Ramón S, Domínguez R, Ramírez L, Paraira M, Olona M, Castelló T, García Fernández L
Spinal Injury Unit, Traumatology and Rehabilitation University Hospital Vall d'Hebrón, Barcelona, Spain.
Spinal Cord. 1997 Oct;35(10):664-73. doi: 10.1038/sj.sc.3100490.
The aim of this study was to correlate traumatic spinal cord injury (SCI) patient's outcome with magnetic resonance imaging (MRI) performed within the first 15 days following trauma. We retrospectively analyzed 55 SCI patients. Upon admission, 28 were diagnosed as having a complete SCI (51%), versus 27 with an incomplete SCI (49%). All of the patients with a normal pattern on MRI (four cases), had an incomplete SCI, whereas all patients (15 cases) presenting with a hemorrhage pattern (Type 1) had a complete SCI (P = 0.0001). Fourteen of the 15 individuals (93.4%) with the edema pattern (Type II) had an incomplete SCI (P = 0.001), while the other patient had neurological deterioration, and a syrinx was noted 2 years later (6.6%). Among the 10 individuals showing a contusion pattern (Type III), seven were admitted with an incomplete SCI (70%) and three with a complete SCI (30%). The compression pattern tends to be associated with a complete SCI in 77.8% (seven of nine patients). All patients with a transection pattern on MRI (two cases) were clinically diagnosed as having a complete SCI. Early functional prognosis may be established on the basis of clinical presentation of SCI and associated MRI. Cord hemorrhage and transection are irreversible, while edema has a potential for neurological recovery. Cord contusion tends to be associated with an incomplete SCI, unlike the compression pattern, in which the prognosis depends on the degree of the initial neurological damage.
本研究的目的是将创伤性脊髓损伤（SCI）患者的预后与创伤后15天内进行的磁共振成像（MRI）结果相关联。我们回顾性分析了55例SCI患者。入院时，28例被诊断为完全性SCI（51%），27例为不完全性SCI（49%）。所有MRI表现正常的患者（4例）均为不完全性SCI，而所有表现为出血型（1型）的患者（15例）均为完全性SCI（P = 0.0001）。15例表现为水肿型（II型）的患者中有14例（93.4%）为不完全性SCI（P = 0.001），另1例患者出现神经功能恶化，2年后发现有脊髓空洞形成（6.6%）。在10例表现为挫伤型（III型）的患者中，7例入院时为不完全性SCI（70%），3例为完全性SCI（30%）。压迫型在9例患者中有7例（77.8%）倾向于与完全性SCI相关。所有MRI表现为横断型的患者（2例）临床诊断为完全性SCI。早期功能预后可根据SCI的临床表现及相关MRI来确定。脊髓出血和横断是不可逆的，而水肿有神经功能恢复的可能。脊髓挫伤倾向于与不完全性SCI相关，与压迫型不同，压迫型的预后取决于初始神经损伤的程度。
