patients,surgical group).The American Spinal Injuiy Association(ASIA)score,ASIA impairment scale(AIS)and Japanese Orthopedic Association(JOA)score were assessed before treatment and at final follow-up.According to status of cervical spinal canal degeneration,the patients were further divided into two kinds including nondegeneration(type A)cind degeneration(types B,C,D).The age and ASIA score and JOA score before treatment and at final follow-up were compared between two kinds of patients.Results In all,4 patients were classified as type A,22 as type B,34 a

关 键 词：颈椎 脊髓损伤 椎间盘韧带复合体 

分 类 号：R651.2[医药卫生—外科学]