胸腰椎骨折合并急性脊髓损伤MRI表现与神经功能的相关性

The correlation between nerve functional changes in acute spinal cord injury with thoracic-lumbar spinal fracture and severity of damage revealed with MRI

目的探讨胸腰椎骨折合并急性脊髓损伤(ASCI)MRI表现与神经功能改变的相关性。方法117例胸腰椎骨折合并ASCI患者,于伤后7d内治疗前及治疗后2周分别检查患者的神经功能,用GE1.5TSignaMRI诊断仪检查脊髓损伤病灶范围大小、信号类型、脊髓受压程度、椎管狭窄程度,并分析其与神经功能改变的相关性。结果①MRI显示脊髓损伤病灶范围大小:Ⅰ级27例,Ⅱ级36例,Ⅲ级54例;MRIN/N27例,N/Hi33例,Hi/Hi5例,Lo/Hi43例,脊髓横断9例;脊髓受压72例,未受压45例;椎管狭窄Wolter评分:0分45例,1分16例,2分39例,3分17例。②Franket分级:治疗前A级65例,B级41例,C级5例,D级3例,E级3例;治疗后A级57例,B级5例,C级2例,D级1例,E级52例。结论①MRI显示ASCI的脊髓损伤病灶范围大小、信号类型、脊髓受压程度、椎管狭窄程度与神经功能改变有相关性;②MRI表现为水肿或脊髓压迫的,预后较好;MRI表现为出血、坏死或脊髓横断的,预后较差。

Objective To investigate the correlation between nerve functional changes in acute spinal cord injury (ASCI) with thoracic-lumbar spinal fracture and severity of damage revealed with MRI. Methods 117 cases with ASCI were undergone 1.5T MRI examination within 7 days after acute spinal cord injury (reexamination was at the second week after treatment), and the changes of various nerves function were recorded. The relationship between the area of the lesion, variation of MRI signals, compression of spinal cord, severity of spinal stenosis and changes of various nerves function was explored. Results ① The focus ranges shown by MRI were grade Ⅰ in 27 cases, grade Ⅱ in 36 and grade Ⅲ in 54; The signals were N/N in 27 cases, N/Hi in 33, Hi/Hi in 5, Lo/Hi in 43 and spinal cord transection in 9; MRI showed spinal cord compression in 72 cases and no compression in 45 cases; The spinal canal stenosis scores were 0 in 45 cases, 1 in 16, 2 in 39 and 3 in 17. ② The Frankel grading preoperatively showed: Grade A in 65 cases, B in 41, C in 5, D in 3 and E in 3; And those postoperatively were A in 57, B in 5, C in 2, D in 1 and E in 52. Conclusions ① MRI shows that the area of the lesion, variation of MRI signals, compression of the spinal cord and severity of spinal stenosis are correlated with the changes of various nerves functional abilities. ② The prognoses of ASCI that MRI shows edema or compression of the spinal cord are good, and the prognoses of ASCI that MRI shows bleeding, necrosis or transection of the spinal cord are poor.