颈椎颈髓损伤的MRI表现与临床意义

颈椎及颈髓损伤伤情严重，为创伤主要致残和致死原因之一。X线平片、脊髓造影及CT能成功地诊断颈椎管骨性结构损伤，但对脊髓、椎间盘及韧带结构损伤的诊断主要依据间接征象，治疗方案主要靠体格检查、骨折移位和椎管变形程度而定’‘、”。磁共振成像（MRI）可直观脊髓和椎管骨性与非骨性结构，是脊椎脊髓损伤诊断的重大突破”’。本文报告我院1993年4月至1995年8月共46例颈椎颈髓损伤的MRI影像学特点及其临床意义。1一般资料本组男36例，女IO例。年龄18～6O岁。全部病例均在伤后3～god内行MR扫描。其致伤原因为车祸、刀刺伤、压砸伤…     

颈髓急性损伤后的磁共振波谱评价

目的:探讨颈髓急性损伤后磁共振波谱(1H-MRS)的诊断价值。方法:对19例急性颈髓损伤患者根据神经功能分为完全性损伤及不全性损伤两组,选取创区与创区头侧远端颈髓行1H-MRS,半定量分析氮-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)和乳酸(Lac)含量的比值。结果:颈髓完全性损伤组中NAA/Cho、NAA/Cr显著减低,Lac/Cho显著增高,其创区头侧远端Lac/Cho含量也增高(P<0.05);不完全损伤组中仅Lac/Cho含量增加,头侧远端乳酸含量亦增高(P<0.05)。颈髓损伤不同程度组间NAA/Cho、NAA/Cr有显著性差异(P<0.05)。结论:1H-MRS所测NAA/Cho、NAA/Cr从代谢水平反映颈髓损伤的不同程度,创区头侧远端Lac/Cho比值增高提示颈髓隐匿损伤的存在。     

急性颈髓损伤与神经恶化

急性颈髓损伤并发症较多、死亡率高，特别是泌尿系感染、褥疮、肺部感染、呼吸衰竭、深静脉栓塞、肺栓塞是常见致死的原因。近年来对伤后神经恶化逐渐认识，文献报告发生率高达10％。自1997年1月～2002年6月收治的89例急性颈髓损伤后有11例出现神经恶化，本文加以分析总结。     

急性颈椎颈髓损伤后呼吸道管理

颈髓的解剖和生理与呼吸功能关系密切,颈椎、颈髓损伤后,呼吸功能会受到不同程度的影响,而高位颈髓损伤对呼吸功能的影响更大.因此,加强颈椎、颈髓损伤病人呼吸道的管理,改善通气功能尤为重要.作者对此进行了综述,旨在提高对此类病人呼吸道管理的水平,促进康复.     

MRI影像对急性颈髓损伤神经功能预后的判断——100例患者的前瞻性研究

急性脊髓损伤患者神经功能损伤程度及其预后变化较大，目前尚缺乏客观有效的影像学评价和判断方法。本研究通过前瞻陛研究急性颈髓损伤病例MRI影像上的定量、定性指标与预后的关系，试图寻找一些可用于判断颈髓预后的影像学指标。研究共入组急性颈髓损伤患者100例，其中男性79例，女性21例，平均年龄45岁（17～96岁）。采用ASIA评分评价神经功能。     

急性颈髓损伤患者腹胀原因分析与护理对策

回顾性分析57例急性颈髓损伤患者腹胀发生的原因。其主要原因为颈髓损伤后神经反射中断致麻痹性肠梗阻，并存腹部脏器损伤、消化道应激性溃疡或穿孔等。提出客观正确评估患者病情，密切观察患者生命体征变化，加强心理护理、饮食护理、基础护理及健康知识教育等综合措施，是防止并发症发生的关键。     

急性完全性颈髓损伤的治疗策略

目的探讨急性完全性颈髓损伤患者救治和早期处理上的策略。方法对63例急性完全性颈髓损伤行颅骨牵引、大剂量甲基强的松龙、神经节苷脂、脱水药物、康复以及手术等治疗,分析其并发症和预后情况。结果本组住院期间死亡6例,其中合并伤致死亡3例,颈脊髓损伤并发症致死亡3例。55例获得平均10个月(5～39个月)随访,5例因颈脊髓损伤后期并发症死亡;32例截瘫平面有不同程度的降低。结论系统的综合治疗对急性完全性颈髓损伤治疗有关键的作用。     

急性无骨折脱位型颈髓损伤的MRI表现与治疗

１８例无骨折脱位型颈髓损伤伤后１周内行ＭＲＩ检查，表现为颈髓受损区Ｔ２加权高信号Ｔ１加权等或略低信号，椎间盘突出硬膜外血肿压迫脊髓等。１１例手术采用前路减压并植骨，或后路单开门减压或椎管成形术同时药物治疗；７例保守治疗以牵引以及药物治疗为主。     

急性颈髓损伤患者腹胀原因分析与护理对策

回顾性分析57例急性颈髓损伤患者腹胀发生的原因.其主要原因为颈髓损伤后神经反射中断致麻痹性肠梗阻,并存腹部脏器损伤、消化道应激性溃疡或穿孔等.提出客观正确评估患者病情,密切观察患者生命体征变化,加强心理护理、饮食护理、基础护理及健康知识教育等综合措施,是防止并发症发生的关键.     

急性脊髓损伤模型大鼠血清和脊髓的代谢组学研究

目的:采用~1H NMR核磁共振代谢组学的方法研究急性脊髓损伤模型大鼠的代谢组学特征及生物标志物,探讨核磁共振代谢组学应用于脊髓损伤研究的可行性。方法:取8周龄清洁级雄性SD大鼠20只,体重(200±10)g,按照随机数字法分为假手术组和模型组,每组10只,模型组采用改良的Allens法制作急性脊髓不完全损伤模型,假手术组不损伤脊髓,术后第1、5、7天采用BBB运动功能评分法进行行为学观察,术后第7天收集脊髓组织作病理学观察,核磁共振代谢组学对两组大鼠血清和脊髓样本进行代谢组学分析。结果:BBB评分显示假手术组术后后肢运动无明显改变,各时间点差异无统计学意义,模型组大鼠术后双下肢呈迟缓性瘫痪,BBB运动评分较低,各时间点差异存在统计学意义,两组运动功能评分在各时间点的差异均有统计学意义;病理切片显示假手术脊髓结构正常,神经分布均匀,模型组脊髓组织结构紊乱,神经元数目减少,存在炎性细胞浸润和空腔坏死组织。代谢组学分析表明,血清中极低密度脂蛋白(VLDL)、低密度脂蛋白(LDL)、谷氨酰胺(glutamine)、柠檬酸(citrate)、二甲基甘氨酸(DMG)等物质和脊髓中谷胱甘肽(glutathione)、3-羟基丁酸(3-OH-butyrate)、N-乙酰天冬氨酸(NAA)、磷酸胆碱(GPC)、谷氨酸(glutamate)、抗坏血酸(ascorbate)等物质浓度有明显变化(P0.05)。结论 :通过对假手术组和模型组大鼠血清和脊髓样本进行代谢组学检测和分析得到了两组样本的差异性代谢物质,有助于解释急性脊髓损伤后血清和脊髓组织中的特异性小分子物质的变化规律,为后期针对性地研究这些代谢标记物在急性脊髓损伤中的作用提供研究基础。     

急性颈髓损伤后的低钠血症

[目的]探讨急性颈髓损伤后低钠血症的病因、发病机制、诊断和治疗。[方法]回顾性分析2004年-2006年收治的急性颈髓损伤后低钠血症患者15例的临床资料。[结果]全组患者入院24—72h内血钠低于130mmol／L，其中5例低于120mmol／L。14例尿钠40—68mmol／L，1例尿钠为148mmol／L；尿渗透压420～980mmol／L，12例患者经适当的补盐和限制水摄入量治疗，低钠症状2～3周内改善；2例发热患者因发热不能严格限制水摄入，其中1例2个月后恢复，另1例失访；1例患者补盐限水后病情加重，调整治疗方案后恢复。[结论]颈髓损伤越重，损伤后低钠血症发生率越高；颈髓损伤后低钠血症多由抗利尿激素分泌异常综合征引起；血钠浓度，血、尿渗透压等是诊断依据；适当补充钠盐和液体量是有效的治疗方法。     

Outcome of the acute abdomen in patients with previous spinal cord injury

Background : Patients with spinal cord injury (SCI) have always posed difficulties for the diagnosis of an acute abdomen. The aim of the present study was to define this problem retrospectively at Princess Alexandra Hospital and to assess the results of treatment for these patients. Methods : A retrospective review was conducted of 133 SCI patients admitted with an acute abdomen in the 16 years prior to this analysis at the Spinal Injuries Unit (SIU) of Princess Alexandra Hospital. There were 21 patients who conformed to the study criteria. All the patients had sustained traumatic SCI at or above the level of T11, more than 1 month prior to admission. Results : There were 13 male and eight female patients. The time lapse between SCI and the onset of an acute abdomen ranged from 1.5 months to 27 years. The age range was 26–79 years. The majority of patients had C6 injuries (six patients). There were 18 patients with injury levels above T6 and three patients with injuries below this level. The time taken to diagnose the cause of the acute abdomen ranged between 1 day and 3 months. Investigations were found to be useful in making the diagnoses in 61.9% of cases. There were 14 patients who had surgical interventions. Five patients had surgical complications and there were two deaths in the study. The length of follow up was 1–132 months. The mortality in the study was 9.5%. Conclusion : An aggressive approach to the diagnosis and treatment of the acute abdomen in SCI patients with suspicious symptoms is recommended. A high index of suspicion should be maintained in those patients with pre‐existing SCI who present with abdominal trauma.     

脊髓急性损伤后神经细胞凋亡的时相和空间分布特点

目的 研究脊髓急性损伤后神经细胞的凋亡及其时相和空间特点。方法 大鼠脊髓（T8,9）经中度压迫损伤后,分别在30min、2h、4h、8h、24h、48h、72h、7d、14d、和21d处死取材（n=4)。应用HE、Nissl染色及凋亡细胞原位末端标记法对脊髓组织进行标记。结果 损伤4h后,在损伤段及邻近段可见末端标记阳性神经细胞,损伤段灰质中阳性细胞数8h达高峰,24h白质中阳性胶质细胞数量达高峰。相邻节段阳性细胞数量在72h达高峰。阳性细胞以白质中胶质细胞为主,主要分布于相邻节段。结论 脊髓损伤后神经细胞凋亡是继发损伤期的重要病理变化,并有其时相和空间分布特点。     

Surgery in incomplete spinal cord injury

A case of spinal cord injury treated surgically is reported; it is unusual in that it showed the classic indication for surgery—a documented progression of neurological impairment. The patient made a full recovery following anterior decompression of the spinal cord. We believe this case gives added evidence that surgery does have a valuable place in the management of certain selected spinal cord injuries. The literature is reviewed.     

The value of dynamic cervical MRI in management of selected patients presenting traumatic cervical cord injury

OBJECTIVE: The purpose of this report is to describe our experience with dynamic cervical MRI for detection of cervical spinal cord instability in patients presenting spinal cord trauma without fracture or dislocation of the spinal column. MATERIAL AND METHODS: Since January 2000 a total of 95 patients presenting spinal cord trauma have been treated in our department. All patients underwent MRI for diagnostic work-up. Dynamic MRI was performed if spinal cord instability was suspected. Whenever possible, high-quality plain radiography dynamic views were obtained (coma, severe deficit, study of the cervicothoracic junction). RESULTS: Dynamic MRI allowed diagnosis of spinal cord instability in 6 patients with a mean age of 65 years (range, 45 to 75). Instability occurred during extension in 4 patients and during flexion and extension in one case. In the remaining case instability was associated with herniation of a cervical disc due to a severe cervical sprain. All 6 patients underwent early surgical stabilization that allowed improvement in-hospital patient care and quick transfer to rehabilitation centers. CONCLUSION: Dynamic MRI can be a useful tool to detect unstable spinal cord instability in some patients presenting noncompressive spinal cord injuries.     

高血糖对急性脊髓损伤后果的影响

目的探讨给予高渗糖对急性脊髓损伤后神经学功能恢复的影响。方法将16只健康禁食的大白兔随机分为两组,采用Alien’s脊髓损伤模型,在脊髓损伤前一组动物接受50％高渗糖0．5g／kg体重（处理组）,另一组采用等容量生理盐水对照（对照组）,脊防损伤前后采股动脉血测定血糖并于损伤后3天进行神经学评分。结果处理组与对照组相比,血糖水平显著增高（P＜0．04）,72小时后的神经功能评分也明显不如对照组（P＜0．01）。结论急性脊髓损伤期间的高血糖可加重脊髓继发性损伤。     

Motor versus somatosensory evoked potential changes after acute experimental spinal cord injury in rats

Summary In this study, averaged cortical somatosensory evoked potentials (SEP) after sciatic nerve stimulation, and lower extremity muscle responses after motor cortex stimulation (MEP) were compared in rats. 10 animals served as light (25g-cm) and 10 animals as severe (80g-cm) acute spinal cord injury group after weight dropping trauma. After the initial loss of components, both SEP and MEP recovered in most cases in the light injury group. In the severe injury group, however, no recovery was observed in cortical SEPs, while the muscle MEP recovered in some animals. Light spinal cord injury had little effect on muscle MEPs and caused a paradoxical amplitude increase in some MEP recordings. Latency values of muscle MEPs did not show great changes after either kind of injury, while cortical SEP latency was considerably delayed.In this model cortical SEPs were more sensitive to light spinal cord injury than muscle MEPs after single electrical cortical stimuli. Severe spinal cord injury caused amplitude changes or loss of waves from both SEP and MEP.This work was partly presented in the poster sections at 39. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie, Köln (F. R. G., May 8-1, 1988 and Congress of the International Medical Society of Motor Disturbances, Rome, Italy, June 2–4, 1988.     

猪胸腰段脊髓火器伤后早期血糖变化

目的建立家猪胸腰段脊髓火器伤模型和改良Allens打击伤后全瘫模型,观察伤后早期血糖的变化。方法将实验动物随机分为两组,其中火器伤(G)组6只,在全麻状态下制作胸腰段(L1,2)脊髓火器伤模型;打击伤(C)组6只,L1节段脊髓行改良Allen’s打击。各组动物分别于伤前、伤后0.5、1、2、4h检测血糖。结果两组动物在伤后4h内均出现高血糖,以伤后0.5h最高,而伤后1～4h逐渐降低。G组血糖的升高幅度较C组显著(P<0.01)。结论由于火器伤后血糖升高幅度较大,故脊髓火器伤后早期应慎用葡萄糖液。