成人无骨折脱位型急性颈脊髓损伤影像学分型及可信度评价  

Radiological classification and its credibility assessment of acute cervical spinal cord injury without fracture or dislocation in adults

作　　者：王洪立[1] 聂聪[1] 吕飞舟[1,2] 马晓生 夏新雷[1] 姜建元[1] Wang Hongli;Nie Cong;Lyu Feizhou;Ma Xiaosheng;Xia Xinlei;Jiang Jianyuan(Department of Orthopedics,Huashan Hospital,Fudan Universily,Spine Center of Fudan Universily,Shanghai 200040,China;Department of Orthopedics,Shanghai Fifth People's Hospital of Frudan Universily,Shanghai 200240,China)

机构地区：[1]复旦大学附属华山医院骨,复旦大学脊柱外科中心,上海200040 [2]复旦大学附属上海市第五人民医院骨科,200240

出　　处：《中华创伤杂志》2021年第10期911-918,共8页Chinese Journal of Trauma

基　　金：上海市临床重点专科项目(shslczdzk05502);复旦大学附属华山医院“优秀人才培养奖励计划”。

摘　　要：目的建立成人无骨折脱位型急性颈脊髓损伤影像学分型系统并进行可信度评价。方法采用回顾性病例系列研究分析2010年1月至2018年12月复旦大学附属华山医院收治的132例无骨折脱位型急性颈脊髓损伤患者临床及影像学资料,其中男97例,女35例;年龄18~82岁[(57.4±17.8)岁]。根据颈脊髓是否存在受压及致压物来源、是否存在椎间盘韧带复合体(DLC)损伤等因素建立无骨折脱位型急性颈脊髓损伤影像学分型系统,进一步分析各型病例数、年龄及致伤原因。另收集24例无骨折脱位型急性颈脊髓损伤患者临床及影像学资料,由未参与该分型系统制定的骨科医师在规定时间内完成影像学分型评估,计算Kappa系数对该分型进行可信度评价。结果无骨折脱位型急性颈脊髓损伤影像学分型系统分为Ⅰ~Ⅳ型:Ⅰ型为脊髓存在明显受压,致压因素主要为颈椎后纵韧带骨化和(或)颈椎管狭窄等基础病理改变;Ⅱ型为脊髓存在明显受压,致压因素主要为外伤性椎间盘突出和(或)硬膜外血肿;Ⅲ型为脊髓不存在明显受压,但存在明确的DLC损伤征象;Ⅳ型为脊髓不存在明显受压,且不伴或仅存在可疑DLC损伤征象。其中Ⅰ型、Ⅱ型可同时伴或不伴DLC损伤。Ⅰ型 83例(62.9%),年龄(62.2±15.7)岁,以跌倒伤(37例,44.6%)为主,其次为交通伤(31例,37.3%)。Ⅱ型17例(12.9%),年龄(55.8±13.4)岁,以交通伤(9例,52.9%)和坠落伤(5例,29.4%)多见。Ⅲ型24例(18.2%),年龄(53.6±16.3)岁,以坠落伤(9例,37.5%)和交通伤(8例,33.3%)多见。Ⅳ型8例(6.1%),年龄(37.4±11.6)岁,以交通伤(4例,50.0%)和运动伤(3例,37.5%)多见。分型可信度评估显示不同观察者之间患者分型相同百分比为79.2%~87.5%,平均81.2%;Kappa系数为0.691~0.866,平均0.789,可信度为基本可信(0.61~0.80)。结论成人无骨折脱位型急性颈脊髓损伤影像学分型系统可信度高,各型年龄分布及致伤原因的差异性提示该Objective To establish a radiological classification system for acute cervical spinal cord injury without fracture or dislocation in adults and evaluate its credibility.Methods A retrospective case series study was performed to analyze the clinical and radiological data of 132 patients with acute cervical spinal cord injury without cervical fracture or dislocation admitted to Huashan Hospita,Fudan University from January 2010 to December 2018.There were 97 males and 35 females,aged 18-82 years[(57.4±17.8)years].The radiological classification system of acute cervical spinal cord injury without fracture and dislocation in adults was established based on spinal cord compression and its compressors,and the disco-ligamentous complex(DLC)injury.The number,age and causes of injury of each subtype were further analyzed.Another 24 patients with acute cervical spinal cord injury without fracture and dislocation were collected and assessed to calculate the Kappa coefficient for credibility assessment in the radiological classification by orthopedie surgeons who did not participate in the establishment of the classification.Results The radiological classification system of acute cervical spinal cord injury without fracture or dislocation in adults ineluded types Ⅰ-Ⅳ.Type Ⅰ was the cervical spinal cord significantly compressed by the existed pathological factors such as the ossification of the posterior longitudinal ligament of the cervical spine and/or cervical spinal canal stenosis before the injury;Type Ⅱ was the cervical spinal cord significantly compressed by traumatic disc herniation and/or epidural hematoma;Type Ⅱ was the spinal cord without obv ious compression,but with definite DLC injury;Type IV was the spinal cord without obvious compression,accompanied with no or only suspicious DLC injury.Type Ⅰ and type Ⅱ could be with or without DLC injury.Eighty-three patients(62.9%)were classified as type Ⅰ,with the age of(62.2±15.7)years,and the main cause of injury was fall injury(37 patients,44.6%),follo

关 键 词：颈椎 脊髓损伤 影像学分型 

分 类 号：R651.2[医药卫生—外科学]