MRI信号改变定位椎板切除减压范围在无骨折脱位颈脊髓损伤治疗中的应用

Application of Locating Laminectomy Decompression Range with Increased Signal Intensity on MRI in the Treatment of Cervical Spinal Cord Injury without Bone Fracture Dislocation: A Report of 16 cases

目的根据MRI颈脊髓信号异常平面决定椎板切除减压范围,观察侧块螺钉固定结合不同范围全椎板切除减压治疗在颈脊髓损伤的临床疗效。方法 2008年9月-2011年12月收治颈脊髓损伤患者16例。其中男10例,女6例,高处坠落伤5例,车祸11例,MRI显示脊髓损伤信号改变波及2个节段3例,3个节段9例,4个节段4例,椎间盘损伤变性12例,椎间盘轻度突出4例,均诊断为颈脊髓损伤伴高位截瘫,均行后路手术治疗。根据手术方式将16位患者分为观察组(9例)及对照组(7例),均采用后路侧块螺钉固定结合全椎板切除减压治疗,观察组减压范围以MRI提示颈脊髓信号异常为中心,对照组减压范围均为颈3～颈7。比较两组治疗前后的ASIA评分改变。结果 16例患者均得到随访,随访10～48个月,平均17个月,脊髓神经恢复功能按照ASIA运动评分,平均增长值:对照组(42.75±12.56)高于观察组(20.52±11.60),差异有统计学意义(P<0.05)。观察组患者ASIA分级分布:术前A级4例,B级4例,C级1例,末次家庭随访时A级4例,B级3例,C级2例;对照组术前A级3例,B级3例,C级1例,末次家庭随访时A级2例,B级1例,C级2例,D级2例,对照组ASIA分级术前与术后比较,差异有统计学意义(P<0.05);观察组ASIA分级术前与术后比较,差异无统计学意义(P>0.05);比较两组ASIA分级改善率,对照组明显优于观察组(P<0.05)。结论根据MRI提示的颈脊髓信号异常平面决定侧块螺钉固定及颈椎板切除范围治疗颈脊髓损伤疗效不佳,减压范围扩大至颈3-颈7疗效较好。

Objective To observe the clinical efficacy of lateral mass screw fixation combined with different range of total laminectomy decompression in the treatment of cervical spinal cord injury without bone fracture dislocation based on decompression range decided by cervical spinal cord signal abnormality plane on MRI.Methods Sixteen patients with cervical spinal cord injury treated from September 2008 to December 2011 were divided into observation group（n=9） and control group（n=7） according to different surgical approach.Patients in both groups underwent posterior lateral mass screw fixation combined with total laminectomy decompression treatment.Decompression range of the observation group regarded cervical spinal cord signal abnormality on MRI as the center,while decompression ranged of the control group were C3-C7.American Spinal Injury Association（ASIA） grade system scores before and after the treatment between the two groups were compared and analyzed.Results There were ten males and six females with 5 cases of falling injury and 11 cases of road accident injury.MRI results indicated that signal change involved two segments in three cases,three segments in nine cases,and four segments in four cases,and there were 12 cases of intervertebral disc injury and four cases of lumbar disc herniation.All of them were diagnosed as cervical spinal cord injury with paraplegia,and treated with posterior surgical method.Sixteen patients were followed up for an average of 17 months ranged from 10 months to 48 months.Based on ASIA motor score,the average growth of nerve recovery score in the observation group（42.75 ± 12.56） was significantly higher than that in the control group（20.52 ± 11.60）（P0.05）.For the observation group,there were four cases of ASIA grade A,four grade B and one grade C before surgery,and four grade A,three grade B and two grade C at the last follow-up（P0.05）.For the control group,there were three cases of ASIA grade A,three grade B and one grade C before surgery,and two grade A,one grade B and two grade C at the last follow-up（P0.05）.Improvement rate of the control group was significantly better than that of the observation group（P0.05）.Conclusion Cervical laminectomy range determined by cervical spinal cord signal abnormality plane on MRI should be based on MRI T2-weighted signal change.The clinical efficacy of decompression extending to C3-C7 is a better choice.