创伤性颈脊髓损伤患者华勒氏变性的磁共振成像研究

doi:10.3969/j.issn.1006-9771.2024.04.015

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (4): 487-492.doi: 10.3969/j.issn.1006-9771.2024.04.015

创伤性颈脊髓损伤患者华勒氏变性的磁共振成像研究

袁媛¹^,^2a, 周红俊¹^,^2a(), 卫波¹^,^2a(), 丛欣莹¹^,^2b, 刘根林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:2023-12-07 修回日期:2024-03-13 出版日期:2024-04-25 发布日期:2024-05-08
通讯作者: 周红俊，E-mail： zh87569303@qq.com；卫波，E-mail： wogre@163.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。
基金资助:
国家重点研发计划项目(2020YFC2007505)

Wallerian degeneration in patients with traumatic cervical spinal cord injury: a magnetic resonance imaging study

YUAN Yuan¹^,^2a, ZHOU Hongjun¹^,^2a(), WEI Bo¹^,^2a(), CONG Xinying¹^,^2b, LIU Genlin¹^,^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:2023-12-07 Revised:2024-03-13 Published:2024-04-25 Online:2024-05-08
Contact: ZHOU Hongjun, E-mail: zh87569303@qq.com; WEI Bo, E-mail: wogre@163.com
Supported by:
China National Key R & D Program(2020YFC2007505)

摘要/Abstract

摘要：

目的探讨创伤性颈脊髓损伤患者脊髓华勒氏变性(WD)的磁共振成像(MRI)信号特点。

方法回顾性分析2015年1月至2021年12月在北京博爱医院脊髓损伤康复科住院康复的191例创伤性颈脊髓损伤患者的临床资料，对常规颈椎MRI的矢状位及轴位T₂加权像(T₂WI)进行影像学评估，将其分为WD组和非WD组。比较两组性别、年龄、损伤机制、美国脊柱损伤协会残损分级(AIS)、神经平面、伤后获得MRI的时间差等，并分析WD在脊髓的背柱区(DC)、外侧脊髓丘脑束区(ST)和外侧皮质脊髓束区(CS)的信号特点。

结果 115例(60.2%)出现WD。WD组与非WD组年龄、损伤机制、AIS的等级分布和伤后获得MRI时间差有显著性差异(Z > 3.820, χ² > 9.104, P < 0.05)。WD组中，在损伤部位的上方，DC、ST的WD发生率分别为100%和87%；在损伤部位的下方，CS的WD发生率为35.7%。根据WD信号出现的方式将其分为3组，只出现DC变化的15例(13%)，DC合并ST发生变化为59例(51.3%)，DC、ST、CS 3个位置均有变化的41例(35.7%)。3组间伤后获得MRI的时间差有显著性差异(H = 90.794, P < 0.05)，3组间AIS等级分布无显著性差异(P > 0.05)。

结论创伤性颈脊髓损伤患者的常规MRI检查T₂WI可检测到WD信号，且WD的发生与伤后时间存在关联。

关键词: 创伤性颈脊髓损伤, 华勒氏变性, 磁共振成像, 美国脊柱损伤协会残损分级

Abstract:

Objective To explore the signal characteristics of Wallerian degeneration (WD) of the spinal cord in patients with traumatic cervical spinal cord injury.

Methods A retrospective analysis was conducted. From January, 2015 to December, 2021, the clinical data of 191 patients with traumatic cervical spinal cord injury in Beijing Boai Hospital were included. According to sagittal and axial T₂-weighted images (T₂WI) of routine cervical magnetic resonance imaging (MRI), the patients were divided into WD group and non-WD group. The gender, age, mechanism of injury, American Spinal Injury Association Impairment Scale (AIS), neurological level, and time interval to obtain MRI after injury were compared between two groups. The characteristics of WD in dorsal column (DC), lateral spinothalamic tract (ST) and lateral corticospinal tract (CS) were analyzed.

Results A total of 115 cases (60.2%) showed WD. There were significant differences in age, mechanism of injury, AIS grade, and time interval to obtain MRI after injury between two groups (Z > 3.820, χ² > 9.104, P< 0.05). In WD group, the occurrence rates of WD in DC and ST above the injury site were 100% and 87%, respectively. Below the injury site, the occurrence rate of WD in CS was 35.7%. Based on the pattern of WD signal appearance, three groups were identified: 15 cases (13%) had only DC signal changes, 59 cases (51.3%) had changes in both DC and ST, and 41 cases (35.7%) had changes in all the three locations (DC, ST and CS). There was significant difference in the time interval to obtain MRI after injury (H = 90.794, P< 0.05) among three groups, while there was no significance in AIS grade (P> 0.05).

Conclusion Routine MRI examination with T₂WI could detect WD signals in patients with traumatic cervical spinal cord injury, and the occurrence of WD is associated with post-injury time.

Key words: traumatic cervical spinal cord injury, Wallerian degeneration, magnetic resonance imaging, American Spinal Injury Association Impairment Scale

中图分类号:

R651.2

袁媛, 周红俊, 卫波, 丛欣莹, 刘根林, 郑樱, 郝春霞, 张缨, 王一吉, 康海琼, 逯晓蕾, 蒙倩茹. 创伤性颈脊髓损伤患者华勒氏变性的磁共振成像研究[J]. 《中国康复理论与实践》, 2024, 30(4): 487-492.

YUAN Yuan, ZHOU Hongjun, WEI Bo, CONG Xinying, LIU Genlin, ZHENG Ying, HAO Chunxia, ZHANG Ying, WANG Yiji, KANG Haiqiong, LU Xiaolei, MENG Qianru. Wallerian degeneration in patients with traumatic cervical spinal cord injury: a magnetic resonance imaging study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 487-492.

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参考文献 29

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项目	合计	WD组(n = 115)	非WD组(n = 76)	χ²/Z值	P值
性别/n
女	28	15	13	0.603	0.531
男	163	100	63
年龄/岁	45.00(32.00, 56.00)	33(25.00, 45.50)	54(46.75, 61.00)	3.820	< 0.001
损伤机制/n
无骨折脱位	90	44	46	9.104	0.003
骨折/脱位	101	71	30
AIS 分级/n
A^a	45	34	11	16.413	< 0.001
B^a	26	20	6
C^ab	39	26	13
D^b	81	35	46
神经平面
C_2-4	132	77	55	0.628	0.428
C_5-8	59	38	21
获得MRI时间/d	97(37, 197)	108(51.5, 200)	93.5(28.75, 175.75)	94.618	< 0.001

项目	WD			H值	P值
项目	DC	DC+ST	DC+ST+CS	H值	P值
AIS分级/n				0.493	0.096
A	4	20	10
B	2	10	8
C	6	12	8
D	3	17	15
时间差/d	35(22,73)	115(92,227)	211(154,326)	90.794	< 0.001

创伤性颈脊髓损伤患者华勒氏变性的磁共振成像研究

Wallerian degeneration in patients with traumatic cervical spinal cord injury: a magnetic resonance imaging study

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