CAJ | 학술논문

目的：观察颈椎管狭窄伴无骨折脱位型颈脊髓损伤（ cervical spinal cord injury without fracture and disloca-tion，CSCIWFD）的MRI表现及术中探查发现，探讨颈椎管狭窄伴CSCIWFD颈椎不稳定因素及MRI在判断颈椎不稳定中的作用。方法纳入2002年5月至2013年8月泸州医学院附属医院脊柱外科58例颈椎管狭窄伴CSCIWFD患者，其中男性37例，女性21例，年龄34~71岁，平均（51.7±8.2）岁。入院时JOA脊髓功能评分4~13分，平均（7.2±2.3）分。受伤至入院时间平均（24±12）h，小于3 d者47例。58例患者均为颈脊髓功能不完全性损伤，颈脊髓损伤类型：脊髓中央损伤综合征26例，前脊髓损伤综合征14例，脊髓半切综合征（ Brown-Sequard综合征）6例，无法明确划分为四种不完全性损伤的某一类型12例。根据相关临床资料一期采用经颈后路单开门椎管扩大成形+颈前路椎管减压植骨融合内固定术，记录术中发现颈椎周围软组织、骨韧带结构损伤及颈椎不稳定情况，将MRI检查发现与术中所见进行对比分析。结果颈脊髓损伤部位多位于椎间隙平面，且颈脊髓损伤和相对应的椎间隙节段性颈椎不稳定发生率差异无统计学意义（χ2=1.36，P﹥0.05），即脊髓损伤相对应的椎间隙平面多伴有颈椎节段性不稳定，颈椎管狭窄伴CSCIWFD颈椎节段性不稳与颈椎前后纵韧带和椎间盘损伤、颈脊髓损伤、椎间盘退变等因素有关。结论MRI对颈椎组织结构损伤判断有假阴性结果，但仍能为我们判断颈椎不稳定提供丰富的临床信息，全身麻醉下颅骨牵引观察有无椎间隙增宽对判断颈椎不稳定有一定的补充帮助作用。
목적：관찰경추관협착반무골절탈위형경척수손상（ cervical spinal cord injury without fracture and disloca-tion，CSCIWFD）적MRI표현급술중탐사발현，탐토경추관협착반CSCIWFD경추불은정인소급MRI재판단경추불은정중적작용。방법납입2002년5월지2013년8월로주의학원부속의원척주외과58례경추관협착반CSCIWFD환자，기중남성37례，녀성21례，년령34~71세，평균（51.7±8.2）세。입원시JOA척수공능평분4~13분，평균（7.2±2.3）분。수상지입원시간평균（24±12）h，소우3 d자47례。58례환자균위경척수공능불완전성손상，경척수손상류형：척수중앙손상종합정26례，전척수손상종합정14례，척수반절종합정（ Brown-Sequard종합정）6례，무법명학화분위사충불완전성손상적모일류형12례。근거상관림상자료일기채용경경후로단개문추관확대성형+경전로추관감압식골융합내고정술，기록술중발현경추주위연조직、골인대결구손상급경추불은정정황，장MRI검사발현여술중소견진행대비분석。결과경척수손상부위다위우추간극평면，차경척수손상화상대응적추간극절단성경추불은정발생솔차이무통계학의의（χ2=1.36，P﹥0.05），즉척수손상상대응적추간극평면다반유경추절단성불은정，경추관협착반CSCIWFD경추절단성불은여경추전후종인대화추간반손상、경척수손상、추간반퇴변등인소유관。결론MRI대경추조직결구손상판단유가음성결과，단잉능위아문판단경추불은정제공봉부적림상신식，전신마취하로골견인관찰유무추간극증관대판단경추불은정유일정적보충방조작용。
Objectiv To observe the MRI findings and intra-operative discovery of cervical spinal stenosis accompanied with cervical spinal cord injury without fracture and dislocation( CSCIWFD),and to discuss its instability factors and the func-tion of MRI in assessing cervical instability. Methods Between May 2002 and August 2013,58 patients with cervical spinal stenosis accompanied with CSCIWFD were treated with posterior C3 to C7 expansive open-door laminoplasty combined with one stage anterior decompression,fusion and fixation. There were 21 females and 37 males with an average age of(51. 7 ± 8. 2) years(range,34~71 years). All cases were patients with incomplete spinal cord injury. Among them,26 were central cord syndrome,14 were anterior spinal cord syndrome,6 were Brown-Sequard syndrome,and 12 were mixed type. The mean preop-erative JOA score was(7. 2 ± 2. 3)(range,4 to 13). The mean time interval between injury and admission to hospital was(24 ± 12( hours,and 47 cases were less than 3 days. The injury of soft tissues and bone-ligaments structure and cervical instabili-ty were recorded. Preoperative MRI findings and intra-operative finding were compared. Results Most cervical spinal cord injury site was located in intervertebral space. There was no significant difference between cervical spinal cord injury and local cervical instability incidence rate of corresponding intervertebral space(P﹥0. 05). Most of corresponding intervertebral space of cervical spinal cord injury were accompanied with local cervical instability. Local cervical instability of cervical spinal steno-sis accompanied with CSCIWFD was related to the injury of anterior and posterior longitudinal ligaments and discs( APLLD) and cervical spinal cord and the degeneration of intervertebral disc. Conclusion Although MRI had false negative results in assessing cervical tissues injury,it can provide rich clinical information in assessing cervical instability. Using skull traction un-der general anesthesia to observe intervertebral space broadening was a supplementary method to judge cervical instability.