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

Abstract

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

CLC Number:

R651.2

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.

Figures/Tables 4

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Table 1

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References 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

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

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