影像学检查在无骨折脱位型颈脊髓损伤中的临床应用价值
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摘要
无骨折脱位型颈脊髓损伤(CSCIWOFD)是一种特殊类型的脊髓损伤,以颈椎过伸性损伤为主要损伤机制,患者多有颈椎管狭窄、后纵韧带骨化、黄韧带肥厚以及椎间盘突出等基础疾病,导致迟发性颈椎不稳,出现颈脊髓损伤症状加重。普通X片检查不能发现颈椎周围软组织损伤情况,但可反映颈椎管狭窄以及颈椎不稳等病理改变,磁共振成像对软组织有良好的分辨率,可用于评价颈椎软组织的损伤情况,并明确脊髓损伤节段。随着影像技术的不断提高,DTI技术的应用为疾病的精准诊断和预后提供了理论依据。
Cervical spinal cord injury without fracture and dislocation( CSCIWOFD) is a special type of spinal cord injury. Hyperextension injury is the major injury mechanism. Most patients have cervical spinal canal stenosis,ossification of posterior longitudinal ligament,hypertrophy of ligamentum flavum and protrusion of intervertebral disc,which will lead to tardive cervical instability and increase symptoms of cervical spinal cord injury. X-ray could not find soft tissue damage around cervical vertebra. However,it can relfect the pathological changes of cervical spinal stenosis and instability. Because of the high resolution rate of soft tissue,MRI can evaluate soft tissue injury of cervical spine and identify the injury segment of spinal cord. With the continuous improvement of radiological imaging technology,the application of DTI technology provides a theoretical basis for the accurate diagnosis and prognosis.
Cervical spinal cord injury without fracture and dislocation( CSCIWOFD) is a special type of spinal cord injury. Hyperextension injury is the major injury mechanism. Most patients have cervical spinal canal stenosis,ossification of posterior longitudinal ligament,hypertrophy of ligamentum flavum and protrusion of intervertebral disc,which will lead to tardive cervical instability and increase symptoms of cervical spinal cord injury. X-ray could not find soft tissue damage around cervical vertebra. However,it can relfect the pathological changes of cervical spinal stenosis and instability. Because of the high resolution rate of soft tissue,MRI can evaluate soft tissue injury of cervical spine and identify the injury segment of spinal cord. With the continuous improvement of radiological imaging technology,the application of DTI technology provides a theoretical basis for the accurate diagnosis and prognosis.
引文
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[3]罗彬,冯浩,杨晓茂,等.颈椎管狭窄伴无骨折脱位型颈脊髓损伤颈椎不稳定因素分析[J].实用骨科杂志,2015,21(9):769-773,793.
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[14]赵一丁,杨铁毅,邵进,等.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[J].国际骨科学杂志,2018,39(3):38-42.
[15]Takao T,Morishita Y,Okada S,et al.Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation[J].Eur Spine J,2013,22(10):2228-2231.
[16]Panjabi MM,White AA 3rd.Basic biomechanics of the spine[J].Neurosurgery,1980,7(1):76-93.
[17]Borden AG,Rechtman AM,Gershoncohen J.The normal cervical lordosis[J].Radiology,1960,74(5):806-809.
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[19]Song J,Mizuno J,Inoue T,et al.Clinical evaluation of traumatic central cord syndrome:Emphasis on clinical significance of prevertebral hyperintensity,cord compression,and intramedullary high-signal intensity on magnetic resonance imaging[J].Surg Neurol,2006,65(2):117-123.
[20]Mullin TI,Wang M,Rao RD.Radiographic characterization of prevertebral soft tissue shadow in the cervicothoracic region of normal adults[J].J Surg Res,2013,180(1):73-79.
[21]戴力扬,贾连顺.颈椎椎前软组织的放射学测量[J].中国矫形外科杂志,1995(1):41-42.
[22]Yamagata T,Naito K,Yoshimura M,et al.Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage[J].J Craniovertebr Junction Spine,2017,8(3):179-186.
[23]贾利国,韩文瑞,张永军,等.无骨折脱位型颈脊髓损伤267例治疗分析[J].中国药物与临床,2018,18(Z1):31-32.
[24]颜华东.颈椎前纵韧带损伤的MRI诊断及临床意义[D].长春:吉林大学,2013.
[25]刘新阁,李涛,陈方民,等.MRI在无骨折脱位型颈脊髓损伤诊断和预后分析中的作用[J].中国组织工程研究,2017,21(31):5036-5041.
[26]Matsushita A,Maeda T,Mori E,et al.Can the acute magnetic resonance imaging features reflect neurologic prognosis in patients with cervical spinal cord injury[J].Spine J,2017,17(9):1319-1324.
[27]Szwedowski D,Walecki J.Spinal Cord Injury without Radiographic Abnormality(SCIWORA)-Clinical and Radiological Aspects[J].Pol J Radiol,2014,79(8):461-464.
[28]Nishida N,Kato Y,Imajo Y,et al.Biomechanical analysis of cervical spondylotic myelopathy:The influence of dynamic factors and morphometry of the spinal cord[J].J Spinal Cord Med,2012,35(4):256-261.
[29]Lord EL,Alobaidan R,Takahashi S,et al.Kinetic magnetic resonance imaging of the cervical spine:A review of the literature[J].Global Spine J,2014,4(2):121-128.
[30]Zhang L,Zeitoun D,Rangel A,et al.Preoperative evaluation of the cervical spondylotic myelopathy with flexion-extension magnetic resonance imaging:About a prospective study of fifty patients[J].Spine(Phila Pa 1976),2011,36(17):E1134-1139.
[31]曾洪武,王培军.磁共振扩散加权与弥散张量成像原理分析及比较[J].中国医学影像技术,2005,21(12):1945-1947.
[32]Peterson DJ,Rutman AM,Hippe DS,et al.Test-Retest and Interreader Reproducibility of Semiautomated Atlas-Based Analysis of Diffusion Tensor Imaging Data in Acute Cervical Spine Trauma in Adult Patients[J].AJNR Am J Neuroradiol,2017,38(10):2015-2020.
[33]D'Souza MM,Choudhary A,Poonia M,et al.Diffusion tensor MRimaging in spinal cord injury[J].Injury,2017,48(4):880-884.
[34]Li XH,Li JB,He XJ,et al.Timing of diffusion tensor imaging in the acute spinal cord injury of rats[J].Sci Rep,2015,29(5):12639.
[2]Rozzelle CJ,Aarabi B,Dhall SS,et al.Spinal cord injury without radiographic abnormality(SCIWORA)[J].Neurosurgery,2013,72(2):227-233.
[3]罗彬,冯浩,杨晓茂,等.颈椎管狭窄伴无骨折脱位型颈脊髓损伤颈椎不稳定因素分析[J].实用骨科杂志,2015,21(9):769-773,793.
[4]Lauweryns P.Role of conservative treatment of cervical spine injuries[J].Eur Spine J,2010,19(1):S23-26.
[5]Maeda T,Ueta T,Mori E,et al.Soft tissue damage and segmental instability in adult patients with cervical spinal cord injury without major bone injury[J].Spine(Phila Pa 1976),2012,37(25):E1560-E1566.
[6]Stevenson CM,Dargan DP,Warnock J,et al.Traumatic central cord syndrome:Neurological and functional outcome at 3years[J].Spinal Cord,2016,54(11):1010-1015.
[7]Brodell DW,Jain A,Elfar JC,et al.National trends in the management of central cord syndrome:An analysis of 16,134patients[J].Spine J,2015,15(3):435-442.
[8]易龙,孙天胜,张志成.SLIC评分系统在无骨折脱位型颈脊髓损伤治疗中的应用[J].中国矫形外科杂志,2014,22(4):304-307.
[9]杨海源,蔡卫华.颈椎过伸性损伤机制与病理改变的研究进展[J].脊柱外科杂志,2016,14(2):117-120.
[10]Jiang H,Wang J,Xu B,et al.A model of acute central cervical spinal cord injury syndrome combined with chronic injury in goats[J].Eur Spine J,2017,26(1):56-63.
[11]毛宾尧,应忠追.无骨折脱位颈脊髓损伤的实质探讨[J].中华创伤骨科杂志,1999,1(1):43-45.
[12]Song KJ,Lee SK,Ham DH,et al.Limitation of previous Allen classification and subaxial cervical spine injury classification(SLIC)system in distractive-extension injury of cervical spine:Proposal of modified classification system[J].Eur Spine J,2016,25(1):74-79.
[13]Vaccaro AR,Klein GR,Thaller JB,et al.Distraction extension injuries of the cervical spine[J].J Spinal Disord,2001,14(3):193-200.
[14]赵一丁,杨铁毅,邵进,等.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[J].国际骨科学杂志,2018,39(3):38-42.
[15]Takao T,Morishita Y,Okada S,et al.Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation[J].Eur Spine J,2013,22(10):2228-2231.
[16]Panjabi MM,White AA 3rd.Basic biomechanics of the spine[J].Neurosurgery,1980,7(1):76-93.
[17]Borden AG,Rechtman AM,Gershoncohen J.The normal cervical lordosis[J].Radiology,1960,74(5):806-809.
[18]朱文刚,吴强,席新华,等.无骨折脱位颈髓损伤的MRI分型及临床意义[J].中国矫形外科杂志,2012,20(24):2284-2287.
[19]Song J,Mizuno J,Inoue T,et al.Clinical evaluation of traumatic central cord syndrome:Emphasis on clinical significance of prevertebral hyperintensity,cord compression,and intramedullary high-signal intensity on magnetic resonance imaging[J].Surg Neurol,2006,65(2):117-123.
[20]Mullin TI,Wang M,Rao RD.Radiographic characterization of prevertebral soft tissue shadow in the cervicothoracic region of normal adults[J].J Surg Res,2013,180(1):73-79.
[21]戴力扬,贾连顺.颈椎椎前软组织的放射学测量[J].中国矫形外科杂志,1995(1):41-42.
[22]Yamagata T,Naito K,Yoshimura M,et al.Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage[J].J Craniovertebr Junction Spine,2017,8(3):179-186.
[23]贾利国,韩文瑞,张永军,等.无骨折脱位型颈脊髓损伤267例治疗分析[J].中国药物与临床,2018,18(Z1):31-32.
[24]颜华东.颈椎前纵韧带损伤的MRI诊断及临床意义[D].长春:吉林大学,2013.
[25]刘新阁,李涛,陈方民,等.MRI在无骨折脱位型颈脊髓损伤诊断和预后分析中的作用[J].中国组织工程研究,2017,21(31):5036-5041.
[26]Matsushita A,Maeda T,Mori E,et al.Can the acute magnetic resonance imaging features reflect neurologic prognosis in patients with cervical spinal cord injury[J].Spine J,2017,17(9):1319-1324.
[27]Szwedowski D,Walecki J.Spinal Cord Injury without Radiographic Abnormality(SCIWORA)-Clinical and Radiological Aspects[J].Pol J Radiol,2014,79(8):461-464.
[28]Nishida N,Kato Y,Imajo Y,et al.Biomechanical analysis of cervical spondylotic myelopathy:The influence of dynamic factors and morphometry of the spinal cord[J].J Spinal Cord Med,2012,35(4):256-261.
[29]Lord EL,Alobaidan R,Takahashi S,et al.Kinetic magnetic resonance imaging of the cervical spine:A review of the literature[J].Global Spine J,2014,4(2):121-128.
[30]Zhang L,Zeitoun D,Rangel A,et al.Preoperative evaluation of the cervical spondylotic myelopathy with flexion-extension magnetic resonance imaging:About a prospective study of fifty patients[J].Spine(Phila Pa 1976),2011,36(17):E1134-1139.
[31]曾洪武,王培军.磁共振扩散加权与弥散张量成像原理分析及比较[J].中国医学影像技术,2005,21(12):1945-1947.
[32]Peterson DJ,Rutman AM,Hippe DS,et al.Test-Retest and Interreader Reproducibility of Semiautomated Atlas-Based Analysis of Diffusion Tensor Imaging Data in Acute Cervical Spine Trauma in Adult Patients[J].AJNR Am J Neuroradiol,2017,38(10):2015-2020.
[33]D'Souza MM,Choudhary A,Poonia M,et al.Diffusion tensor MRimaging in spinal cord injury[J].Injury,2017,48(4):880-884.
[34]Li XH,Li JB,He XJ,et al.Timing of diffusion tensor imaging in the acute spinal cord injury of rats[J].Sci Rep,2015,29(5):12639.