Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.
Spine (Phila Pa 1976). 2010 Aug 15;35(18):1684-90. doi: 10.1097/BRS.0b013e3181c9a8c7.
A prospective 10-year follow-up study of patients with whiplash-associated disorders (WAD) and asymptomatic volunteers.
To clarify long-term impact of whiplash injury on patient's symptoms and on magnetic resonance imaging (MRI) findings of the cervical spine.
Long-term prognosis of WAD has not been fully elucidated.
Between 1993 and 1996, we conducted cross-sectional comparative study of 508 acute WAD patients and 497 asymptomatic volunteers, all of whom underwent MRI of the cervical spine. For this follow-up study, 133 WAD patients and 223 control subjects were recruited again. All participants underwent follow-up MRI and physical examination, and answered to questionnaires regarding neck symptoms. Evaluation of MRI included decrease in signal intensity of discs, posterior disc protrusion, disc space narrowing, and foraminal stenosis using 2 to 4 numerical grades. Increase in the numerical grades by one or more was considered to be progression of degenerative changes.
Progression of decrease in signal intensity was observed in 109 WAD patients (82.0%), and 132 control subjects (59.2%), (age, sex adjusted odds ratio [OR]: 3.06), posterior disc protrusion in 101 (75.9%) and in 155 (69.5%) (OR = 1.46), disc space narrowing in 33 (24.8%) and in 59 (26.5%) (OR = 0.98), and foraminal stenosis in 6 (4.5%), and in 20 (9.0%) (OR = 0.52), respectively. Neck pain was observed in 34 WAD patients (25.6%) and 22 control subjects (9.9%) (P < 0.0001). There was no statistically significant correlation between neck pain and progression in each MR finding in either group.
The results of this study suggest that, although some WAD patients are more likely to suffer from long-lasting neck pain, MRI findings cannot explain the symptoms.
一项为期 10 年的随访研究，对象为患有挥鞭样损伤相关疾病（WAD）的患者和无症状志愿者。
明确挥鞭样损伤对患者症状和颈椎磁共振成像（MRI）结果的长期影响。
WAD 的长期预后尚未完全阐明。
1993 年至 1996 年，我们对 508 例急性 WAD 患者和 497 名无症状志愿者进行了横断面对比研究，所有患者均接受了颈椎 MRI 检查。为此项随访研究，我们再次招募了 133 例 WAD 患者和 223 名对照者。所有参与者接受了随访 MRI 和体检，并回答了有关颈部症状的问卷。MRI 评估包括使用 2 至 4 个数字等级评估椎间盘信号强度降低、后椎间盘突出、椎间盘间隙变窄和椎间孔狭窄的进展情况。一个或多个数字等级增加被认为是退行性变化的进展。
109 例 WAD 患者（82.0%）和 132 名对照者（59.2%）观察到信号强度降低的进展（年龄、性别调整后的比值比[OR]：3.06），101 例（75.9%）和 155 例（69.5%）患者观察到后椎间盘突出（OR=1.46），33 例（24.8%）和 59 例（26.5%）患者观察到椎间盘间隙变窄（OR=0.98），6 例（4.5%）和 20 例（9.0%）患者观察到椎间孔狭窄（OR=0.52）。34 例 WAD 患者（25.6%）和 22 名对照者（9.9%）出现颈部疼痛（P<0.0001）。两组中，颈部疼痛与每个 MRI 发现的进展之间均无统计学显著相关性。
本研究结果表明，尽管一些 WAD 患者更有可能长期遭受颈部疼痛，但 MRI 结果无法解释这些症状。
