颈髓过伸性损伤临床表现的多样性及其病理机制探讨

Variability in clinical manifestation of hyperextension injury of the cervical spinal cord and exploration of its pathomechanism

目的:探讨急性颈髓过伸性损伤临床表现的多样性及其病理机制。方法:对2005年12月至2007年3月收治的32例急性颈髓过伸性损伤患者进行回顾性分析。在颈椎侧位X线片上测量有无颈椎管狭窄,发育性颈椎管狭窄为Ⅰ型,退变性颈椎管狭窄为Ⅱ型,发育性合并退变性颈椎管狭窄为Ⅲ型;在颈椎MRI片上观察脊髓压迫情况及T2相上脊髓呈现高信号变化的节段长度,受椎间盘突出和(或)相邻椎体缘向后增生压迫者为a型,源于肥厚的黄韧带压迫者为b型,二者兼有为c型;颈椎侧位X线片上有颈椎管狭窄同时MRI上有明显的颈椎间盘突出和(或)黄韧带肥厚为混合型。总结其临床类型并研究临床类型与影像学上显示的颈椎病理变化的关系。结果:32例患者中表现为完全性四肢瘫4例,均为混合型,其脊髓信号变化累及3个节段以上3例,累及1个节段1例;对称性不完全性四肢瘫14例,混合型13例,c型1例,其脊髓信号变化累及3个节段以上5例,2个节段6例,1个节段2例,脊髓信号无异常1例;中央脊髓损伤综合征12例,其病理分型为Ⅰ型1例,a型7例,c型2例,混合型2例,其脊髓信号变化累及3个节段以上2例,2个节段2例,1个节段5例,脊髓信号无异常3例;半切脊髓损伤综合征2例,均有偏侧型颈椎间盘突出,1例为a型,脊髓信号无异常,另1例为混合型,对应1个节段脊髓水肿;本组无前脊髓损伤综合征患者。结论:急性过伸性颈髓损伤临床表现具有多样性,临床表现与颈椎基础病理变化密切相关,术前分析临床表现类型和相应的病理基础有助于术式选择。

Objective：To explore the variability in clinical manifestation and pathomechanism of acute hyper- extension injury of the cervical spinal cord.Method：Thirty two patients with acute hyperextension injury of the cervical cord from December 2005 to March 2007 were retrospectively reviewed.On the cervical lateral X-ray view,whether cervical spinal stenosis exists or not was measured developed cervical spinal stenosis （DCSS） was classified as type Ⅰ ,degenerative one was type Ⅱ ,developed and degenerative one was type Ⅲ.On cer- vical MR images, compression of the cervical spinal cord and the length of high signal change on T2-weight- ed images were observed.The compression resulted from cervical disc herniation or vertebral osteophyte was type a,from hypertrophic ligamentum flavum was type b,from the both was type c.The one that had both cer- vical spinal stenosis on cervical lateral view of X-ray and cervical disk herniation or hypertrophic ligamentum flavum on MR images was called mixed type.The clinical type of the injuries was summarized and the rela- tionship between the types and the pathological changes of cervical vertebrae disclosed by imaging examina- tion was studied.Result：Among the 32 patients,4 cases were complete tetraplegia,which all belonged to the mixed type ,and spinal cord signal changes involved 3 segments or more in 3 cases and 1 segment in 1 case. 14 cases manifested as symmetric incomplete tetraplegia,of which mixed type was in 13 cases,type c in 1 case,and spinal cord signal changes involved over 3 segments in 5 cases,and 2 segments in 6 case,1 seg- ment in 2 case and 1 case with normal signal.12 cases manifested as acute central cervical spinal cord syndrome,with type Ⅰ in 1 case,type a in 7 cases,type c in 2 cases,mixed type in 2 cases,and spinal cord signal changes involved exceeding 3 segments in 2 cases,and 2 segments in 2 case,1 segment in 5 cases and 3 cases without abnormal signal.2 cases manifested as semi-spinal cord syndrome,one was mixed type with spinal cord edema in a segment,the other was type a and its spinal cord signal was normal,and both presented cervical disc protrusion on one side.Anterior spinal cord syndrome was not found.Conclusion： Clinical manifestation of acute hyperextension injury of the cervical spinal cord reveals diversity.These manifestations are correlated closely with the underlying pathological changes of cervical vertebrae.It is helpful to select an appropriate approach of operation by analyzing specific clinical types and the corresponding pathologic changes in advance.