MRI在无骨折脱位型颈脊髓损伤诊断和预后分析中的作用
发布时间：2018-10-05 16:33
【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,P0.05),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,P0.05);(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(P0.1);(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(P0.05);(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。
[Abstract]:Background: the cervical vertebrae of middle and old people can cause different degrees of spinal canal stenosis due to different reasons, and the probability of cervical spinal cord injury without fracture and dislocation is relatively high when the injury occurs. It has been reported that the cervical spinal cord injury can account for 3- 16 percent of cervical spinal cord injury. Objective: to investigate the role of MRI in the diagnosis and prediction of the prognosis of cervical spinal cord injury without fracture and dislocation, and to analyze the influencing factors of surgical outcome. Methods: from August 2014 to June 2016, 51 adult patients with cervical spinal cord injury without fracture and dislocation were treated in Zibo Central Hospital. According to the imaging data, combined anterior, posterior or anterior posterior approaches were performed respectively. The injury of cervical vertebrae osseous ligament was compared with MRI findings during operation. Univariate and multivariate Logistic regression analysis was used to analyze the age, type of trauma, MRI type of spinal cord injury, time to visit the doctor, signal length of spinal cord injury, ASIA grade of spinal cord injury, degree of stenosis of cervical spinal canal. The effects of 10 factors, such as whether to use hormone therapy within 8 hours after injury, the time from injury to operation, and the operation mode, on the prognosis. Results and conclusion: (1) Cervical MRI showed more comprehensive injury of spinal cord and ligamentum intervertebral disc than that of intraoperative (蠂 ~ 2 ~ 2 ~ (5.966) P 0.05), and cervical spinal cord injury was related to the injury of intervertebral disc ligament complex (); (_ 2). The results of univariate analysis showed that cervical spinal cord injury was related to the injury of intervertebral disc ligament complex (蠂 ~ (2) 2). MRI type of spinal cord injury, signal length of spinal cord injury, ASIA grade of spinal cord injury, degree of cervical spinal canal stenosis, whether to use hormone treatment within 8 hours after injury, the time from injury to operation and the recovery of spinal cord nerve function (P0. 1); (3) were analyzed by multivariate Logistic regression analysis. The MRI type of spinal cord injury, the length of spinal cord injury signal, the degree of cervical spinal canal stenosis, the time from injury to operation were significantly correlated with the recovery of spinal cord nerve function (P0.05); (4). It plays an important role in the diagnosis and prognosis of cervical spinal cord injury without fracture and dislocation, and the degree of spinal cord injury, the degree of cervical spinal canal stenosis and the timing of operation are the main factors influencing the postoperative outcome.
【作者单位】： 滨州医学院;淄博市中心医院骨科;滨州医学院烟台附属医院;
【分类号】：R445.2;R683
，
本文编号：2254090
[Abstract]:Background: the cervical vertebrae of middle and old people can cause different degrees of spinal canal stenosis due to different reasons, and the probability of cervical spinal cord injury without fracture and dislocation is relatively high when the injury occurs. It has been reported that the cervical spinal cord injury can account for 3- 16 percent of cervical spinal cord injury. Objective: to investigate the role of MRI in the diagnosis and prediction of the prognosis of cervical spinal cord injury without fracture and dislocation, and to analyze the influencing factors of surgical outcome. Methods: from August 2014 to June 2016, 51 adult patients with cervical spinal cord injury without fracture and dislocation were treated in Zibo Central Hospital. According to the imaging data, combined anterior, posterior or anterior posterior approaches were performed respectively. The injury of cervical vertebrae osseous ligament was compared with MRI findings during operation. Univariate and multivariate Logistic regression analysis was used to analyze the age, type of trauma, MRI type of spinal cord injury, time to visit the doctor, signal length of spinal cord injury, ASIA grade of spinal cord injury, degree of stenosis of cervical spinal canal. The effects of 10 factors, such as whether to use hormone therapy within 8 hours after injury, the time from injury to operation, and the operation mode, on the prognosis. Results and conclusion: (1) Cervical MRI showed more comprehensive injury of spinal cord and ligamentum intervertebral disc than that of intraoperative (蠂 ~ 2 ~ 2 ~ (5.966) P 0.05), and cervical spinal cord injury was related to the injury of intervertebral disc ligament complex (); (_ 2). The results of univariate analysis showed that cervical spinal cord injury was related to the injury of intervertebral disc ligament complex (蠂 ~ (2) 2). MRI type of spinal cord injury, signal length of spinal cord injury, ASIA grade of spinal cord injury, degree of cervical spinal canal stenosis, whether to use hormone treatment within 8 hours after injury, the time from injury to operation and the recovery of spinal cord nerve function (P0. 1); (3) were analyzed by multivariate Logistic regression analysis. The MRI type of spinal cord injury, the length of spinal cord injury signal, the degree of cervical spinal canal stenosis, the time from injury to operation were significantly correlated with the recovery of spinal cord nerve function (P0.05); (4). It plays an important role in the diagnosis and prognosis of cervical spinal cord injury without fracture and dislocation, and the degree of spinal cord injury, the degree of cervical spinal canal stenosis and the timing of operation are the main factors influencing the postoperative outcome.
【作者单位】： 滨州医学院;淄博市中心医院骨科;滨州医学院烟台附属医院;
【分类号】：R445.2;R683
，
本文编号：2254090
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