脊柱脊髓肿瘤的MR表现

ＭＲ作为检查脊柱、椎管及其内容物的最佳手段已经得到广泛的认同。其可进行多层面、多方位断层 ,特别是矢状面的检查 ,可直接观察到脊髓、蛛网膜下腔 ,不需要造影剂 ,无放射损伤。ＭＲ对各种病变有很高的敏感性 ,明显高于ＣＴ ,而且没有骨伪影 ,尤其在颈胸交界部位。用ＭＲ检查脊椎病变的技术仍在不断改进 :如新的脊柱相阵控线圈的应用 ,不需移动病人或更换线圈 ,可以一次完成全脊柱的检查 ;硬件和软件的改善 ,如高梯度场 2 3～ 40ｍＴ ,切换率提高可达 15 0ｍＴ/Ｍ /ｍｓ或更高 ;快速自旋回波序列的应用 ,可以在较短时间内完成全脊柱Ｔ2加…     

脊髓损伤的低场强MRI诊断

脊髓损伤是一种严重的创伤,致残率高,需用MRI才能确诊.本文收集了经MR检查的脊髓损伤76例,探讨脊髓损伤的低场强MRI表现及临床应用.     

急性颈椎损伤MRI表现与脊髓损伤的相关性

目的　探讨MRI检查在判断急性颈椎损伤患者脊髓损伤程度中的作用。方法　对 82例急性颈椎损伤患者在受伤 2 4h内行MRI检查 ,并进行早期连续的临床检查 ,分析MRI表现与脊髓损伤程度之间的相关性。结果　急性颈椎损伤的 10种MRI表现中 ,髓内出血提示完全性脊髓损伤 (FrankelA级 ) ;脊髓肿胀及脊髓水肿多见于FrankelA -C级的病人 ,同时 ,脊髓肿胀及水肿的程度与脊髓损伤程度成正比 ;脊髓受压多见于FrankelA级和FrankelB级的患者 ;颈椎脱位多见于脊髓损伤程度较重 (FrankelA -C级 )的患者 ;椎管狭窄与脊髓损伤程度之间无明确相关性 ,但多见于老年患者 ;颈椎间盘突出、颈椎椎体骨折、颈椎附件骨折及韧带损伤与脊髓损伤程度间无明显相关性。结论　急性颈椎损伤患者早期行MRI检查 ,可以帮助判断脊髓损伤的程度 ,对治疗方法的选择及准确判断预后具有重要的指导意义。     

大鼠压迫性脊髓损伤的特征性超微病理表现

[目的]观察大鼠压迫性脊髓损伤的特征性超微结构改变。[方法]将20只Wistar成年雄性大鼠置入后路脊髓压迫装置，制成压迫性脊髓损伤动物模型，4周后脊髓取材行高倍透射电镜观察。[结果]发现压迫性脊髓损伤是缺少炎性细胞反应的坏死，单方向性髓鞘断裂和特征性创伤细胞的出现是此类损伤的特异性改变。[结论]这些特征性超微结构改变可为压迫性脊髓损伤的超微病理变化提供更为全面准确的描述，为临床确诊鉴别此类损伤提供可靠理论根据。     

脊柱脊髓损伤专题研讨会会议纪要

脊柱脊髓损伤专题研讨会会议纪要由中华外科杂志编委会、解放军医学杂志编委会和解放军骨科专业学术委员会联合主办，广州军区总医院承办的全国脊柱脊髓损伤研讨会于１９９５年元月在广东省肇庆市召开。会议收到论文１８７篇，参加会议交流１２５篇。本次会议采取中心发言...     

小儿脊柱脊髓损伤

小儿脊柱脊髓损伤相对少见,占全部脊柱脊髓损伤的1%～10%.由于处于生长发育阶段的小儿脊柱在解剖和生物力学方面的特殊性,小儿脊柱脊髓损伤的诊断、治疗和成人有一定区别.幼儿以颈椎高位损伤相对常见,2岁以下幼儿的颈椎损伤约80%表现为高位损伤.随着年龄增大(＞8岁),儿童脊柱解剖特点和损伤类型逐渐接近于成人表现.尽管小儿脊柱脊髓损伤相对少见,由于影像学特征以及幼儿不能很好配合的特点,使得小儿脊柱脊髓损伤的准确诊治比较困难.本文针对这一情况,结合小儿不间发育阶段脊柱解剖特点、脊柱脊髓损伤特点及其具体诊治进行综述.     

脊髓原发和继发损伤

脊髓继发损伤是脊髓组织对创伤所产生的组织反应,造成脊髓损伤加重是对创伤发生反应的部位而言,组织反应可加重脊髓原发损伤。其程度取决于原发损伤的大小,一般不会超过原发损伤的程度。一、脊髓原发与继发损伤的定义(一)脊髓原发损伤指受伤瞬间外力或骨折脱位造成脊髓的损伤。     

Diffusion tensor MR imaging in spinal cord injury

BackgroundThe ability of diffusion tensor imaging (DTI) to complement conventional MR imaging by diagnosing subtle injuries to the spinal cord is a subject of intense research. We attempted to study change in the DTI indices, namely fractional anisotropy (FA) and mean diffusivity (MD) after traumatic cervical spinal cord injury and compared these with corresponding data from a control group of individuals with no injury. The correlation of these quantitative indices to the neurological profile of the patients was assessed.Material and methods20 cases of acute cervical trauma and 30 age and sex matched healthy controls were enrolled. Scoring of extent of clinical severity was done based on the Frankel grading system. MRI was performed on a 3T system. Following the qualitative tractographic evaluation of white matter tracts, quantitative datametrics were calculated.ResultsIn patients, the Mean FA value at the level of injury (0.43+/−0.08) was less than in controls (0.62+/−0.06), which was statistically significant (p value <0.001). Further, the Mean MD value at the level of injury (1.30+/−0.24) in cases was higher than in controls (1.07+/−0.12, p value <0.001). Statistically significant positive correlation was found between clinical grading (Frankel grade) and FA values at the level of injury (r value = 0.86). Negative correlation was found between clinical grade and Mean MD at the level of injury (r value = −0.38) which was however statistically not significant.ConclusionQuantitative DTI indices are a useful parameter for detection of spinal cord injury. FA value was significantly decreased while MD value was significantly increased at the level of injury in cases as compared to controls. Further, FA showed significant correlation with clinical grade. DTI could thus serve as a reliable objective imaging tool for assessment of white matter integrity and prognostication of functional outcome.     

经颅磁刺激运动诱发电位在脊柱脊髓损伤的临床应用研究

目的评价经颅磁刺激运动诱发电位（ＴＭＳＭＥＰ）在脊柱脊髓损伤诊断中的作用。方法测定２１例完全性脊髓损伤患者、３５例不完全性脊髓损伤患者双侧胫前肌与腓肠肌的ＴＭＳＭＥＰ,随访６个月～２年,以２０例正常成人ＴＭＳＭＥＰ作对照。结果２１例完全性脊髓损伤患者中,１９例双侧胫前肌及腓肠肌ＴＭＳＭＥＰ消失,随访截瘫无恢复;２例圆锥损伤有异常ＴＭＳＭＥＰ,截瘫及ＴＭＳＭＥＰ基本恢复。３５例不完全性脊髓损伤患者中,每例均可记录到１块以上靶肌的ＴＭＳＭＥＰ,随访３３例,截瘫及ＴＭＳＭＥＰ均有不同程度的恢复,其中术前２５块靶肌肌力０级而有异常ＴＭＳＭＥＰ,术后肌力除２块无恢复外,其余均有明显恢复或正常。术后ＴＭＳＭＥＰ的恢复时间和程度均较体检所见早且明显。结论ＴＭＳＭＥＰ测定对于脊髓损伤的诊断和预后的估计,有重要的临床应用价值     

脊髓损伤的磁共振成像诊断：（附400例病例分析）

本文总结了４００例脊髓损伤的磁共振成像诊断。分析了脊髓外伤后髓内出血、水肿、变性坏死、软化囊变、胶质增生、空洞形成以及脊髓萎缩等病理改变的磁共振征象．总结了脊髓损伤不同阶段的磁共振信号变化规律，并对脊髓损伤磁共振成像的诊断标准及其分类做了初步探讨。     

经椎弓根减压固定和植重组异体骨治疗脊柱脊髓损伤

目的 :探讨严重脊柱脊髓损伤经一侧椎弓根和椎体后缘复位减压 ,经椎弓根植重组异体骨和椎弓根钉固定的可行性及效果。方法 :经一侧椎弓根和椎体后缘复位或截骨减压 ,用特制环锯套管经椎弓根植重组异体骨 ,以X线片和CT片分类分型 ,评估手术前后骨折复位减压和植重组异体骨融合效果 ;按Frank分类标准评估脊髓损伤和恢复程度。结果 :除A级病人外 ,其他病人脊髓神经功能均进步 1～ 2级 ,无感染和断钉病人 ,脊柱后凸角度矫正后再丢失平均 3° ;部分病人术后早期对重组异体骨有反应 ,但几周后可消失。结论 :经一侧椎弓根椎体后缘复位或截骨减压 ,同样可达到较理想脊髓减压效果 ,经椎弓根植重组异体骨和椎弓根钉固定简单、安全、有效。     

脊髓损伤后血流改变

选用成年狗１０只，于胸９－０给以２０ｇ×２５ｃｍ打击量，应用氢清除法于伤后１５ｍｉｎ～４ｂ测定脊髓血流量（ＳＣＢＦ）。结果显示伤后不同时期灰质血流量均较白质血流量（ｗＳＣＢＦ）为高，近侧节较远侧节亦高，伤后２ｈ，ｗＳＣＢＦ稍升高，但４ｈ恢复正常。作者认为，伤后头几个小时为关键时刻，此时如能采用有效措施，对不全瘫还能逆转。本文结果与文献相比有些差异，可能与实验条件不同及观察时间较短有关。     

Osteoporosis after spinal cord injury.

Dual-photon absorptiometry characterized bone loss in males aged less than 40 years after complete traumatic paraplegic and quadriplegic spinal cord injury. Total bone mass of various regions and bone mineral density (BMD) of the knee were measured in 55 subjects. Three different populations were partitioned into four groups: 10 controls (healthy, age matched); 25 acutely injured (114 days after injury), with 12 reexamined 16 months after injury; and 20 chronic (greater than 5 years after injury). Significant differences (p less than 0.0001) in bone mass mineral between groups at the arms, pelvis, legs, distal femur, and proximal tibia were found, with no differences for the head or trunk. Post hoc analyses indicated no differences between the acutely injured at 16 months and the chronically injured. Paraplegic and quadriplegic subjects were significantly different only at the arms and trunk, but were highly similar at the pelvis and below. In the acutely injured, a slight but statistically insignificant rebound was noted above the pelvis. Regression techniques demonstrated early, rapid, linear (p less than 0.0001) decline of bone below the pelvis. Bone mineral loss occurs throughout the entire skeleton, except the skull. Most bone loss occurs rapidly and below the pelvis. Homeostasis is reached by 16 months at two thirds of original bone mass, near fracture threshold.     

应用改进封闭脊髓窗技术活体观察脊髓损伤后脊髓微循环变化

目的:探讨应用改进的封闭脊髓窗技术活体观察大鼠脊髓损伤后脊髓微循环变化的可行性及效果.方法:改进传统的脊髓窗,设计带有打击探头的脊髓窗.45只SD大鼠随机分为对照组(n=20)和实验组(n=25).实验组大鼠脊髓窗安装完成后进行窗内打击脊髓,然后即时观察并记录打击后2h内打击点周围微动脉直径的变化.对照组大鼠在脊髓窗安装完成后不进行打击,只对脊髓微动脉直径进行连续2h观察并记录.术后两组大鼠进行BBB运动功能评分,处死动物取脊髓标本切片,HE染色,观察脊髓组织改变情况.结果:实验组大鼠打击点周围2～6mm的微动脉直径在打击后10min、30min、1h、2h各时间点均较打击前明显减小,术后2d及7d时BBB功能评分明显低于术前,病理切片可见脊髓打击区神经组织变性液化.对照组大鼠在观测开始及结束时脊髓微动脉直径无明显变化,术后BBB评分与术前BBB评分均为21分,病理切片未见脊髓损伤表现.结论:改进的封闭脊髓窗技术可以有效地实现窗内打击脊髓,并可以安全地对脊髓表面微血管进行活体观测.脊髓表面打击点周围2～6mm的微动脉在脊髓损伤后10min即发生痉挛.     

脊髓损伤后的高凝状态

目的:观察脊髓损伤患者凝血系统的变化。方法:以20例符合条件的脊髓损伤病人为研究对象,分别于伤后2~6h、伤后1、3、5d采集病人股静脉血,测定血浆凝血酶抗凝血酶Ⅲ复合物(TAT)、凝血酶原片段1 2(F1 2)和D-二聚体(D-dimer)浓度;同时测定20名健康献血员TAT、F1 2、D-dimer血浆浓度作为正常对照。结果:正常对照组TAT、F1 2和D-dimer血浆浓度分别为3.1±0.9ng/ml、0.9±0.2nmol/l和42.6±9.3ng/ml。20例脊髓损伤病人伤后2~6hTAT、F1 2、D-dimer血浆浓度即显著增高(P<0.05),分别达45.3±14.2ng/ml、4.1±0.7nmol/l和136.2±14.3ng/ml,伤后1、2d内仍明显高于对照组,伤后3、4d趋于正常。结论:脊髓损伤后可激活凝血系统,造成高凝状态,这种高凝状态于伤后数小时即可发生,且持续存在2~3d。     

儿童无放射学影像异常的脊髓损伤14例临床分析

目的：提高对儿童无放射学影像异常的脊髓损伤（spinal cord injury without radiographic abnormality，SCIWORA）的认识。方法：对1992年1月至2005年8月北京儿童医院住院患者中诊断为“急性脊髓炎”或“脊髓损伤”的187例进行回顾性分析，发现其中14例为SCIWORA。男6例，女8例。年龄1岁3个月～15岁（15岁1例，1岁3个月～7岁13例）。均有明确外伤史。损伤水平在C6～T9，颈髓2例，胸髓12例。脊髓功能ASIA分级：A级9例，C级4例，D级1例。脊柱X线片和CT未见骨折及脱位；MRI检查示脊髓水肿9例,脊髓出血2例，脊髓挫伤3例。采用综合治疗，包括卧床、局部制动，应用激素、脱水剂、神经营养药等。结果：4例患者失访，10例患者随访6个月～5年，平均2年3个月，4例（C级3例，D级1例）患者（均为MRI显示水肿局限者）在伤后6个月运动、感觉及括约肌功能完全恢复（E级）；6例（A级）患者运动、感觉及括约肌障碍未恢复。2例（A级）病初MRI表现为脊髓弥漫水肿者，伤后4～6个月复查MRI脊髓呈萎缩样改变。结论：对怀疑SCIWORA的儿童，应首选MRI检查。脊髓水肿局限者预后好，水肿弥漫或伴有出血、挫伤者预后差。     

The impact of spine stability on cervical spinal cord injury with respect to demographics,management, and outcome: a prospective cohort from a national spinal cord injury registry

Background Context

Emergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear, and classic definitions of CCS do not identify a unique population of patients.