磁共振成像显示完全性颈髓损伤患者脊髓内病变扩展。
Intramedullary lesion expansion on magnetic resonance imaging in patients with motor complete cervical spinal cord injury.
机构信息
Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
出版信息
J Neurosurg Spine. 2012 Sep;17(3):243-50. doi: 10.3171/2012.6.SPINE12122. Epub 2012 Jul 13.
OBJECT
The authors performed a study to determine if lesion expansion occurs in humans during the early hours after spinal cord injury (SCI), as has been established in rodent models of SCI, and to identify factors that might predict lesion expansion.
METHODS
The authors studied 42 patients with acute cervical SCI and admission American Spinal Injury Association Impairment Scale Grades A (35 patients) and B (7 patients) in whom 2 consecutive MRI scans were obtained 3-134 hours after trauma. They recorded demographic data, clinical information, Injury Severity Score (ISS), admission MRI-documented spinal canal and cord characteristics, and management strategies.
RESULTS
The characteristics of the cohort were as follows: male/female ratio 37:5; mean age, 34.6 years; and cause of injury, motor vehicle collision, falls, and sport injuries in 40 of 42 cases. The first MRI study was performed 6.8 ±2.7 hours (mean ± SD) after injury, and the second was performed 54.5 ± 32.3 hours after injury. The rostrocaudal intramedullary length of the lesion on the first MRI scan was 59.2 ± 16.1 mm, whereas its length on the second was 88.5 ± 31.9 mm. The principal factors associated with lesion length on the first MRI study were the time between injury and imaging (p = 0.05) and the time to decompression (p = 0.03). The lesion's rate of rostrocaudal intramedullary expansion in the interval between the first and second MRI was 0.9 ± 0.8 mm/hour. The principal factors associated with the rate of expansion were the maximum spinal cord compression (p = 0.03) and the mechanism of injury (p = 0.05).
CONCLUSIONS
Spinal cord injury in humans is characterized by lesion expansion during the hours following trauma. Lesion expansion has a positive relationship with spinal cord compression and may be mitigated by early surgical decompression. Lesion expansion may be a novel surrogate measure by which to assess therapeutic effects in surgical or drug trials.
目的
作者进行了一项研究，以确定在脊髓损伤（SCI）后的早期几小时内，人类是否会发生病灶扩大，就像在 SCI 的啮齿动物模型中已经确定的那样，并确定可能预测病灶扩大的因素。
方法
作者研究了 42 例急性颈段 SCI 患者，入院时美国脊髓损伤协会损伤分级为 A 级（35 例）和 B 级（7 例），其中 2 例连续 MRI 扫描分别在创伤后 3-134 小时进行。他们记录了人口统计学数据、临床信息、损伤严重程度评分（ISS）、入院时 MRI 记录的椎管和脊髓特征以及治疗策略。
结果
队列的特征如下：男女比例为 37:5；平均年龄为 34.6 岁；42 例中有 40 例的损伤原因是机动车碰撞、摔倒和运动损伤。第一次 MRI 研究是在受伤后 6.8 ±2.7 小时（均值±标准差）进行的，第二次是在受伤后 54.5 ± 32.3 小时进行的。第一次 MRI 扫描时病灶的矢状内髓长度为 59.2 ± 16.1mm，而第二次扫描时病灶的长度为 88.5 ± 31.9mm。第一次 MRI 研究中与病灶长度相关的主要因素是损伤与影像学之间的时间（p=0.05）和减压时间（p=0.03）。在第一次和第二次 MRI 之间，病灶矢状内髓的扩展速度为 0.9 ± 0.8mm/小时。与扩展速度相关的主要因素是脊髓最大压缩（p=0.03）和损伤机制（p=0.05）。
结论
人类的脊髓损伤表现为创伤后几小时内的病灶扩大。病灶扩大与脊髓压迫呈正相关，早期手术减压可能减轻病灶扩大。病灶扩大可能是一种新的替代指标，可用于评估手术或药物试验中的治疗效果。
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