發(fā)布時間：2018-05-11 09:00

  本文選題：磁共振成像 + 頸髓損傷��； 參考：《長江大學》2017年碩士論文

【摘要】：無骨折脫位型頸髓損傷(Cervical spinal cord injury without fracture and dislo cation)即國際上統(tǒng)一命名的無放射影像學異常的頸髓損傷(cervical spinal cord inj ury without radiographic abnormality,CSCIWORA)是一種特殊類型的頸脊髓損傷,特指頸部受到外傷后,經X線、CT等檢查手段,頸椎未發(fā)現(xiàn)明顯骨折或脫位的一種臨床常見疾病,占頸髓損傷的37%~52%。此病對于成人而言,由于既往頸椎存在基礎病變,如椎管狹窄致儲備空間減小、椎間盤膨出或突出以及后縱韌帶鈣化(Ossification of posterior longitudinal ligament,OPLL)等病變,即使輕微的外力也可致頸髓損傷,尤其是頸椎過度后伸及屈曲時,椎管矢狀徑變窄、椎間盤突出加重以及黃韌帶皺褶向椎管內突出都可致脊髓受壓,產生臨床癥狀。由于CSCIWORA的隱匿性以及癥狀滯后性的特點,漏診率較高,且X線、CT無陽性表現(xiàn),只有通過MRI才能發(fā)現(xiàn)頸髓損傷,因此對臨床醫(yī)師技術水平要求相對較高,如果不及時診斷或者治療方法不得當,都會產生嚴重后果。CSCIWORA的病因仍然沒有研究透徹,多數認為是多種因素共同作用的結果,其最直接的致傷因素多為摔傷、墜落傷以及事故傷等,其共同點是頭頸部受到外力均不大。目前其治療方法多數學者也各抒己見,缺乏理論性依據,本文應用相關評分標準及統(tǒng)計學方法對其治療提供一定的理論依據,為臨床上CSCIWORA的治療起到一定的幫助作用。目的:探討成人無骨折脫位型頸脊髓損傷患者MRI椎前高信號、椎管矢狀徑與神經功能的相關性。本研究旨在對已經實施手術CSCIWORA患者根據MRI椎前信號進行分組,在入院時、出院后一個月、三個月、六個月和十二個月的功能評分對比結果應用統(tǒng)計學方法進行處理,從而得出MRI椎前信號與神經功能的相關性。方法:回顧性分析荊州市中心醫(yī)院等三級甲等醫(yī)院2010年1月至2016年12月收治的無骨折脫位型頸脊髓損傷患者病例資料80例,根據MRIT2序列有無椎前高信號分為椎前高信號組和無椎前高信號組,其中椎前高信號組40例,男31例,女9例,年齡21~83歲,平均(58.10±14.78)歲;無椎前高信號組40例,男29例,女11例,年齡32~77歲,平均(55.05±10.36)歲。通過MRI正中矢狀面測量下頸椎各椎間盤層面椎管矢狀徑,并記錄年齡、性別、受傷原因及椎管狹窄節(jié)段數;采用美國脊髓損傷協(xié)會(American Spinal Injury Association,ASIA)和神經功能分級及JOA運動評分對神經功能進行評價。應用日本骨科學會(JOA)評分標準對所有入選病例在入院、出院、三個月、六個月和十二個月時評分并分別計算出其JOA增加幅度,應用兩獨立樣本t檢驗并對比其結果;然后應用國際脊髓損傷協(xié)會(American Spinal Injury Association,ASIA)神經分級標準在入院時、出院后一個月、三個月、六個月和十二個月隨訪時進行功能評價,應用秩和檢驗,對所得結果進行分析。結果:對所得結果應用統(tǒng)計學軟件SPSS17.0分析,計量資料用X±S表示。對椎前高信號組與無椎前高信號組治療前后JOA評分別行兩獨立樣本t檢驗,入院P0.05(無顯著性差異),出院P0.1;三個月P0.05;六個月P0.05(有顯著性差異)。應用兩獨立樣本t檢驗分別對椎前高信號組入院時、出院時、三個月、六個月、十二個月時的JOA評分增加幅度與無椎前高信號組入院時、出院一個月、三個月、六個月、十二個月時JOA評分增加幅度相對比,結果P0.05(有顯著性差異)。運用ASIA神經分級標準進行評估,在入院及出院六個月隨訪,并對其神經功能的恢復情況進行等級劃分,并應用Mann-Whitney U秩和檢驗,出院后六個月時P0.05,有統(tǒng)計學意義。ASIA運動評分椎前高信號組為52.56±31.97,無椎前高信號組為67.70±22.83,兩組差異有統(tǒng)計學意義(P=0.013);椎前高信號組患者的髓內高信號發(fā)生率明顯高于無椎前高信號組(P=0.006);兩組患者ASIA運動評分與損傷節(jié)段椎間盤層面椎管矢狀徑存在正相關(P=0.003),且椎管狹窄節(jié)段越多,ASIA分級越差。結論:成人無骨折脫位頸脊髓損傷MRI椎前高信號、椎管矢狀徑均與傷后神經功能相關,而存在多節(jié)段椎管狹窄的患者更易遭受嚴重的頸髓損傷。
[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.

【學位授予單位】：長江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.2

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