沈祥 徐宏光赵泉来 马明明 张骞 俞宏星

    (皖南医学院第一附属医院弋矶山医院脊柱外科，安徽芜湖241001)

    无骨折脱位型颈脊髓损伤与颈椎退行性变影像学相关性研究*

    沈祥 徐宏光**赵泉来 马明明 张骞 俞宏星

    (皖南医学院第一附属医院弋矶山医院脊柱外科，安徽芜湖241001)

    背景：无骨折脱位型颈脊髓损伤为常见颈椎外伤，对其损伤机制的认识正在不断加强，了解其与颈椎退行性变是否具有相关性在临床上至关重要。

    目的：研究无骨折脱位型颈脊髓损伤与颈椎退行性变在影像学上的相关性。

    方法：回顾性研究2012年6月至2014年6月收治的48例不同原因造成的无骨折脱位型颈脊髓损伤患者的影像学表现，包括颈椎X线片、CT平扫及MRI检查。男27例，女21例；年龄35～68岁，平均(55.6±2.3)岁。其中退变性椎管狭窄25例(52.08%)，椎体前后缘明显退变骨赘形成30例(62.50%)，椎间盘退变突出45例(93.75%)，椎前水肿及血肿21例(43.75%)。对损伤节段椎间盘行Pfirrmann退变分级，退变为Ⅲ～Ⅴ级者36例(75%)；对损伤节段相邻终板软骨行Modic改变分型，仅3例(6.25%)发生Modic改变，均为Ⅱ型改变。

    结果：无骨折脱位型颈脊髓损伤与颈椎退行性变在影像学上有显著相关性，并有明显特征性变化，包括颈椎管退行性狭窄、颈椎间盘退变性突出及压迫相应节段脊髓产生的特征性变化，而与相邻终板软骨无明显相关性。

    结论：根据颈椎退行性变及退变程度对患者进行颈脊髓损伤评估，为临床上诊断及治疗提供重要依据。

    脱位；脊髓损伤；颈椎；脊髓小脑变性

    Background:ound:Spinal cord injury without radiographic abnormality is a kind of common cervical trauma.It is clinically important to understandwhether there is correlation between the diseaseand cervicaldegeneration.

    Objective:tive:To investigate the correlation between hyperextension injury and degeneration of cervical spine in imaging appearance.

    Methods:hods:A total of 48 patientswith spinal cord injury butwithout radiographic abnormality at cervical spine by different causes,who were treated between June 2012 and June 2014,wereenrolled in this retrospective study.Their imaging data including radiograph,CT and MRIw ere evaluated.There were 27males and 21 femalesw ith an average age of(55.6±2.3) years(range,35-68 years).Therewere 25 patients(52.08%)with degenerated spinal stenosis,30(62.50%)w ith osteophyte, 45(93.75%)w ith disc degenerative protrusion,and 21(43.75%)with haematoma and oedema at the anterior of vertebral body.According to the Pfirrmann grading system,there w ere 36 patients(75%)w ith gradeⅢ-Ⅴdisc degeneration.M odic changesof cervicalendplateoccurred in 3 patients(6.25%). ......