术前颈椎MRI对成人无骨折脱位型颈脊髓损伤术后预后的分析

李家冉; 郭涛

doi:10.16766/j.cnki.issn.1674-4152.002975

术前颈椎MRI对成人无骨折脱位型颈脊髓损伤术后预后的分析

doi: 10.16766/j.cnki.issn.1674-4152.002975

李家冉^{1, 2},
郭涛^{1, 2, ,}

1.
贵州医科大学临床医学院，贵州贵阳 550025
2.
贵州省人民医院骨科，贵州贵阳 550499

基金项目:

贵州省科技厅基础计划项目黔科合基础-ZK[2022]一般247

贵州省卫生健康委科学技术基金项目 gzwkj2021-246

贵州省人民医院博士基金 GZSYBS[2021]05号

详细信息

通讯作者:
郭涛，E-mail：guotao04b@sina.com

中图分类号: R681.53 R744
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- HTML全文浏览量: 128
- PDF下载量: 19
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-05

Analysis of preoperative cervical MRI in the prognosis of spinal cord injury without radiological abnormalities in adults after surgery

LI Jiaran^{1, 2},
GUO Tao^{1, 2
, ,}

1.
Clinical Medicial College, Guizhou Medical University, Guiyang, Guizhou 550025, China

摘要

摘要: 目的探讨成人无骨折脱位型颈脊髓损伤术后脊髓功能恢复与术前颈椎MRI的相关性。方法选取2016年1月—2021年9月在贵州省人民医院脊柱外科行手术治疗的无骨折脱位型颈脊髓损伤患者52例，采用JOA评分和改善率评定患者颈脊髓损伤功能。针对脊髓损伤MRI类型、脊髓损伤MRI范围进行单因素logistic回归分析和多因素logistic回归分析，分析其与成人无骨折脱位型颈脊髓损伤术后预后的相关性，并明确其中最主要的影响因素。结果无骨折脱位型颈脊髓损伤患者52例。男性41例，女性11例，年龄为36~76(58.50±10.46)岁。入院时JOA评分为(5.69±2.09)分，末次随访JOA评分为(11.84±2.79)分，改善率为(54.49±20.18)%。单因素logistic回归分析显示脊髓损伤MRI类型、脊髓损伤MRI范围与成人无骨折脱位型颈脊髓损伤术后预后相关(P < 0.05)，多因素logistic回归分析显示脊髓损伤MRI类型较脊髓损伤MRI范围对成人无骨折脱位型颈脊髓损伤术后脊髓功能恢复影响更大。结论脊髓损伤MRI类型、脊髓损伤MRI范围与无骨折脱位型颈脊髓损伤患者的脊髓功能恢复密切相关，水肿+出血型、脊髓损伤MRI范围>4 cm患者脊髓功能恢复预后最差。
- MRI /
- 颈脊髓损伤 /
- 手术治疗 /
- 术后预后
Abstract: Objective To investigate the correlation between recovery of spinal cord function and preoperative cervical MRI after surgery for spinal cord injury (SCI) without radiological abnormalities in adults. Methods Fifty-two patients with SCI without radiological abnormalities who underwent surgical treatment in the Department of Spine Surgery of Guizhou Provincial People ' s Hospital from January 2016 to September 2021 were selected, and the patients ' cervical SCI function was evaluated by JOA score and improvement rate. Single-factor logistic regression analysis and multi-factor logistic regression analysis were performed for SCI MRI type and SCI MRI range to analyze their correlation with the postoperative prognosis of adult spinal cord injury without radiological abnormality, and to identify the main influencing factors among them. Results There were 52 patients with SCI without radiological abnormalities. There were 41 males and 11 females, aged 36-76 years old, with a mean age of (58.50±10.46) years old. The JOA score was (5.69±2.09) at baseline and (11.84±2.79) at the last follow-up, with an improvement rate of (54.49±20.18)%. Single-factor logistic regression analysis showed that the type of MRI of SCI and the extent of MRI of SCI were associated with the prognosis after surgery for cervical SCI in adults without fracture dislocation (P < 0.05), and multi-factor logistic regression analysis showed that the type of MRI of SCI had a greater effect on recovery of spinal cord function after surgery for cervical SCI in adults without fracture dislocation than the extent of MRI of SCI. Conclusion The MRI type of SCI and the MRI extent of SCI were closely related to spinal cord function recovery in patients with SCI without radiological abnormalities, and the prognosis of spinal cord function recovery was worst in patients with edema and hemorrhage type and MRI extent of SCI>4 cm.
- MRI /
- Cervical spinal cord injuries /
- Surgery /
- Postoperative prognosis
利益冲突 无

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图 1 脊髓损伤MRI类型

注: 水肿+出血型, 患者, 男性, 62岁, 受伤后4 d拍摄的颈椎MRI, A为T₁WI可见脊髓损伤区高信号改变, B为T₂WI可见脊髓损伤区高信号改变。

Figure 1. MRI type of spinal cord injury

下载: 全尺寸图片幻灯片

图 2 脊髓损伤MRI范围

注：脊髓损伤的最高点与最低点连线的长度即为脊髓损伤MRI范围，脊髓损伤MRI范围为69.40 mm。

Figure 2. MRI range of spinal cord injury

下载: 全尺寸图片幻灯片

图 3 颈脊髓损伤典型影像学资料

注：患者，男性，69岁，A、B、C为术前颈椎CT三维成像；D、E为术前颈椎MRI。

Figure 3. Typical imaging data of cervical spinal cord injury

下载: 全尺寸图片幻灯片

表 1 52例SCIWORA患者的观察项目及其赋值方法

Table 1. Observed items and their assignments in 52 SCIWORA patients

变量	赋值方法
脊髓损伤MRI范围	<1.5 cm=1；≥1.5 cm且<4.0 cm=2；≥4.0 cm=3
脊髓损伤MRI类型	水肿=(0，0)；出血=(1, 0)；水肿+出血=(0, 1)
脊髓恢复情况	优、良=1；可、差=2

下载: 导出CSV

表 2 52例SCIWORA患者术后脊髓预后单因素logistic回归分析

Table 2. Univariate logistic regression analysis of postoperative spinal cord prognosis in 52 SCIWORA patients

变量		术后脊髓功能优良(例)	术后脊髓功能可差(例)	B	SE	Wald χ²	P值	OR(95% CI)
脊髓损伤MRI范围	<1.5 cm	9	5			10.201		1
	≥1.5 cm且<4.0 cm	13	9	1.836	1.211	2.297		6.273(0.584~67.404)
	≥4.0 cm	4	12	2.529	0.847	8.914	0.003	12.545(2.384~66.010)
脊髓损伤MRI类型	水肿	23	11			6.192		1
	出血	1	3	0.734	0.730	1.010		2.083(0.498~8.717)
	水肿+出血	2	12	2.015	0.827	5.941	0.015	7.500(1.484~37.905)

下载: 导出CSV

表 3 52例SCIWORA患者术后脊髓预后多因素logistic回归分析

Table 3. Multifactorial logistic regression analysis of spinal cord prognosis after surgery in 52 SCIWORA

变量	B	SE	Wald χ²	P值	OR 值(95% CI)
脊髓损伤MRI范围	0.930	0.456	4.162	0.041	2.534(1.037~6.189)
脊髓损伤MRI类型	1.305	0.467	7.812	0.005	3.688(1.477~9.208)

下载: 导出CSV

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