中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (9): 1388-1394.doi: 10.12307/2022.434

• 脊柱植入物 spinal implant • 上一篇    下一篇

脊髓型颈椎病发生创伤性颈髓中央综合征的危险因素分析

吴  亮1,王  强2,王文博1,辛天闻1,郗  焜1,唐锦程1,徐敬之1,陈  亮1,顾  勇1   

  1. 1苏州大学附属第一医院骨科,江苏省苏州市   215006;2苏州市独墅湖医院,江苏省苏州市   215000
  • 收稿日期:2021-05-25 修回日期:2021-05-26 接受日期:2021-07-16 出版日期:2022-03-28 发布日期:2021-12-10
  • 通讯作者: 顾勇,副主任医师,苏州大学附属第一医院骨科,江苏省苏州市 215006 陈亮,主任医师,苏州大学附属第一医院骨科,江苏省苏州市 215006
  • 作者简介:吴亮,男,1993年生,江苏省苏州市人,汉族,苏州大学附属第一医院在读博士,主要从事脊柱外科及骨组织工程研究。 王强,男,1992年生,江苏省苏州市人,汉族,2017年苏州大学毕业,硕士,医师,主要从事脊柱外科及骨组织工程研究。
  • 基金资助:
    国家自然科学基金(82072438),项目负责人:顾勇;国家自然科学基金(81972078),项目负责人:陈亮

Risk factors for traumatic central cord syndrome underlying with cervical spondylotic myelopathy

Wu Liang1, Wang Qiang2, Wang Wenbo1, Xin Tianwen1, Xi Kun1, Tang Jincheng1, Xu Jingzhi1, Chen Liang1, Gu Yong1   

  1. 1Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China; 2Suzhou Dushuhu Public Hospital, Suzhou 215000, Jiangsu Province, China
  • Received:2021-05-25 Revised:2021-05-26 Accepted:2021-07-16 Online:2022-03-28 Published:2021-12-10
  • Contact: Gu Yong, Associate chief physician, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China Chen Liang, Chief physician, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • About author:Wu Liang, Doctoral candidate, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China Wang Qiang, Master, Physician, Suzhou Dushuhu Public Hospital, Suzhou 215000, Jiangsu Province, China Wu Liang and Wang Qiang contributed equally to this article.
  • Supported by:
    National Natural Science Foundation of China, No. 82072438 (to GY); No. 81972078 (to CL)

摘要:

文题释义:
脊髓型颈椎病:为脊柱退行性疾病,也是颈椎病最为严重的亚型。颈椎结构的退变可造成颈椎管狭窄、慢性颈髓受压或血供障碍、脊髓高信号改变,从而使脊髓功能受损。同时,此类患者一旦发生创伤病情可能快速进展,脊髓功能急剧恶化,导致严重的功能障碍或残疾。
创伤性颈髓中央综合征:是最常见的创伤性颈髓损伤类型,约占颈髓不完全性损伤的70%,具有典型的上肢运动功能障碍重于下肢的特征,并伴随不同程度的感觉或括约肌功能障碍。虽然总体预后良好,但不少患者仍遗留手内在肌无力或萎缩、手精细活动障碍、泌尿功能障碍或行走不稳等后遗症,生活质量严重降低。


背景:一些脊髓型颈椎病患者在遭受某些低能量外伤或仅为颈部一过伸性动作后即出现神经症状恶化,表现为典型的创伤性颈髓中央综合征症状,虽然总体预后良好,但不少患者仍遗留一些后遗症。
目的:探讨脊髓型颈椎病患者遭受低能量损伤后发生创伤性颈髓中央综合征的危险因素,并探讨与神经功能障碍的相关性。
方法:回顾性分析2012年1月至2016年12月在苏州大学附属第一医院就诊的具有低能量外伤史的181例脊髓型颈椎病患者,根据是否出现创伤性颈髓中央综合征症状分为出现组(68例)和未出现组(113例),探讨患者受伤前的一般情况、临床表现及影像学等因素对创伤性颈髓中央综合征发病的影响,并分析其与神经功能的相关性。研究获苏州大学附属第一医院医学伦理委员会批准,审核编号:(2021)伦研批第053号。
结果与结论:①两组患者的平均年龄、性别构成比差异无显著性意义(P > 0.05),出现组过伸型损伤多于未出现组(P < 0.05);②受伤前,两组轴性痛、下肢近端肌无力、手或上肢感觉障碍及本体感觉障碍阳性率比较差异均无显著性意义(P > 0.05),出现组手内肌无力、肌张力增高、腱反射亢进及病理征阳性率均高于未出现组(P < 0.05);③出现组C2-7前凸角小于未出现组(P < 0.05),颈椎失稳率、硬性/混合性比例及“钳夹型”比例均高于未出现组(P < 0.05),椎管狭窄程度和颈髓受压程度均高于未出现组(P < 0.05),其中椎管狭窄程度> 50%和颈髓受压程度> 25%比例均高于未出现组(P < 0.05),髓内高信号改变比例、长度及2级比例均高于未出现组(P < 0.05);④Logistic回归分析表明,创伤性颈髓中央综合征可能的危险因素为过伸型损伤、手内在肌力、肌张力增高、病理征阳性、颈椎曲度不良、颈椎失稳、压迫物类型、来源、椎管狭窄程度、颈髓受压程度及髓内高信号;⑤相关性分析显示,年龄、手内在肌力、下肢肌张力、病理征、颈椎曲度、稳定性、椎管狭窄程度、颈髓受压程度及髓内高信号与创伤性颈髓中央综合征的神经功能评分呈显著负相关(P < 0.05)。

https://orcid.org/0000-0002-5208-7318 (吴亮) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 脊髓型颈椎病, 创伤性颈髓中央综合征, 低能量损伤, 脊髓损伤, 神经功能障碍, 危险因素, 相关分析

Abstract: BACKGROUND: Some patients with cervical spondylotic myelopathy suffer from certain low-energy trauma or only a single hyperextension movement of the neck, and then their neurological symptoms deteriorate, showing typical symptoms of traumatic central cervical syndrome. Although the overall prognosis is good, many patients still have some sequelae.  
OBJECTIVE: To analyze the risk factors of traumatic central cervical syndrome in patients with cervical spondylotic myelopathy suffering from low-energy trauma, and the correlation with neurological dysfunction.
METHODS:  Between January 2012 and December 2016, the clinical data of 181 cervical spondylotic myelopathy patients, treated in the First Affiliated Hospital of Soochow University, with a history of low-energy trauma were retrospectively analyzed. According to whether traumatic central cervical syndrome occurred, patients were divided into appearing group (68 cases) and non-appearing group (113 cases). The potential risk factors and their correlations with the neurological function of traumatic central cervical syndrome were analyzed, including patients’ general condition, clinical manifestations and imaging findings. This study was approved by the Medical Ethics Committee of First Affiliated Hospital of Soochow University (approval No. (2021)053).  
RESULTS AND CONCLUSION: (1) Average age and gender were not statistically significant between the two groups (P > 0.05). However, the incidence of hyperextension injury in appearing group was more than in non-appearing group (P < 0.05). (2) Ratios of axial pain, weakness of proximal lower limb, proprioception dysfunction and hand sensory dysfunction were not statistically significant between the two groups (P > 0.05). Hand muscle weakness, hypermyotonia, tendon hyperreflexia and positive pathological signs in the appearing group were higher than those in the non-appearing group (P < 0.05). (3) The C2-7 Cobb angle of the appearing group was lower than that of the non-appearing group (P < 0.05), and the proportion of instability, rigid/mixed ratio and “anterior-posterior clamp type” in the appearing group were higher than those in the non-appearing group (P < 0.05). Both spinal stenosis and cervical spinal cord compression were higher in the appearing group than those in the non-appearing group (P < 0.05). With higher proportions of maximum canal compromise >50% and maximum spinal cord compression >25%, the maximum canal compromise and maximum spinal cord compression in the appearing group were both greater than those in the non-appearing group (P < 0.05). The ratio, length and grade 2 of intramedullary high signal intensity in appearing group were higher than those in the non-appearing group (P < 0.05). (4) Logistic regression analysis indicated that the possible risk factors for traumatic central cervical syndrome were hyperextension injury, intrinsic hand strength, hypermyotonia, positive pathological signs, poor cervical curvature, spine instability, compression type, compression source, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity. (5) The correlation analysis indicated that age, intrinsic hand muscle strength, lower limb muscle tone, pathological signs, cervical curvature, cervical stability, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity were significantly negatively correlated with neurological function scores (P < 0.05).

Key words: cervical spondylotic myelopathy, traumatic central cord syndrome, low-energy trauma, spinal injury, neurological dysfunction, risk factors, correlation analysis

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