MRI在成人无骨折脱位型颈脊髓损伤中的应用价值

The Application Value of MRI in Adult Cervical Spinal Cord Injury without Fracture and Dislocation

目的探讨成人无骨折脱位型颈脊髓损伤的临床特征及磁共振成像(magnetic resonance imaging,MRI)早期诊断价值。方法回顾性分析2014年1月—2019年8月丰县人民医院收治的60例被确诊为无骨折脱位型颈脊髓损伤患者的临床及影像学资料,所有患者病程中均有颈椎X线、CT及MRI资料,按照年龄分为青壮年组及中老年组,比较两组临床及影像学特征性数据。结果所有患者均于外伤后出现颈髓损伤的临床表征,X线及CT无骨折及脱位、CT未见明确颈髓髓内异常密度灶,MRI T2WI及脂肪抑制序列图像可见颈段脊髓肿胀、水肿或挫伤;好发部位以C3~C4多见,多伴颈椎骨质增生、椎间盘突出、黄韧带或后纵韧带肥厚等所致的颈段椎管狭窄症;青壮年组、中老年组在致伤原因中高能量损伤占比分别为78.6%、17.4%,差异有统计学意义(χ^(2)=15.846,P<0.001)、并发症发生率分别为14.3%、71.7%,差异有统计学意义(χ^(2)=14.577,P<0.001)及椎管狭窄程度分别为(7.32±1.69)、(5.92±1.53)mm,差异有统计学意义(t=2.926,P=0.005);出院前患者ASIA脊髓损伤水平评分中感觉功能评分及运动功能评分分别为(112.63±4.72)分、(64.35±5.33)分较入院时(105.07±6.91)分、(57.08±3.41)分均有所改善,差异有统计学意义(t=6.998、8.900,P<0.001)。结论成人无骨折脱位型颈脊髓损伤结合病史、临床及MRI检查,对该病有一定的诊断价值。

Objective To investigate the clinical features and early diagnosis value of magnetic resonance imaging(MRI)of adult cervical spinal cord injury without fracture and dislocation.Methods Retrospective analysis of the clinical and imaging data of 60 patients with cervical spinal cord injury without fracture and dislocation admitted to Fengxian People's Hospital from January 2014 to August 2019.All patients had cervical spine X-ray,CT and MRI during the course of their illness.The data were divided into young and middle-aged groups and middle-aged and elderly groups according to age,and the clinical and imaging characteristics of the two groups were compared.Results All patients had clinical signs of cervical spinal cord injury after trauma.X-ray and CT showed no fracture or dislocation.CT showed no clear abnormal density of cervical spinal cord.MRI T2WI and fat suppression sequence images showed cervical spinal cord swelling and edema or contusion;the most common sites were C3-C4,usually with cervical spinal stenosis caused by cervical spine hyperostosis,intervertebral disc herniation,ligamentum flavum or posterior longitudinal ligament hypertrophy;causes of injury high-energy injuries were 78.6%,17.4%,the difference was statistically significant(χ^(2)=15.846,P<0.001).The incidence of complications was 14.3%,71.7%,the difference was statistically significant(χ^(2)=14.577,P<0.001),and the degree of spinal canal stenosis was(7.32±1.69)mm,(5.92±1.53)mm,the difference was statistically significant(t=2.926,P=0.005).The scores of sensory function and motor function in Asia SCI level score at discharge were(112.63±4.72)points and(64.35±5.33)points,respectively,compared with(105.07±6.91)points and(57.08±3.41)points at admission,and the differences were statistically significant(t=6.998,8.900,P<0.001).Conclusion Cervical spinal cord injury without fracture and dislocation in adults combined with medical history,clinical and MRI examinations,has a certain diag nostic value for the disease.