MRI对CSCIWORA患者术后脊髓功能恢复情况的预测研究

Predictive Study of MRI on Spinal Cord Function Postoperative Recovery in Patients with CSCIWORA

探讨磁共振成像(MRI)技术预测无放射学异常的脊髓损伤(CSCIWORA)患者术后脊髓功能恢复情况的效能。选择139例运动跌倒致CSCIWORA患者为研究对象,根据术后脊髓功能恢复情况分为良好组(n=103)和非良好组(n=36)。比较两组一般资料、MRI检测结果,对数据进行统计分析。结果显示,非良好组受伤至手术时间长于良好组,脊髓损伤美国脊髓损伤协会(ASIA)分级较良好组严重(P<0.05);非良好组脊髓损伤MRI类型水肿+出血、颈椎MRI椎前高信号患者多于良好组,脊髓损伤信号长度高于良好组,有效颈椎管率低于良好组(P<0.05);受伤至手术时间、脊髓损伤ASIA分级、脊髓损伤MRI类型、颈椎MRI椎前高信号、脊髓损伤信号长度、有效颈椎管率均与日本骨科学会(JOA)评分改善率相关(P<0.05);单一MRI参数中脊髓损伤信号长度的AUC最大,但仍低于各MRI参数联合的AUC(0.922)。可见,脊髓损伤MRI类型、颈椎MRI椎前高信号、脊髓损伤信号长度及有效颈椎管率与CSCIWORA患者术后脊髓功能恢复情况有关,采用MRI技术可对术后脊髓功能转归做出可靠预测。

This study investigated the efficacy of magnetic resonance imaging(MRI) in predicting the postoperative recovery of spinal cord function in patients with spinal cord injury without radiological abnormalities(CSCIWORA). 139 patients with CSCIWORA caused by sports falls were selected as the research subjects, and they were divided into good group(n=103) and non-good group(n=36) according to the recovery situation of spinal cord function after surgery. The general data and MRI test results of the two groups were compared, and the data Statistical analysis was performed. The results showed that the time from injury to surgery was longer in the non-good group than in the good group, and the ASIA classification of spinal cord injury was more severe than in the good group(P<0.05). The patients in non-good group with spinal cord injury MRI type edema + hemorrhage and anterior cervical MRI high signal were more than the good group, and the signal length of spinal cord injury was higher than in the good group, while the effective cervical canal rate was lower than in the good group(P<0.05). Time from injury to operation,American Spinal Injury Association (ASIA)classification of spinal cord injury,MRI type of spinal cord injury,cervical MRI prevertebral hyperintensity,signal length of spinal cord injury,and effective cervical spinal canal rate were all correlated with the improvement rate of the Japanese Orthopaedic Association(JOA)score(P<0.05).The AUC of spinal cord injury signal length was the largest among single MRI parameters,but it was still lower than the AUC of all MRI parameters combined(0.922).It can be seen that the type of spinal cord injury MRI,cervical MRI prevertebral high signal,spinal cord injury signal length and effective cervical canal rate are related to the recovery of spinal cord function in patients with CSCIWORA after surgery.MRI technique can reliably predict the regression of spinal cord function after surgery.