颈椎过伸性损伤患者椎间盘韧带复合体损伤的影像特点及其临床意义

The imaging features of intervertebral disco-ligamentous complex injury in cervical spine hyperextension injury and their clinical significance

目的:探讨颈椎过伸性损伤中椎间盘韧带复合体(disco-ligamentous complex,DLC)损伤的影像特点及其临床意义。方法:对2007年7月～2011年11月在我院手术治疗且病历资料完整的50例颈椎过伸性损伤患者的临床资料进行回顾性分析。均有颈脊髓损伤,脊髓功能Frankel分级:A级4例,B级8例,C级11例,D级27例。按术前患者X线片、CT及MRI显示的脊髓受压原因,将患者分为3组:单纯单个椎间盘突出(herniated nucleus pulposus,HNP)组14例,合并颈椎病(cervical spondylosis,CS)组26例,合并后纵韧带骨化(ossification of the posterior longitudinal ligament,OPLL)组10例,分析各组患者DLC损伤的影像特点及手术方式的异同。结果:50例患者均有颈椎前纵韧带和椎间盘的损伤,其中8例伴后纵韧带损伤,5例伴关节突骨折,3例伴棘突间韧带损伤。50例患者均有颈脊髓受压与损伤,均行颈椎减压、融合与内固定术,手术节段包括DLC损伤节段与脊髓受压节段。HNP组的DLC损伤均为1个节段,DLC损伤节段与脊髓受压节段一致率为92.85%,均采用前路手术。合并CS组,1个节段DLC损伤16例,2个节段6例,3个节段4例,多节段损伤时均为相邻节段,DLC损伤节段与脊髓受压节段一致率为84.61%,行前路手术23例、后路手术3例。合并OPLL组,1个节段DLC损伤4例,2个节段6例,DLC损伤节段与脊髓受压节段一致率为60%,行前路手术1例、后路手术5例、前后联合入路手术4例。术后3个月时脊髓功能Frankel分级,28例提高1级,22例无变化。结论:颈椎过伸性损伤患者的DLC损伤特点与术前的颈椎病理状态有关,DLC损伤节段与脊髓受压节段不完全一致;制定手术方案时,颈椎稳定性重建应包括DLC损伤节段,同时兼顾脊髓受压节段的减压。

Objectives： To investigate the imaging features of disco-ligamentous complex（DLC） injury in patients with cervical spine hyperextension injury and their clinical significance.Methods： From July 2007 to November 2011,50 patients treated surgically due to cervical hyperextension injury with completed clinical data were retrospectively analyzed.All patients suffered from cervical spine injury.Frankel grades were 4 cases with grade A,8 cases with grade B,11 cases with grade C,and 27 cases with grade D.According to the type of preoperative spinal cord compression demonstrated on X-ray,CT and MRI imaging,patients were divided into three groups： herniated nucleus pulposus（HNP） group： simple herniated nucleus pulpous,14 cases;cervical spondylosis（CS） group： combined with cervical spondylosis,26 cases;ossification of the posterior longi tudinal ligament（OPLL） group： combined with ossification of the posterior longitudinal ligament,10 cases,and the characteristics of the injued DLC and different surgical approaches for three groups were analyzed.Results： All 50 cases with cervical hyperextension injury had anterior longitudinal ligament and intervertebral disc injury.Among them,8 patients had posterior longitudinal ligament injury,5 had facet joint fracture and 3 patients had interspinous ligament injury.All 50 patients suffering from cervical spinal cord compression underwent decompression,fusion and internal fixation.The segments included injured DLC segments and spinal cord compression segments.In HNP group,the consistent rate of DLC level and the spinal cord compression level was 92.85%,all patients underwent anterior approaches;in combined CS group,the DLC injury was noted as single level in 16,two in 6 and three in 4 patients,the consistent rate of DLC injury level and the spinal cord compression level was 84.61%,23 cases underwent anterior and 3 underwent posterior approaches;in combined OPLL group,the DLC injury was noted as single level in 4 patients and two in 6 patients,with the consistent rate of 60%,1 case underwent anterior,5 cases underwent posterior and 4 cases underwent combined approaches.The Frankel grade in 28 cases improved one grade,but 22 cases remained unchanged 3 months after surgery.Conclusions： The characteristics of DLC injury is associated with the preoperative cervical pathological state,and DLC injury level is not completely consistent with the level of spinal cord compression.Cervical stability reconstruction should include injured DLC segments as well as spinal cord decompression level.