无骨折脱位型颈脊髓损伤患者低位颈椎稳定性与预后的相关性

摘要

Objective To investigate the correlation between the stability of low cervical spine and the prognosis in patients with cervical spinal cord injury without fracture or dislocation.Methods Forty seven patients with cervical spinal cord injury without fracture or dislocation treated in Shanghai Pudong New Area Gongli Hospital from January 2010 to June 2015 were retrospectively reviewed.Patients were divided into a group with stable low cervical spine (SLCV,without prevertebral hyperintensity)and the other group with unstable low cervical spine (NSLCV,with prevertebral hyperintensity)according to the presence of pre-vertebral high signal (PVH)on MRI T2WI.Preoperative prevertebral hyperintensity length,visual analogue score(VAS),Japanese Orthopaedic Association(JOA)score and neck disability index(NDI) scores and postoperative JOA score recovery rate were measured,respectively.The correlation between prevertebral hyperintensity length and preoperative JOA score and postoperative JOA score recovery rate was analyzed.Results The preoperative VAS,JOA score and NDI of two groups were significantly different (P<0.05).There was no significant difference in VAS,JOA score,NDI and JOA score improvement rate between the two groups at the last follow-up (P>0.05).The length of prevertebral hyperintensity and preoperative JOA score had significantly negative correlation (r=-0.693,P<0.01).The postoperative improvement rate of JOA score also had significantly negative correlation (r=-0.571,P<0.01).Conclusion For patients with low cervical instability,apart from adequate decompression,the stability of the lower cervical spine should be reconstructed to obtain a better prognosis.%目的 探讨无骨折脱位型颈脊髓损伤患者低位颈椎稳定性与其预后的相关性.方法 回顾性分析2010年1月至2015年6月在上海市浦东新区公利医院接受手术治疗的47例无骨折脱位型颈脊髓损伤患者资料.依据术前检查MRI T2 WI矢状位是否存在椎体前高信号将患者分为:低位颈椎稳定组(SLCV组,无椎体前高信号)和低位颈椎不稳定组(NSLCV组,有椎体前高信号).测定患者术前的椎体前高信号长度、手术前后视觉模拟评分(VAS)、日本骨科协会(JOA)颈脊髓功能评分以及颈椎功能障碍指数(NDI),计算术后JOA评分改善率.对椎体前高信号长度与术前JOA评分及术后JOA评分改善率的相关性作统计学分析.结果 术前两组患者的VAS和JOA评分差异有统计学意义(P<0.05).术后末次随访时,两组患者的VAS、JOA评分及JOA评分改善率差异无统计学意义(P>0.05).椎体前高信号长度与术前JOA评分存在显著负相关(r=-0.693,P<0.01),与术后JOA评分改善率也存在显著负相关(r=-0.517,P<0.01).结论 对于低位颈椎不稳的无骨折脱位型颈脊髓损伤患者在充分减压的同时应重建低位颈椎的稳定性,使其获得更佳的预后效果.