急诊科急性外伤性脊髓损伤的磁共振成像、临床表现、治疗方式和神经预后之间的关系

IF 2.3 Q3 EMERGENCY MEDICINE
Mustafa Ulusoy, Neşe Çolak, Servan Küçük, Serap Sarı, Ali Balcı
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引用次数: 0

摘要

目的:脊髓损伤(SCI)可导致运动、感觉或自主神经功能障碍,并与发病率和死亡率增加相关。本研究旨在探讨核磁共振成像(MRI)和急诊科(ED)的临床表现对创伤性脊髓损伤患者神经预后的影响。方法:本观察性研究纳入了2009年1月1日至2019年10月1日在Dokuz eyyl大学医院急诊科收治的59例创伤性脊髓损伤患者。临床表现采用美国脊髓损伤协会(ASIA)量表进行评估。比较完全损伤组(ASIA A)和不完全损伤组(ASIA B、C、D和E)的人口学特征、临床表现、MRI参数、治疗和短期(28±7天)神经预后。结果:脊髓损伤发生率为98.7 / 100万。中位年龄37岁(IQR: 27-52),男性占86.4%。常见的原因包括潜入浅水(30.5%)和从高处坠落(25.4%)。完全损伤(ASIA A)占40.7%,不完全损伤(ASIA B、C、D、E)占59.3%。最常见的影响水平是C4(18.6%)和C5(23.7%)。完全损伤组无明显改善,而44%的不完全损伤组有明显改善(P < 0.001)。常见的MRI表现包括脊髓水肿(96.6%)、椎体骨折/脱位(86.4%)和软组织损伤(84.7%)。完全性脊髓损伤组与不完全性脊髓损伤组在椎骨骨折/脱位(P = 0.016)、脊髓受压(P = 0.003)、椎管狭窄(P = 0.008)、髓内出血(P≤0.001)、出血/出血性挫伤(P≤0.001)、前韧带损伤(P = 0.001)、后韧带损伤(P = 0.01)、椎管最大受压(MCC) (P = 0.006)、病变长度(P = 0.008)等方面的MRI表现差异有统计学意义。结论:外伤性脊髓损伤主要影响年轻男性,通常由潜水、高空坠落和机动车事故等活动引起。初步临床评估不足以预测神经预后。尽管MRI的发现在完全性脊髓损伤中更为常见,但病变长度和MCC并不能可靠地预测短期神经系统的改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The relationship between magnetic resonance imaging, clinical findings, treatment modalities, and neurological outcomes in acute traumatic spinal cord injury in the emergency department.

The relationship between magnetic resonance imaging, clinical findings, treatment modalities, and neurological outcomes in acute traumatic spinal cord injury in the emergency department.

The relationship between magnetic resonance imaging, clinical findings, treatment modalities, and neurological outcomes in acute traumatic spinal cord injury in the emergency department.

Objectives: Spinal cord injury (SCI) can lead to motor, sensory, or autonomic dysfunction and is associated with increased morbidity and mortality. This study aimed to investigate the impact of magnetic resonance imaging (MRI) and clinical findings in the Emergency Department (ED) on neurological outcomes in patients with traumatic SCI.

Methods: This observational study included 59 patients with traumatic SCI admitted to Dokuz Eylül University Hospital's ED between January 1 2009, and October 1, 2019. Clinical findings were assessed using the American Spinal Injury Association (ASIA) scale. Demographics, clinical findings, MRI parameters, treatment, and short-term (28 ± 7 days) neurological outcomes were compared between the complete (ASIA A) and incomplete (ASIA B, C, D, and E) injury groups.

Results: The incidence of SCI was 98.7 per million. The median age was 37 years (IQR: 27-52), with 86.4% of the patients being male. Common causes included diving into shallow water (30.5%) and falling from heights (25.4%). Complete injury (ASIA A) was observed in 40.7% of cases, while incomplete injury (ASIA B, C, D, and E) was found in 59.3%. The most frequently affected levels were C4 (18.6%) and C5 (23.7%). No improvement was observed in the complete injury group, whereas 44% of the incomplete injury group showed improvement (P < 0.001). Common MRI findings included cord edema (96.6%), vertebral fracture/dislocation (86.4%), and soft-tissue injury (84.7%). Significant differences in MRI findings between the complete and incomplete SCI groups were observed in vertebral fracture/dislocation (P = 0.016), cord compression (P = 0.003), canal stenosis (P = 0.008), intramedullary hemorrhage (P ≤ 0.001), hemorrhage/hemorrhagic contusion (P ≤ 0.001), anterior ligament damage (P = 0.001), posterior ligament damage (P = 0.01), maximum canal compression (MCC) (P = 0.006), and lesion length (P = 0.008).

Conclusion: Traumatic SCI primarily affects young males, often resulting from activities such as diving into shallow water, falls from heights, and motor vehicle accidents. Initial clinical assessments are insufficient for predicting neurological outcomes. Although MRI findings are more frequent in complete SCI, lesion length, and MCC do not reliably predict short-term neurological improvement.

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来源期刊
CiteScore
1.70
自引率
0.00%
发文量
30
审稿时长
22 weeks
期刊介绍: The Turkish Journal of Emergency Medicine (Turk J Emerg Med) is an International, peer-reviewed, open-access journal that publishes clinical and experimental trials, case reports, invited reviews, case images, letters to the Editor, and interesting research conducted in all fields of Emergency Medicine. The Journal is the official scientific publication of the Emergency Medicine Association of Turkey (EMAT) and is printed four times a year, in January, April, July and October. The language of the journal is English. The Journal is based on independent and unbiased double-blinded peer-reviewed principles. Only unpublished papers that are not under review for publication elsewhere can be submitted. The authors are responsible for the scientific content of the material to be published. The Turkish Journal of Emergency Medicine reserves the right to request any research materials on which the paper is based. The Editorial Board of the Turkish Journal of Emergency Medicine and the Publisher adheres to the principles of the International Council of Medical Journal Editors, the World Association of Medical Editors, the Council of Science Editors, the Committee on Publication Ethics, the US National Library of Medicine, the US Office of Research Integrity, the European Association of Science Editors, and the International Society of Managing and Technical Editors.
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