创伤性颈脊髓损伤程度与磁共振成像的关系

doi:10.3969/j.issn.1006-9771.2023.06.015

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (6): 725-730.doi: 10.3969/j.issn.1006-9771.2023.06.015

创伤性颈脊髓损伤程度与磁共振成像的关系

袁媛¹^,^2a, 周红俊¹^,^2a(), 丛欣莹¹^,^2b, 刘根林¹^,^2a, 卫波¹^,^2a, 郑樱¹^,^2a, 郝春霞¹^,^2a, 张缨¹^,^2a, 王一吉¹^,^2a, 康海琼¹^,^2a, 逯晓蕾¹^,^2a, 蒙倩茹¹^,^2a

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院，a.脊髓损伤康复科；b.影像科，北京市100068

收稿日期:2022-09-09 修回日期:2023-03-20 出版日期:2023-06-25 发布日期:2023-07-14
通讯作者: 周红俊，男，主任医师。E-mail： zh87569303@qq.com
作者简介:袁媛(1983-)，女，汉族，山东泰安市人，硕士，主治医师，主要研究方向：脊髓损伤康复。

Relationship between impairment and magnetic resonance imaging finding in patients with traumatic cervical spinal cord injury after surgery

YUAN Yuan¹^,^2a, ZHOU Hongjun¹^,^2a(), CONG Xinying¹^,^2b, LIU Genlin¹^,^2a, WEI Bo¹^,^2a, ZHENG Ying¹^,^2a, HAO Chunxia¹^,^2a, ZHANG Ying¹^,^2a, WANG Yiji¹^,^2a, KANG Haiqiong¹^,^2a, LU Xiaolei¹^,^2a, MENG Qianru¹^,^2a

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. a. Department of Spinal Cord Injury Rehabilitation; b. Department of Radiology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2022-09-09 Revised:2023-03-20 Published:2023-06-25 Online:2023-07-14
Contact: E-mail: zh87569303@qq.com

摘要/Abstract

摘要：

目的探讨磁共振成像轴位T₂加权像(T₂WI)脑脊髓损伤中心(BASIC)评分评定创伤性颈脊髓损伤患者的价值。
方法回顾性分析2015年1月至2021年12月在北京博爱医院住院康复的创伤性颈脊髓损伤患者175例。统计患者的性别、年龄、受伤原因、损伤机制、AIS分级，对患者颈椎磁共振成像矢状位及轴位T₂WI进行BASIC评分、单节段/多节段损伤、有/无髓内出血的影像学评估。按照损伤机制将患者分为骨折/骨折脱位型(n = 92)和无骨折脱位型(n = 83)，比较两组人口学指标和磁共振成像T₂WI评估指标，并探讨AIS分级与BASIC评分、有/无髓内出血、单节段/多节段损伤之间的关系。
结果两组性别、年龄和AIS分级均有非常高度显著性差异(t = -10.276, χ² > 12.570, P < 0.001)，受伤原因无显著性差异(P > 0.05)。两组间BASIC评分，髓内出血、单节段损伤发生率均有非常显著性差异(χ² > 8.703, P < 0.01)。AIS分级与BASIC评分显著相关(r = 0.790, P < 0.001)，有/无髓内出血、单节段/多节段损伤间的AIS分级有显著性差异(χ² > 5.516, P < 0.05)。
结论磁共振成像T₂WI的BASIC评分是创伤性颈脊髓损伤患者脊髓损伤严重程度的预测指标。不同损伤机制患者BASIC评分有差异。

关键词: 创伤性颈脊髓损伤, 美国脊柱损伤协会残损分级, 磁共振成像, 脑脊髓损伤中心评分

Abstract:

Objective To explore the application of Brain and Spinal Injury Center (BASIC) score in evaluation of traumatic cervical spinal cord injury.
Methods From January, 2015 to December, 2021, 175 patients with traumatic cervical spinal cord injury in Beijing Bo'ai Hospital were analyzed. Gender, age, cause of injury, injury mechanism and American Spinal Injury Association Impairment Scale (AIS) grade were collected. The sagittal and axial T₂ weighted imaging (T₂WI) of the patients were evaluated with BASIC score, single/multi-segment injury, and with/without intramedullary hemorrhage. According to the injury mechanism, the patients were divided into two groups: with fracture/fracture dislocation (n = 92) and without fracture and dislocation (n = 83). The baseline demographic indicators and T₂WI evaluation indicators were compared between the two groups, and the relationship between AIS grade and BASIC score, intramedullary hemorrhage, single/multi-segment injury were investigated.
Results There were significant differences in gender, age and AIS grade, BASIC score, and the rates of inntramedullary hemorrhage and single segment injury of T₂WI between two groups (t = -10.276, χ² > 8.703, P < 0.01); however, no difference was found in the cause of injury (P > 0.05). The AIS grade was significantly correlated with the BASIC score (r = 0.790, P < 0.001). There was significant difference in AIS grade between intramedullary hemorrhage or not, and single/multi-segment injury (χ² > 5.516, P < 0.05).
Conclusion The BASIC score of T₂WI is a predictor of the severity of spinal cord injury after traumatic cervical spinal cord injury, and is different with the injury mechanisms.

Key words: traumatic cervical spinal cord injury, American Spinal Injury Association Impairment Scale, magnetic resonance imaging, Brain and Spinal Injury Center score

中图分类号:

R651.2

袁媛, 周红俊, 丛欣莹, 刘根林, 卫波, 郑樱, 郝春霞, 张缨, 王一吉, 康海琼, 逯晓蕾, 蒙倩茹. 创伤性颈脊髓损伤程度与磁共振成像的关系[J]. 《中国康复理论与实践》, 2023, 29(6): 725-730.

YUAN Yuan, ZHOU Hongjun, CONG Xinying, LIU Genlin, WEI Bo, ZHENG Ying, HAO Chunxia, ZHANG Ying, WANG Yiji, KANG Haiqiong, LU Xiaolei, MENG Qianru. Relationship between impairment and magnetic resonance imaging finding in patients with traumatic cervical spinal cord injury after surgery[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 725-730.

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参考文献 29

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项目	骨折/骨折脱位型(n = 92)	无骨折脱位型 (n = 83)	合计(n = 175)	t/χ²/Z值	P值
性别(男/女)/n	70/22	79/4	149/26	12.570	< 0.001
年龄/岁	34.5±13.68	53.22±10.32	43±15	-10.276	< 0.001
受伤原因/n				5.930	0.313
高处坠落	18	10	28
机动车事故	30	38	68
摔伤	22	20	42
运动损伤	8	3	11
重物砸伤	7	4	11
自行车事故	7	8	15
AIS分级/n				66.495	< 0.001
A	40	2	42
B	22	4	26
C	15	22	37
D	15	55	70
E	0	0	0
获得MRI时间/d	104.5(61.5, 197.5)	69(38, 163)	95(46, 190)	-2.570	0.010

创伤性颈脊髓损伤程度与磁共振成像的关系

Relationship between impairment and magnetic resonance imaging finding in patients with traumatic cervical spinal cord injury after surgery

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MRI评估指标	n	骨折/骨折脱位型(n = 92)	无骨折脱位型(n = 83)	合计(n = 175)	χ²值	P值
BASIC评分					60.160	< 0.001
1分	1	0	1	1
2分	103	30	73	103
3分	37	29	8	37
4分	34	33	1	34
是否髓内出血					25.370	< 0.001
是	31	29	2	31
否	144	63	81	144
损伤节段类型					8.703	0.003
单节段损伤	146	84	62	146
多节段损伤	29	8	21	29

AIS分级	BASIC评分				合计
AIS分级	1分	2分	3分	4分	合计
A	0	0	18	24	42
B	0	7	11	8	26
C	0	30	5	2	37
D	1	66	3	0	70
合计	1	103	37	34	175

AIS分级	髓内出血		损伤节段
AIS分级	无	有	单节段	多节段
A	26	16	39	3
B	15	11	23	3
C	33	4	29	8
D	70	0	55	15
χ²值	5.516		34.126
P值	0.018		< 0.001

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