过伸性颈髓损伤磁共振分型与术式选择

目的通过磁共振分型研究，探讨过伸性颈椎颈髓损伤后合理的手术方式。方法对44例接受手术治疗的过伸性颈髓损伤患者进行回顾性分析。按MRI上显示的脊髓压迫情况将颈髓损伤分为五型，Ⅰa型（限于1～2个间盘层面前方压迫型）11例、Ⅰb型（3个间盘层面及以上前方压迫型）6例、Ⅱ型（单纯发育性椎管狭窄型）2例、Ⅲa型（限于1～2个间盘层面前后压迫型）8例、Ⅲb型（3个间盘层面及以上前后压迫型）17例。手术方式分前路、后路、前后联合入路三种减压植骨固定术式。Ⅰa型患者均采用前路术式；Ⅰb型和Ⅱ型患者7例采用后路术式，1例采用联合入路术式；Ⅲ型（Ⅲa型和Ⅲb型）患者8例采用前路术式，9例采用后路术式，8例采用联合人路术式。研究各型所采取的手术方式的疗效。结果经6～24个月随访，比较手术前后的Frankel分级及ASIA运动功能评分变化。41例脊髓功能有改善，较术前提高1～3级。Ⅰa型前路组、Ⅰb型和Ⅱ型后路组及Ⅲ型前路组、后路组、联合人路组术后较术前ASIA评分均有提高，差异有统计学意义（P〈0．05）。Ⅲ型前路组ASIA评分增加值最小，其中联合入路组大于后路组大于前路组，差异有统计学意义（均P〈0．05），但联合入路组和后路组相比差异无统计学意义（P〉0．05）。结论过伸性颈髓损伤的磁共振分型有助于术式选择，前路减压植骨内固定是治疗Ⅰa型损伤的有效术式，后路减压植骨内固定是治疗Ⅰb型和Ⅱ型损伤的有效术式；前后路联合术式和后路术式治疗Ⅲ型损伤的疗效均优于前路术式，单纯前路术式疗效较差。

MRI Typing and Operation Method Choice of Hyperextension Injury of the Cervical Spinal Cord

Objective To explore the reasonable approach in surgery for hyperextension injury of the cervical spinal cord（HEICSC）based on the study of MRI typing. Methods Forty-four patients of HEICSC,36 males and 8 females ,aged 28- 67,were retrospectively analyzed. According to spinal cord compression showed on MR images ,the injuries are classified into 5 types：type Ⅰ a （anterior compression restriet at 1- 2 disk decks, 11 cases）,type Ⅰb （anterior compression exceeding 2 disk decks, 6 cases） ;type Ⅱ （only developed cervical spinal stenosis, 2cases） ,type Ⅲ a （anterior-posterior compression restrict at 1-2 disk decks, 8cases）,type Ⅲ b （anterior-posterior compression exceeding 2 disk decks, 17 cases）. Forty-four cases underwent surgery via anterior approach （AA ,n = 20） ,posterior approach （PA,n=16）,or combined approach（CA,n=8）aceording to the different operation methods and among them,all the cases of type I a underwent surgery via AA,7 eases of type Ⅰ b and type Ⅱ via PA,1 casevia CA,8 cases of type Ⅱ via AA, 9 cases via PA and 8 cases via CA ,then followed up for 6-24 months. The therapeutic effects were studied. Results After operation,the Frankel grade was ascended 1-3 grades in 41 patients;The ASIA grade was ascended in all the groups of the AA of type Ⅰ a,the PAof typeⅠ b and type Ⅱ ,the AA,PA and CA of type Ⅲ in comparison with preoperative grade （all P〈0.05）;the combined approach and posterior approach groups were both ascended in comparison with that of the anterior approach group（both P（0.05）,however,there was not significant difference between the CA and PA groups（P〉0.05）. Conclusion The MRI typing is helpful to operation method choice to treat hyperextension injury of cervical spine. Anterior decompression-graft-internal fixation is effective to treat injury of type I a and posterior one is effective choice of injury of type Ⅰ b and type Ⅱ . The therapeutic effects of combined approach and posterior one for the injury of type Ⅲ ,which are often more severe,are superior to that of anterior one which were often poor.