过伸性颈椎脊髓损伤的影像学特征与临床意义

过伸性颈椎脊髓损伤的影像学特征与临床意

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作者：贾宁阳,王晨光,陈雄生,周许辉,宋滇文

【摘要】［目的］探讨过伸性颈椎脊髓伤影像学特点，为临床治疗方法选择提供依据。［方法］对本组78例因不同原因造成的颈椎过伸性损伤的影像学表现，包括X线片、CT、MRI不同的影像特征进行回顾性分析。椎前阴影增宽57例（73.1%），其中36例损伤节段前间隙增宽或伴颈椎前缘撕脱骨折，局限性增宽占17.5% ，弥漫性占82.5%退变性和发育性椎管狭窄63例。CT平扫显示椎体前后缘明显退变骨赘形成37例，椎间盘变性突出21例。MRI的特征性表现为椎间盘和前纵韧带损伤61例（78.2% ）。椎体前血肿及水肿57例， 64例表现脊髓不同程度受压或损伤。根据影像学变化，提出影像学诊断根据。［结果］过伸性颈椎脊髓损伤影像有明显特征性变化，包括骨和前纵韧带、椎间盘及相应节段的脊髓存在特征性变化；脊髓损伤与影像学表现有明显相关性，临床上可能表现典型急性脊髓中央综合征，但多数表现不同程度神经功能障碍。［结论］影像学变化特征结合临床表现特点，为过伸性颈脊髓损伤诊断及其早期治疗方法选择提供影像学依据。

【关键词】颈椎；过伸性脊髓伤；影像学表现

Abstract：［Objective］To investigate imaginological evidences of hyperxtensive injury of cervical spine and to evaluate its use in clinics.［Method］Seventy eight patients with hyperextension injury at cervical spine by different cause were estimated by radiograph、CT and MRI.Fifty seven cases(73.1%) appeared with widen of soft tissue of anteriorspine, including focal type(17.5%) and diffused type(82.5%). Thirty six cases showed avulsion fracture of anterior edge in the cervical spine. Sixty three cases showed degeneration and developmental spinal stenosis,twenty one cases appeared integral vertebral canal. No contrast CT scan showed osteophyte of thirty seven cases and intervertebral discs degeneration and protrusion of twenty one cases.Sixty one cases(78.2%) with both disc and anterior longitudinal ligament injury showed by MRI, fifty seven cases showed haematoma and oedema at the anterior of the vertebral body. Sixty four cases accompanied with different spinal cord injury.［Result］Obvious imaging feature for hyperextension injury of cervical spine,including anterior longitudinal ligament,intervertebral disc and spinal cord were found.There exists good relationship between spinal cord injury and imaging appearance. Clinically it showed typical central syndrome,but mostly showed us

neuron-functional disturbance of different degree.［Conclusion］Combining of imaginological apperarance including radiograph,CT,MRI can provide evidences for diagnosis of hyperextension and help to treat acute hyperextension cervical injury.

Key words：cervical spine; hyperextension injury;

imaging appearance

过伸性颈椎损伤是颈椎的一种较为常见的损伤机制，既往已有许多报导。研究发现，过伸性颈椎脊髓损伤病理变化及影像学表现有许多特殊性，其临床功能障碍状况差别较大，过伸性颈椎损伤可能较多表现椎间盘及韧带等软组织损伤，偶有骨损伤，可以表现不同程度的脊髓损伤。回顾本组78例，提出讨论重新认识过伸性颈椎脊髓损伤影像学特点，有助于诊断治疗选择。

1 临床资料

本组78例，男67例，女11例，男女比为5∶1。最小27岁，最大74岁。平均57.2岁，其中26～30岁2例，31～40岁3例，41～50岁14例，51～60岁39例，61～70岁14例，71～78岁6例。

1.1 病程

损伤后至就诊时间最短7 h，最长21 d，其中6～8 h以内3例，8～24 h 9例，24 h～7 d 15例，7～14 d 29例，15～21 d 22例。超过21 d的陈旧性损伤不包括本组之列。

1.2 损伤原因

(1)平地跌倒，头面部撞击物体或平地伤38例。多系夜间行路不稳所致；(2)高处跌落，头面部撞物体致伤18例；(3)交通肇事17例，汽车肇事如紧急刹车，或汽车撞击骤停，额面部撞击物体；(4)体育运动伤5例。

1.3 损伤与病变节段

C3、45例，C3～54例，C4、523例，C4～611例，C5、624例，C5～78例，C6、73例。

1.4 临床症状