颈髓挥鞭样损伤的回顾性研究

目的通过对临床资料的回顾性分析,探讨颈髓挥鞭样损伤病例手术的必要性。方法根据治疗方式和损伤后MR I所示脊髓受压程度的不同,将2004年4月～2006年4月收治的36例过伸性颈椎损伤患者分成3组：非手术治疗组（8例）、受压不明显者手术组（10例）、受压明显者手术组（18例）;比较3组间治疗前后的ASIA评分及Frankel分级改变。结果所有患者获得12～24个月随访,神经功能行ASIA评分及Frankel分级,手术组均高于非手术治疗组（P〈0.05）。结论过伸性颈脊髓损伤尽早手术减压是最大限度恢复神经功能的关键。凡存在明显神经功能障碍、MR I提示有颈髓损伤,无论是否有明显脊髓受压者都应早期手术。手术可避免因颈椎管高压和颈椎不稳造成的继发性脊髓损伤,保证其远期疗效。     

伴颈神经根病的无症状颈椎退变性脊髓压迫的治疗

目的探讨伴颈神经根病的无症状颈椎退变性脊髓压迫(asymptomatic spondylotic cervical cord compression,A-SCCC)的治疗。方法回顾分析本院2009年6月~2012年6月收治的34例伴颈神经根病的A-SCCC患者病例资料,患者入院后先接受系统的非手术治疗,如果神经功能无缓解或加重,则行手术治疗,收集患者一般情况及影像学资料,于治疗前后不同时间点通过日本骨科学会(Japanese Orthopaedic Association,JOA)评分评价临床治疗效果。结果34例患者平均随访4个月,其中23例经非手术治疗获得不同程度的改善;11例改善不明显,其中8例改手术治疗,3例患者继续非手术治疗(2例症状逐渐缓解,1例出现脊髓病临床表现)。治疗后及随访期间非手术组与手术组患者JOA评分均较治疗前明显改善,差异有统计学意义(P0.01)。结论多数伴颈神经根病的A-SCCC患者经过系统非手术治疗后病情可以缓解,部分仍需手术治疗,伴颈神经根病或脊髓高信号的A-SCCC不必预防性手术,但需密切观察病情变化。     

颈脊髓损伤MRI的诊断分型(附66例手术所见分析)

本文报告66例急性颈髓损伤,通过MRI检查,有三种压迫颈髓情况:1.单纯椎间盘突出,2.椎间盘与骨折块一起压迫颈髓;3.单独骨折块压迫颈髓。在脊髓成像上显示的病理变化;1.硬脊膜与脊髓水肿,在T_2—wis上为明亮的高信号成像;2.脊髓信号呈暗淡的低信号成像;3.脊髓信号变化的脊段没有脊髓受压现象。在治疗上:单纯椎间盘突出患者效果比较满意,椎间盘与骨折块同时压迫者或单独骨折块压迫者效果比较差;脊髓信号变化与受压平面不一致者,可给予保守治疗,必要时,手术能获得满意效果。     

脊髓型颈椎病颈椎术后出现颈髓内MRI T2W1高信号的分析

目的分析脊髓型颈椎病颈椎术后出现颈髓内MRI T2W1高信号的相关因素。方法回顾性分析自2015-03—2019-01采用颈椎后路椎板单开门扩大成形内固定术治疗的55例脊髓型颈椎病,术后经MRI检查39例脊髓内无异常信号(无信号组),16例脊髓内出现T2W1高信号(高信号组)。结果 55例均顺利完成手术与检查,随访时间10～48个月,平均23.9个月。2组性别比较差异无统计学意义(P0.05);高信号组年龄较无信号组大,病程较无信号组长,压迫节段较无信号组多,术后1年JOA评分改善率较无信号组低,差异有统计学意义(P0.05)。结论颈髓MRI T2加权像出现异常信号常发生在年龄较大、病史较长、压迫节段较多的患者,该异常影像学表现可以作为手术结果的预测因子,常常提示脊髓发生了严重的缺血性改变和较差的恢复潜力,应积极采取手术治疗。     

慢性压迫性颈脊髓病的手术疗效与MRI表现分析

目的：分析慢性压迫性颈脊髓病的MRI表现,探讨术前预测慢性压迫性颈脊髓病手术疗效的意义。方法：对115例慢性压迫性颈脊髓病患者的MRI和术后半年以上复查的81例MRI图像,选椎管矢径最窄节段脊髓进行分辨、测量和对照,并依据脊髓功能40分评分法对疗效进行评定。结果：髓内有边界清楚局限性T1WI低或等信号、T2WI高信号灶的26例,术后玉术前MRI各测量值皆无显著性差异（P＞0.05）,术后改善率＜30％。髓内无上述异常信号灶的89例,其术后MRI各值及改善率与术前髓断面积、髓断面积与管断面积比值大小呈正相关。结论：术前髓内有无边界清楚局限性T1WI、T2WI异常信号灶、髓断面积的大小、髓断面积与管断面积比值可作为预测手术疗效的依据。     

创伤性颈脊髓损伤的早晚期手术疗效比较

[目的]评价创伤性颈脊髓损伤早期手术的效果及MRI揭示预后的价值. [方法]2001年9月～2004年8月,对36例创伤性颈脊髓损伤患者行手术治疗,伤后72 h内为早期手术,72 h后为晚期手术.术前MRI T2加权像髓内信号改变长度>20 mm为长变化,信号改变≤20 mm或无明显信号改变为短变化.随访时间为24～48个月,平均32个月.采用日本骨科学会(JOA)标准进行入院时和随访时脊髓功能评分,通过计算恢复率评价神经改善状况. [结果]术后24个月随访时,早期手术组恢复率高于晚期手术组(P<0.01);MRI T2加权像信号短变化组恢复率高于信号长变化组(P<0.01),差异均有统计学意义.不同手术时机与MRI T2加权像脊髓信号改变间存在交互作用. [结论]创伤性颈脊髓损伤后,手术时间越早,MRI T2加权像脊髓信号变化越短,术后神经功能恢复率越高.     

无骨折、脱位的颈脊髓损伤

通过对176例外伤性颈脊髓损伤中24例无骨折、脱位病例的回顾分析,认为MRI对不伴骨折或脱位的颈髓损伤的诊断是目前较可靠手段。提出这些病例可分为脊髓压迫型和无脊髓压迫型。治疗上前者以前路减压为佳,而脊髓内外联合减压术对阻止后者神经损害的进展有帮助。早期诊断,尽早制动,牵引乃至手术十分必要。     

多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的手术入路选择及疗效分析

目的 :比较不同手术入路治疗多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的手术疗效,为手术方案的选择提供理论依据。方法:收集2011年1月~2014年12月就诊于上海长征医院脊柱外科的45例多节段脊髓型颈椎病伴髓内MRI T2WI高信号改变患者的临床资料,根据手术入路的不同分为颈前路手术组(A组)和颈后路手术组(B组),其中A组男17例,女5例,年龄54.36±6.18岁;B组男19例,女4例,年龄58.09±8.83岁。在颈椎MRI T2WI上测量0.1cm2的高信号区与同一矢状面上0.1cm2正常颈髓内信号区的强度比值,比较两组患者末次随访时的JOA评分、神经功能改善率、髓内高信号强度比值及术后并发症的发生率。结果:所有患者均定期随访,随访时间为16.84±9.95个月。两组患者性别构成比、年龄、病程、病变节段数、术前JOA评分、术前髓内高信号强度比值、术后随访时间均无统计学差异(P0.05)。A组末次随访时JOA评分为14.64±1.09分,B组为13.09±1.56分,A组明显高于B组(P0.05);A、B组神经功能改善率分别为(64.14±12.76)%、(35.08±20.52)%,A组神经功能改善率明显优于B组(P0.05)。A组末次随访时髓内高信号强度比值为1.36±0.14,B组为1.53±0.15,A组显著低于B组(P0.05)。A组患者术后并发症发生率为13.64%,B组为13.05%,两组间比较差异无统计学意义(P0.05)。结论 :多节段脊髓型颈椎病伴髓内MRI T2WI高信号时,前、后路手术后患者的神经功能和髓内高信号强度均有改善,但前路手术能更好地提高术后神经功能,并降低髓内高信号强度比值。     

急性创伤性无骨折脱位型颈髓损伤的临床研究

目的　探讨急性创伤性无骨折脱位型颈脊髓损伤的机制及治疗方法。方法　 75例患者行常规 X线摄片、CT扫描及 MRI检查。结果　常规 X线摄片及 CT扫描均不能确切了解颈脊髓损伤的病因及机理。根据 MRI检查分为两种类型 ,a)颈椎间盘突出颈脊髓损伤型 ,本组 6 2例。4 9例脊髓受压明显者予以手术治疗 ,13例脊髓受压较轻者予以非手术治疗。b)无颈椎间盘突出颈脊髓损伤型 ,13例均予以非手术治疗。随访 6 7例 ,随访时间 1～ 10 a,平均 4 a,除2例 Frankel A级、1例 Frankel B级无恢复外 ,其余患者神经功能均有不同程度恢复。结论　无骨折脱位型颈脊髓损伤应尽早行 MRI检查 ,以明确临床类型。对颈脊髓受压明显的颈椎间盘突出者 ,应尽早手术治疗 ,对无颈椎间盘突出者采用大剂量甲基强的松龙等非手术治疗 ,亦具有较好的疗效。     

急性颈脊髓损伤髓内出血水肿患者术后神经功能恢复的风险因素分析

目的 观察伴髓内出血水肿的急性颈脊髓损伤(cervical spinal cord injury, CSCI)患者的手术减压效果,并分析术后神经功能恢复不良的预测因素。方法 回顾性分析该院于2018年3月～2022年3月收治的71例伴髓内出血水肿的急性CSCI患者资料,测量其术前MRI所示的髓内出血信号长度(intramedullary hemorrhage length, IHL)、髓内水肿信号长度(intramedullary edema length, IEL)、脊髓受压指数(maximum spinal cord compression, MSCC)等指标。于术前、术后3 d时,评价其ASIA运动评分(the ASIA motor score, AMS),并计算其AMS恢复率;术后6个月,以AIS分级改善≥1级判定为术后神经功能恢复(改善组),以AIS分级未改善甚至加重判定为术后神经功能未恢复(未改善组)。比较两组患者的相关资料,并采用多元Logistic回归分析得出CSCI患者术后神经功能恢复不良的预测因素。结果 术后6个月,有54例(76.1%)患者的神经功能AIS分级改善...     

下颈椎损伤分类评分系统的临床应用

目的评估SLIC评分系统对下颈椎损伤治疗的指导作用。方法对76例下颈椎损伤患者行颈椎X线、CT、MRI检查和系统的神经学体检,按照SLIC系统的原则对骨折形态、间盘韧带复合体(DLC)状态和神经功能状态3个方面进行评估。根据影像学检查将骨折形态分为:无异常、压缩型、爆裂型、牵张型和旋转/平移型;将DLC损伤分为:无损伤型、不确定型、断裂型;根据神经学体检将神经损伤状态分为:无损伤、神经根损伤、完全性/不完全性脊髓损伤和持续脊髓压迫损伤。根据SLIC评分系统选择治疗方法,评估患者的神经功能恢复情况和并发症发生情况。结果 76例均获得随访,时间9~22(12.6±1.2)个月。15例评分≤4分的患者选择非手术治疗,其中有4例评分=4分者转为手术治疗;8例评分=4分及53例评分≥5分的患者均选择手术治疗。治疗后除6例脊髓完全性损伤者神经功能无好转外,其余患者神经功能均有不同程度的改善。结论 SLIC评分系统具有较高的可靠性,且使用简单,易于掌握,此方法对于颈椎损伤的评估较全面和准确,可以作为患者临床治疗选择的依据。     

老年无骨折脱位型颈脊髓损伤的诊治及围手术期管理

目的分析老年无骨折脱位型颈脊髓损伤的成因及损伤机制,探讨MRI表现、治疗方法选择,并对围手术期管理提出指导。方法回顾2003年3月~2013年10月收治的〉60岁的无骨折脱位型颈脊髓损伤296例,对发生机制、伤后MRI片脊髓信号改变、治疗手段对神经恢复的影响进行分析,对伤后MRI上脊髓T2加权像高信号变化进行分型。结果 236例患者MRI T2加权像有信号变化,其中Ⅰ型125例、Ⅱ型79例、Ⅲ型27例、Ⅳ型5例。296例患者中,手术治疗222例,非手术治疗74例。2组神经功能恢复率有明显区别（P〈0.05）;且伤后早期（〈72 h）手术患者的症状改善率高于稍晚手术患者。伤后颈脊髓内MRI的T2加权像异常信号可以分为4型。结论老年颈脊髓损伤患者有明显神经损伤症状者应尽早手术治疗。患者术前应戒烟、行呼吸功能练习和体位训练,术后应早期离床活动,以促进神经功能恢复及减少并发症发生。     

脊髓型颈椎病MRI-T_2WI髓内高信号与临床预后的相关研究

目的探讨脊髓型颈椎病MRI-T2WI髓内高信号与临床预后的关系。方法将2009年7月至2011年7月诊治的57例脊髓型颈椎病患者根据MRI-T2WI髓内高信号不同分为MRI-T2WI无髓内高信号、髓内高信号模糊境界不清、髓内高信号明亮清晰境界清楚3组进行研究,对患者的年龄、病程、术前JOA评分、脊髓压缩比进行比较,随访时给予术后JOA评分并计算术后改善率,探讨髓内高信号对脊髓型颈椎病患者预后的指导意义。结果 57例患者中34例（59.65%）出现髓内高信号,其中髓内高信号模糊境界不清者18例,髓内高信号明亮清晰境界清楚者16例。脊髓型颈椎病不伴髓内高信号或伴髓内高信号模糊境界不清的患者术后改善率较高,手术效果较好;脊髓型颈椎病伴髓内高信号明亮清晰境界清楚的患者术后改善率较低,手术效果较差。结论脊髓型颈椎病患者的预后与患者的年龄、病程、脊髓受压比例及髓内高信号等多种因素相关,MRI-T2WI髓内高信号对患者的手术预后有指导意义。     

急性颈椎损伤MRI表现与脊髓损伤的相关性

目的　探讨MRI检查在判断急性颈椎损伤患者脊髓损伤程度中的作用。方法　对 82例急性颈椎损伤患者在受伤 2 4h内行MRI检查 ,并进行早期连续的临床检查 ,分析MRI表现与脊髓损伤程度之间的相关性。结果　急性颈椎损伤的 10种MRI表现中 ,髓内出血提示完全性脊髓损伤 (FrankelA级 ) ;脊髓肿胀及脊髓水肿多见于FrankelA -C级的病人 ,同时 ,脊髓肿胀及水肿的程度与脊髓损伤程度成正比 ;脊髓受压多见于FrankelA级和FrankelB级的患者 ;颈椎脱位多见于脊髓损伤程度较重 (FrankelA -C级 )的患者 ;椎管狭窄与脊髓损伤程度之间无明确相关性 ,但多见于老年患者 ;颈椎间盘突出、颈椎椎体骨折、颈椎附件骨折及韧带损伤与脊髓损伤程度间无明显相关性。结论　急性颈椎损伤患者早期行MRI检查 ,可以帮助判断脊髓损伤的程度 ,对治疗方法的选择及准确判断预后具有重要的指导意义。     

Injury to the spinal cord without any radiographic abnormality in a child

Spinal cord injury without radiographic abnormalities (SCIWORA) is a diagnostic challenge most commonly encountered in pediatric patients. The unique hypermobility and ligamentous laxity of the pediatric bony cervical and thoracic spine may predispose to SCIWORA. A four-year-old girl was admitted for polytrauma. During monitorization deterioration in her neurological status was observed. Magnetic resonance imaging (MRI) showed an abnormal intensity in the spinal cord at the level of T11-L3, suggesting SCIWORA. We did not consider surgery and treated the patient with a conservative approach and rehabilitation program. The patient achieved a functional capacity sufficient to perform essential activities. A detailed neurologic examination should be undertaken particularly in polytrauma pediatric patients and MRI should be employed in suspected cases.     

Relationship between magnetic resonance imaging findings and spinal cord injury in extension injury of the cervical spine

Objective

The purpose of this study was to determine the relationship between magnetic resonance imaging (MRI) findings and neurologic symptoms in cervical spine extension injury and to analyze the MRI parameters associated with neurologic outcome.

Materials and methods

This study included 102 patients with cervical spine extension injury, whose medical records and MRI scans at the time of injury were available. Quantitative MRI parameters such as maximum spinal canal compression (MSCC), maximum cord compromise (MCC), and lesion length showing intramedullary signal changes were measured. Furthermore, intramedullary hemorrhage, spinal cord edema, and soft tissue damage were evaluated. Fisher’s exact test was used for a cross-analysis between the MRI findings and the three American Spinal Injury Association category groups depending on the severity level of neurologic injury: complete (category A), incomplete (categories B–D), and normal (category E).

Results

MSCC accounted for 23.05, 19.5, and 9.94 % for the complete, incomplete, and normal AIS categories, respectively, without showing statistically significant differences (P = 0.085). MCC was noted in 22.05, 15.32, and 9.2 %, respectively, with the complete-injury group (AIS category A) showing significantly higher. In particular, cases of complete injury had >15 % compression, accounting for 87.5 % (P < 0.001). The mean intramedullary lesion length was significantly higher in complete-injury patients than in incomplete-injury patients (24.22 vs. 8.24 mm). Intramedullary hemorrhage and spinal cord edema were significantly more frequently observed in complete-injury cases (P < 0.001). The incidence of complete injury was proportional to the severity of soft tissue damage.

Conclusion

MCC, intramedullary lesion length, intramedullary hemorrhage, and spinal cord edema were MRI parameters associated with poor neurologic outcomes in patients with cervical spine extension injury.

     

Osteoradionecrosis of the cervical spine resulting from radiotherapy for primary head and neck malignancies: operative and nonoperative management. Case report

Osteoradionecrosis is a process of dysvascular bone necrosis and fibrous replacement following exposure to high doses of radiation. The poorly vascularized necrotic tissue may cause pain and/or instability, and it cannot resist infection well, which may result in secondary osteomyelitis. When these processes affect the cervical spine, the resulting instability and neurological deficits can be devastating, and immediate reestablishment of spinal stability is paramount. Reconstruction of the cervical spine can be particularly challenging in this subgroup of patients in whom the spine is poorly vascularized after radical surgery, high-dose irradiation, and infection. The authors report three cases of cervical spine osteoradionecrosis following radiotherapy for primary head and neck malignancies. Two patients suffered secondary osteomyelitis, severe spinal deformity, and spinal cord compression. These patients underwent surgery in which a vascularized fibular graft and instrumentation were used to reconstruct the cervical spine; subsequently hyperbaric oxygen (HBO) therapy was instituted. Fusion occurred, spinal stability was restored, and neurological dysfunction resolved at the 2- and 4-year follow-up examinations, respectively. The third patient experienced pain and dysphagia but did not have osteomyelitis, spinal instability, or neurological deficits. He underwent HBO therapy alone, with improved symptoms and imaging findings. Hyperbaric oxygen is an essential part of treatment for osteoradionecrosis and may be sufficient by itself for uncomplicated cases, but surgery is required for patients with spinal instability, spinal cord compression, and/or infection. A vascularized fibular bone graft is a very helpful adjunct in these patients because it adds little morbidity and may increase the rate of spinal fusion.     

自发性椎管内硬膜外、硬膜下血肿的诊断和治疗

探讨比较自发性硬脊膜外、硬膜下血肿的出血原因、临床表现、影像特征及治疗预后。结合相关文献，回顾性分析7例自发性硬脊膜外血肿和1例自发性硬膜下血肿的流行病学、发病机制、部位，临床特征、神经功能状态，以及手术，保守治疗和预后。结果有6例患者手术治疗，1例痊愈，2例保守治疗，1例痊愈。自发性硬脊膜外，硬膜下血肿多急性起病,硬脊膜外较硬膜下血肿更为常见，且MRI显示椎管内占位影较CT明显。MRI检查是诊断本病最佳方法。手术减压是改善预后的主要方法。起病到治疗的时间间隔越短预后越好。     

Tuberculosis of spine: neurological deficit

The most dreaded neurological complications in TB spine occur in active stage of disease by mechanical compression, instability and inflammation changes, while in healed disease, these occur due to intrinsic changes in spinal cord secondary to internal salient in long standing kyphotic deformity. A judicious combination of conservative therapy and operative decompression when needed should form a comprehensive integrated course of treatment for TB spine with neurological complications. The patients showing relatively preserved cord with evidence of edema/myelitis with predominantly fluid collection in extradural space on MRI resolve on non-operative treatment, while the patients with extradural compression of mixed or granulomatous nature showing entrapment of spinal cord should be undertaken for early surgical decompression. The disease focus should be debrided with removal of pus caseous tissue and sequestra. The viable bone should only be removed to decompress the spinal cord and resultant gap should be bridged by bone graft. The preserved volume of spinal cord with edema/myelitis and wet lesion on MRI usually would show good neural recovery. The spinal cord showing myelomalacia with reduced cord volume and dry lesion likely to show a poor neural recovery. The internal kyphectomy is indicated for paraplegia with healed disease. These cases are bad risk for surgery and neural recovery. The best form of treatment of late onset paraplegia is the prevention of development of severe kyphosis in initial active stage of disease.