成人CSCIWORA患者MRI椎前高信号、椎管矢状径与手术预后的关系

发布时间：2018-05-11 09:00

本文选题：磁共振成像 + 颈髓损伤　；参考：《长江大学》2017年硕士论文

【摘要】：无骨折脱位型颈髓损伤(Cervical spinal cord injury without fracture and dislo cation)即国际上统一命名的无放射影像学异常的颈髓损伤(cervical spinal cord inj ury without radiographic abnormality,CSCIWORA)是一种特殊类型的颈脊髓损伤,特指颈部受到外伤后,经X线、CT等检查手段,颈椎未发现明显骨折或脱位的一种临床常见疾病,占颈髓损伤的37%~52%。此病对于成人而言,由于既往颈椎存在基础病变,如椎管狭窄致储备空间减小、椎间盘膨出或突出以及后纵韧带钙化(Ossification of posterior longitudinal ligament,OPLL)等病变,即使轻微的外力也可致颈髓损伤,尤其是颈椎过度后伸及屈曲时,椎管矢状径变窄、椎间盘突出加重以及黄韧带皱褶向椎管内突出都可致脊髓受压,产生临床症状。由于CSCIWORA的隐匿性以及症状滞后性的特点,漏诊率较高,且X线、CT无阳性表现,只有通过MRI才能发现颈髓损伤,因此对临床医师技术水平要求相对较高,如果不及时诊断或者治疗方法不得当,都会产生严重后果。CSCIWORA的病因仍然没有研究透彻,多数认为是多种因素共同作用的结果,其最直接的致伤因素多为摔伤、坠落伤以及事故伤等,其共同点是头颈部受到外力均不大。目前其治疗方法多数学者也各抒己见,缺乏理论性依据,本文应用相关评分标准及统计学方法对其治疗提供一定的理论依据,为临床上CSCIWORA的治疗起到一定的帮助作用。目的:探讨成人无骨折脱位型颈脊髓损伤患者MRI椎前高信号、椎管矢状径与神经功能的相关性。本研究旨在对已经实施手术CSCIWORA患者根据MRI椎前信号进行分组,在入院时、出院后一个月、三个月、六个月和十二个月的功能评分对比结果应用统计学方法进行处理,从而得出MRI椎前信号与神经功能的相关性。方法:回顾性分析荆州市中心医院等三级甲等医院2010年1月至2016年12月收治的无骨折脱位型颈脊髓损伤患者病例资料80例,根据MRIT2序列有无椎前高信号分为椎前高信号组和无椎前高信号组,其中椎前高信号组40例,男31例,女9例,年龄21~83岁,平均(58.10±14.78)岁;无椎前高信号组40例,男29例,女11例,年龄32~77岁,平均(55.05±10.36)岁。通过MRI正中矢状面测量下颈椎各椎间盘层面椎管矢状径,并记录年龄、性别、受伤原因及椎管狭窄节段数;采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)和神经功能分级及JOA运动评分对神经功能进行评价。应用日本骨科学会(JOA)评分标准对所有入选病例在入院、出院、三个月、六个月和十二个月时评分并分别计算出其JOA增加幅度,应用两独立样本t检验并对比其结果;然后应用国际脊髓损伤协会(American Spinal Injury Association,ASIA)神经分级标准在入院时、出院后一个月、三个月、六个月和十二个月随访时进行功能评价,应用秩和检验,对所得结果进行分析。结果:对所得结果应用统计学软件SPSS17.0分析,计量资料用X±S表示。对椎前高信号组与无椎前高信号组治疗前后JOA评分别行两独立样本t检验,入院P0.05(无显著性差异),出院P0.1;三个月P0.05;六个月P0.05(有显著性差异)。应用两独立样本t检验分别对椎前高信号组入院时、出院时、三个月、六个月、十二个月时的JOA评分增加幅度与无椎前高信号组入院时、出院一个月、三个月、六个月、十二个月时JOA评分增加幅度相对比,结果P0.05(有显著性差异)。运用ASIA神经分级标准进行评估,在入院及出院六个月随访,并对其神经功能的恢复情况进行等级划分,并应用Mann-Whitney U秩和检验,出院后六个月时P0.05,有统计学意义。ASIA运动评分椎前高信号组为52.56±31.97,无椎前高信号组为67.70±22.83,两组差异有统计学意义(P=0.013);椎前高信号组患者的髓内高信号发生率明显高于无椎前高信号组(P=0.006);两组患者ASIA运动评分与损伤节段椎间盘层面椎管矢状径存在正相关(P=0.003),且椎管狭窄节段越多,ASIA分级越差。结论:成人无骨折脱位颈脊髓损伤MRI椎前高信号、椎管矢状径均与伤后神经功能相关,而存在多节段椎管狭窄的患者更易遭受严重的颈髓损伤。
[Abstract]:Cervical spinal cord injury without fracture and dislo cation) is an internationally unified nomenclature of cervical spinal cord injury without radiological abnormalities (cervical spinal cord) is a special type of cervical spinal cord injury, especially after neck trauma, With X-ray, CT, and so on, the cervical spine has not found a common disease or dislocation of the cervical spine, which accounts for the 37%~52%. disease of the cervical spinal cord injury. For adults, the underlying cervical lesions, such as spinal stenosis, reduce the reserve space, intervertebral disc swelling or the calcification of the posterior longitudinal ligament (Ossification of posterior longitudi). Nal ligament, OPLL) and other lesions, even slight external force can cause cervical spinal cord injury, especially when the cervical vertebra is overstretched and flexed, the sagittal diameter of the spinal canal is narrowed, the disc herniation is aggravated, and the Yellow toughened fold to the spinal canal can cause the spinal cord compression to produce clinical symptoms. The missed diagnosis is due to the concealment of the CSCIWORA and the hysteresis of the symptoms. High rate, and X-ray, CT no positive performance, only through MRI can detect the cervical spinal cord injury, so the clinician technical level is relatively high, if not timely diagnosis or treatment is not appropriate, the cause of the serious consequences of.CSCIWORA is still not thoroughly studied, most of the results are the results of a variety of factors, the most Most of the direct injury factors are wounding, falling and accident injury. The common point is that the external force of the head and neck is not very strong. At present, the methods of treatment for many mathematical people also express their own views and lack theoretical basis. In this paper, the relevant scoring standards and statistical methods are used to provide some theoretical basis for the treatment of CSCIWORA. Objective: To investigate the correlation between MRI anterior high signal, vertebral canal sagittal diameter and nerve function in adult patients without fracture and dislocation of cervical spinal cord. This study aims to group the patients who have been operated on CSCIWORA according to the MRI anterior vertebral signal, one month, three months, six months and twelve months after admission. The correlation of functional score and comparison was performed with statistical methods, and the correlation between MRI anterior vertebral signal and nerve function was obtained. Methods: retrospective analysis of 80 cases of non fracture and dislocation of cervical spinal cord injury patients from January 2010 to December 2016 in Jingzhou Central Hospital and other three grade A hospitals were analyzed. The high signal group was divided into pre vertebral high signal group and no anterior vertebral high signal group, of which 40 cases of anterior vertebral high signal group, 31 male and 9 female, age 21~83 years, average age (58.10 + 14.78) years, 40 cases of anterior vertebral high signal group, 29 men, 11 women, age (55.05 + 10.36) years old, and the sagittal sagittal sagittal sagittal plane of lower cervical vertebra were measured by MRI median sagittal plane. The age, sex, the cause of injury and the number of spinal stenosis segments were recorded, and the neurological function was evaluated by the American Spinal Injury Association (ASIA), the neurological function classification and the JOA exercise score. All the selected cases were admitted to hospital, discharged, three months, and six. The JOA increase was calculated at the month and twelve months and the results were compared with the two independent sample t test. Then the International Association for spinal cord injury (American Spinal Injury Association, ASIA) classification was used to evaluate the function of one month, three months, six months, and twelve months after discharge. The results were analyzed by using the rank sum test. Results: the results were analyzed with statistical software SPSS17.0, and the measurement data were expressed in X + S. The JOA scores before and after the treatment of the pre vertebral high signal group and the non vertebral high signal group were two independent samples t test, the admission P0.05 (no significant difference), the discharge of P0.1, the three month P0.05, and six months P0.05. (there was significant difference). When the two independent sample t test was admitted to the pre vertebral high signal group, the JOA score increased at the discharge, three months, six months, and twelve months, and the JOA score increased in one month, three months, six months, twelve months, and the result was significant difference (significant difference). The ASIA neural grading standard was used to evaluate, followed up for six months of admission and discharge, and the recovery of nerve function was graded, and the Mann-Whitney U rank and test were used, and P0.05 at six months after discharge. The statistically significant.ASIA exercise score was 52.56 + 31.97 in the pre vertebral high signal group and 67.70 + 2 in the non vertebral high signal group. 2.83, the difference between the two groups was statistically significant (P=0.013); the incidence of intramedullary high signal in the patients with the anterior vertebral high signal group was significantly higher than that without the anterior vertebral high signal group (P=0.006); the two groups of patients had positive correlation with the intervertebral disc sagittal diameter of the injured segment (P=0.003), and the more the stenosis segments of the spinal canal, the worse the ASIA classification was. Conclusion: there is no adult in the spinal canal. The cervical spinal cord injury in fracture dislocation is MRI high signal, and the sagittal diameter of the vertebral canal is related to the nerve function after injury, but the patients with multiple segment spinal stenosis are more vulnerable to severe cervical spinal cord injury.

【学位授予单位】：长江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.2

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