无骨折脱位颈脊髓损伤颈髓MRI表现与治疗策略

Cervical MRI and treatment strategy in adult cervical spinal cord injury without fracture or dislocation

目的：根据伤后颈脊髓MRI不同表现对无骨折脱位颈脊髓损伤（ CSCIWFD）采取不同的治疗策略,观察临床疗效和安全性,分析疗效差异原因并探讨治疗方案选择。方法回顾分析接受治疗并获得完整随访的56例中老年CSCIWFD患者的临床资料。对颈椎MRI提示有颈髓受压伴髓内高信号且有神经症状者建议手术,对颈髓无压迫伴或不伴髓内高信号者建议非手术治疗。按治疗建议和患者选择分为3组：建议手术且患者接受手术组（ A组,39例）,建议手术但患者拒绝手术组（ B组,11例）,非手术治疗组（ C组,6例）。神经功能评估按ASIA分级,对3组治疗后神经功能的恢复结果进行比较。结果患者均获得随访,时间20-88个月。结果显示,神经功能改善情况A组好于B组, C组神经功能改善满意。结论颈髓MRI表现是中老年CSCIWFD患者是否手术的重要参考依据。颈髓受压或颈髓接触伴髓内高信号,手术治疗效果优于非手术治疗；如颈髓无压迫、无明显失稳,即使有神经症状且髓内有高信号,应采用非手术治疗。

Objective To observe the treatment strategy and curative effect for adult cervical spinal cord injury with-out fracture and dislocation（ CSCIWFD） ,and to analysis the difference in order to find the ideal treatment. Methods A retrospective review was conducted on 56 cases of middle and old age patients with CSCIWFD. Patients who had neurologic symptom with MRI evidence of cervical spine compression and local high density sign were suggested to do surgery. Patients had no cervical spine cord compression with or without high density received conservative treatment. The patients were divided into three groups, surgery was suggested and patients accepted group （ group A, 39 cases） , suggested and not accepted group （ group B, 11 cases） and non-surgical treatment group（ group C, 6 cases） . Neuro-logical function improvement ASIA grade were compared among three groups. Results The patients were followed up for 20-88 months. The neurological recovery rate of patients in group A was better than group B. The neurological re-covery in group C was satisfactory. Conclusions MRI is the important basis to determine whether patients with CSCIWFD needing surgery. If there are neurological symptoms, intramedullary high signal and the cervical spinal cord is compressed or touched, surgical treatment is better than conservative. If there is no compression of cervical spinal cord and spinal instability, even with the neurologic symptoms and intramedullary high signal, conservative treatment should be conducted.