脊髓内信号变化与无骨折脱位型颈髓损伤患者临床症状及预后的关系

Relationship between increased signal intensity and clinical symptoms and prognosis in patients with cervical spine cord injury without radiographic abnormality

目的探讨颈髓内高信号变化情况与无骨折脱位型颈髓损伤患者术后临床症状及预后的关系。方法将106例接受手术治疗的伴有脊髓高信号的无骨折脱位型颈髓损伤患者纳入研究,术后1年根据患者颈髓内高信号的转归情况分为3组;A组20例,颈髓内高信号强度无明显减弱;B组38例,颈髓内高信号强度减弱;C组48例,颈髓内高信号完全消失。比较各组日本骨科协会(Japanese Orthopedic Association,JOA)评分及术后神经功能恢复状况。结果术后3组JOA评分均显著高于术前,C组JOA评分高于A组和B组,差异有统计学意义(P<0.05)。B组神经功能改善率高于A组,C组神经功能改善率高于A组和B组,差异均有统计学意义(P<0.05)。结论颈髓损伤患者脊髓内多出现高信号改变,给予脊髓减压术后,高信号消失者预后较好,髓内高信号持续存在提示患者预后较差。

Objective To investigate the relationship of increased signal intensity(ISI)and the clinical symptoms and prognosis in patients with cervical spine cord injury without radiographic abnormality(CSCIWORA).Methods A total of 106 cases of CSCIWORA patients with ISI were enrolled in the study.Based on the prognosis of ISI at 1 year after operation,they were divided into 3 groups.Group A(20 cases):the ISI was not significantly reduced.Group B(38 cases):the ISI significantly weakened.Group C(48 cases):the ISI disappeared completely.The neurological function recovery based on Japanese Orthopedic Association(JOA)score was evaluated and compared.Results The postoperative JOA scores at all patients had significantly increased when compared with the preoperative level(P<0.05),and the JOA scores of group C were higher than those of group A and group B(P<0.05).The neurological function improvement rate in group B was higher than that in group A,while group C was higher than that in group A and group B(P<0.05).Conclusion CSCIWORA patients usually accompanied with ISI.Once surgery is given,a better prognosis will get if ISI disappeared and a poor prognosis will obtain if ISI existence.