无骨折脱位颈脊髓损伤颈髓MRI表现与治疗策略

发布时间：2019-07-07 21:21

【摘要】：目的根据伤后颈脊髓MRI不同表现对无骨折脱位颈脊髓损伤(CSCIWFD)采取不同的治疗策略,观察临床疗效和安全性,分析疗效差异原因并探讨治疗方案选择。方法回顾分析接受治疗并获得完整随访的56例中老年CSCIWFD患者的临床资料。对颈椎MRI提示有颈髓受压伴髓内高信号且有神经症状者建议手术,对颈髓无压迫伴或不伴髓内高信号者建议非手术治疗。按治疗建议和患者选择分为3组:建议手术且患者接受手术组(A组,39例),建议手术但患者拒绝手术组(B组,11例),非手术治疗组(C组,6例)。神经功能评估按ASIA分级,对3组治疗后神经功能的恢复结果进行比较。结果患者均获得随访,时间20~88个月。结果显示,神经功能改善情况A组好于B组,C组神经功能改善满意。结论颈髓MRI表现是中老年CSCIWFD患者是否手术的重要参考依据。颈髓受压或颈髓接触伴髓内高信号,手术治疗效果优于非手术治疗;如颈髓无压迫、无明显失稳,即使有神经症状且髓内有高信号,应采用非手术治疗。
[Abstract]:Objective to observe the clinical efficacy and safety of cervical spinal cord injury (CSCIWFD) according to the different manifestations of cervical spinal cord MRI after injury, to observe the clinical efficacy and safety, to analyze the reasons for the difference of curative effect and to explore the choice of treatment plan. Methods the clinical data of 56 middle-aged and elderly patients with CSCIWFD were analyzed retrospectively. Operation is recommended for patients with cervical spinal cord compression with intramedullary hyperintensity and neurological symptoms suggested by MRI, and non-surgical treatment is recommended for patients without cervical spinal cord compression with or without intramedullary hyperintensity. According to the treatment suggestion and patient selection, the patients were divided into three groups: group A (n = 39), group B (n = 11) and group C (n = 6). According to ASIA grade, the recovery results of nerve function in the three groups were compared. Results all the patients were followed up for 20 脳 88 months. The results showed that the improvement of nerve function in group A was better than that in group B, and the improvement of nerve function in group C was satisfactory. Conclusion MRI findings of cervical spinal cord are important reference for middle-aged and elderly patients with CSCIWFD. If cervical spinal cord compression or cervical spinal cord contact with intramedullary hyperintensity is superior to non-surgical treatment, if the cervical spinal cord is not compressed and there is no obvious instability, even if there are neurological symptoms and intramedullary hyperintensity, non-surgical treatment should be used.
【作者单位】：解放军第306医院骨科全军脊柱外科中心;
【分类号】：R651.2;R445.2

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