【摘要】：背景:中老年人的頸椎可因不同原因?qū)е虏煌潭鹊淖倒塥M窄,在受傷時發(fā)生無骨折脫位頸髓損傷概率也相對較高,有文獻報道可占頸段脊髓損傷的3%-16%。目的:探討MRI在診斷和預(yù)測無骨折脫位型頸脊髓損傷預(yù)后中的作用,并分析手術(shù)效果的影響因素。方法:回顧分析2014年8月至2016年6月就診于淄博市中心醫(yī)院的51例成人無骨折脫位型頸脊髓損傷患者,根據(jù)影像學(xué)資料,分別采取前路、后路或前-后路聯(lián)合手術(shù),將術(shù)中所見頸椎骨韌帶損傷與MRI表現(xiàn)對比。使用單因素和多因素Logistic回歸分析患者的年齡、外傷類別、脊髓損傷MRI類型、受傷到就診時間、脊髓損傷信號長度、脊髓損傷ASIA分級、頸椎管狹窄程度、傷后8 h內(nèi)是否使用激素治療、受傷至手術(shù)的時間、手術(shù)方式等10個因素對預(yù)后的影響。結(jié)果與結(jié)論:(1)頸椎MRI較術(shù)中所見更全面顯示了脊髓及椎間盤韌帶復(fù)合體損傷(χ~2=5.966,P0.05),且頸脊髓損傷與相應(yīng)椎間隙平面椎間盤韌帶復(fù)合體損傷有關(guān)(χ~2=1.53,P0.05);(2)單因素分析結(jié)果表明,脊髓損傷MRI類型、脊髓損傷信號長度、脊髓損傷ASIA分級、頸椎管狹窄程度、傷后8 h內(nèi)是否使用激素治療、受傷至手術(shù)時間與脊髓神經(jīng)功能恢復(fù)相關(guān)(P0.1);(3)再經(jīng)多因素Logistic回歸分析,脊髓損傷MRI類型、脊髓損傷信號長度、頸椎管狹窄程度、受傷至手術(shù)時間與脊髓神經(jīng)功能恢復(fù)有明顯相關(guān)性(P0.05);(4)結(jié)果提示,頸椎MRI因其組織分辨優(yōu)勢,在診斷無骨折脫位型頸脊髓損傷及預(yù)測其預(yù)后中具有重要作用;脊髓損傷程度、頸椎管狹窄程度及手術(shù)時機是影響術(shù)后療效的主要因素。
[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.
【作者單位】： 濱州醫(yī)學(xué)院;淄博市中心醫(yī)院骨科;濱州醫(yī)學(xué)院煙臺附屬醫(yī)院;
【分類號】：R445.2;R683
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本文編號：2254090