DTI在评估老年外伤性颈脊髓损伤患者临床预后中的价值

The Value of DTI in Evaluating the Clinical Prognosis of Traumatic Cervical Spinal Cord Injury in the Elderly

目的研究磁共振弥散张量成像(DTI)在评估老年患者外伤性不全性颈髓损伤临床预后中的价值。方法选择老年外伤性颈髓损伤患者25例,术前采用DTI评估脊髓损伤程度(FA值)、颈椎CT评估颈椎管狭窄程度(Pavlov比率),分析上述指标与患者术前及术后6月步行功能(Nurick步态)、术后6月握力改善及日常生活能力(Barthel指数)相关性。根据术后1月常规MRIT2信号变化,将患者分为信号不变或增强组(n=11)及信号消退组(n=14),观察两组患者运动恢复差异。结果退行性颈椎管狭窄(Pavlov比率)与老年外伤性颈髓损伤患者术前及术后6月Nurick步态、术后6月握力改善及Barthel指数无相关(P﹥0.05);脊髓损伤区域FA值与术前及术后6月Nurick步态呈负相关(P﹤0.05),与握力改善呈正相关(P﹤0.05),与Barthel指数无相关(P﹥0.05)。两组患者术前及术后6月Nurick步态、术后6月握力改善及Barthel指数有统计学差异(P﹤0.05)。结论DTI及MRIT2高信号1月内消退可以预测老年外伤性颈髓损伤患者临床预后。

Objective To study the value of diffusion tensor imaging in evaluating the clinical prognosis of elderly patients with traumatic incomplete cervical spinal cord injury.Methods 25 elderly patients with traumatic cervical spinal cord injury were selected,the degree of spinal cord injury and spinal canal stenosis were evaluated by DTI(fractional anisotropy,FA)and CT(Pavlov ratio),we analysed the correlation between above indexes and walking function(Nurick gait),grip strength improvement and ability of daily living(Barthel index)before and 6 months after operation.According to the changes of MRI T2 signal a month after operation,we divided the patients into signal invariant or enhanced(s+)and signal degraded(s-)group,the difference of motor function recovery was analysed.Results There was no correlation between degenerative cervical stenosis(Pavlov ratio)and Nurick gait,grip strength improvement and Barthel index in elderly patients with spinal cord injury before and 6 months after operation(P﹥0.05).The FA value in spinal cord injury was negatively correlated with Nurick gait before and 6 months after operation(P﹤0.05),positively correlated with the improvement of grip strength(P﹤0.05),but had no correlation with Barthel Index(P﹥0.05).There were significant differences in Nurick gait,grip strength improvement and Barthel index between T2 signal invariable or enhanced group(s+,n=11)and signal regression group(s-,n=14)before and 6 months after operation(P﹤0.05).Conclusion DTI and MRIT2 high signal regression can predict the clinical prognosis of traumatic cervical spinal cord injury in elderly patients.