颈脊髓过伸伤患者退变性因素的分布节段及原因分析

Factors to affect severity of hyperextension injury of the cervical spinal cord

目的研究过伸性颈椎损伤退变程度的相关因素。方法对45例急性过伸性颈椎损伤患者进行回顾分析。所有患者根据影像学和临床查体情况后行改良Frankel分级。根据神经损伤平面结合颈髓髓内高信号征象判定脊髓损伤节段,凡神经平面下整个节段或节段内大部分呈高信号改变者是主要受损脊髓节段,节段内呈现斑片状高信号改变者为一般受损脊髓节段。设计头面部受创、高速运动受创或头面部挫裂较重为重伤力,创伤较轻者为轻伤力。据MRI T2加权椎间盘信号强度判定颈椎间盘退变程度,并进行退变最严重椎间盘分级代表整体颈椎退变分级,轻重程度由0~4级分析外伤力、颈椎退变与受损脊髓节段的关系。结果轻伤者12例,重伤者33例,轻伤组较重伤组脊髓损伤轻、年龄大,组间比较差异具有统计学意义（P〈0.05）。主要受损节段38例共45节,其中C4、5最多;一般受损脊髓节段21例39节。所有患者的颈椎均有明显退变,其中22例发生3级退变,退变严重节段为C5、6。椎间盘处发生退变的受损脊髓节段数为0级无,1级9节,2级20节,3级14节,4级2节。结论外力大小、颈椎节段性退变在颈脊髓过伸性损伤中具有重要作用。

To study factors affect seriously hurt and the cervical spinal cord injury. Methods 45 cases with acute hyperextension injury of the cervical spinal cord injury（SCI） were retrospectively analyzed. All patients were assessed with modified Frankel grading according to the imaging and clinical examination. Spinal cord injuries segments were defined ac- cording to SCI plane and high signal change in spinal cord on MRI. The whole or large part of high signal change segments were supposed to the main injuried spinal cord segments and the staccato or patchy high signal change were supposed to be general injuries spinal cord segments. When the external force acting on head or face suffering was serious, the force produced during high-speed movement or forehead and/or face had severe contused and/or lacerated wound, the force was defined as severe trau- matic force, whereas the reverse situation was defined as slight traumatic force. According to signal magnitude of the cervical discs on T2-weighted MRI images, degeneration of cervical discs and cervical vertebras were classified into 5 degrees（degree 0~ 4 level） and the most serious intervertebral disc degeneration classification on behalf of the whole cervical degeneration classifi- cation. As a result, the correlation respectively with the influence traumatic force, degeneration of cervical discs and cervical vertebras, and cervical spinal cord injury of hyperextension were explored. Results Among the 45 patients, 12 cases were caused by slight traumatic force and 33 cases were caused by serious one. The cervical spinal cord injury of slight traumatic group was slight and their age were older than the serious traumatic group（P〈0.05）. The number of main injuried spinal cord segments was 45 segments in 38 patients and most segments were located at C4 ~5 level. The number of general injuries spinal cord segments was 39 segments in 21 patients. All patients had obvious degeneration of cervical vertebra and the most were de- gree 3 in 22 patients. The severest degenetative segments of the 45 patients were most located in C5~6 level. The number of the main injuried spinal cord segments in different degenerative discs was 0 segments in grade 0, 9 segments in grade 1, 20 seg- ments in grade 2, 14 segments in grade 3, and 2 segments in grade 4. Conclusion The traumatic force size, the degree of instability of cervical vertebrae segment and the degree of cervical stenosis play an important role in the development and progress of hyperextension injury of the cervical spinal cord.