RESUMO
BACKGROUND: Blood oxygenation level dependent functional MRI (BOLD-fMRI) has proven to be a powerful tool for studying the functional change of the brain. In task-state fMRI study, the functional reorganization of sensory and motor cortex has been observed in patients with cervical spondylotic myelopathy. OBJECTIVE: To discuss the correlations between task-state fMRI measurements with clinical symptoms and surgical outcomes of cervical spondylotic myelopathy. METHODS: Eighty-two patients with cervical spondylotic myelopathy undergoing posterior cervical decompression (cervical spondylotic myelopathy group) and forty-five healthy volunteers (normal group) were recruited from January 2018 to January 2019. All subjects underwent fMRI and performed a finger-tapping paradigm with the right hand. The Japanese Orthopaedic Association score was used to evaluate the function of the spinal cord. Japanese Orthopaedic Association score recovery rate less than 50% was defined as a poor result. RESULTS AND CONCLUSION: (1) Japanese Orthopaedic Association score was significantly improved after surgery in the cervical spondylotic myelopathy group compared with that before surgery (P 0.05). Before surgery, VOA ratio (left precentral gyrus/left postcentral gyrus) was significantly higher in the cervical spondylotic myelopathy group than in normal group (P 0.05). VOA ratio was significantly decreased compared with that preoperatively (P < 0.05). (4) Correlation analysis revealed that the VOA in the left precentral gyrus and left postcentral gyrus and VOA ratio were significantly correlated with preoperative Japanese Orthopaedic Association score and postoperative Japanese Orthopaedic Association score recovery rate (P < 0.05). The absolute value of correlation coefficient of VOA ratio with preoperative Japanese Orthopaedic Association score and postoperative recovery rate was largest. (5) Receiver operating characteristic curve analysis showed that the area under the curve value for the VOA ratio was 0.803, indicating strong predictive discrimination, and the cut-off value was 3.621. The area under the curve value for Japanese Orthopaedic Association score was 0.751, and the cut-off value was 8. The predictive effect of VOA ratio was higher than Japanese Orthopaedic Association score. (6) The results indicate that the VOA in the left precentral gyrus and left postcentral gyrus was negatively correlated with severity of clinical symptoms (Japanese Orthopaedic Association score). Preoperative VOA ratio can effectively predict the recovery of spinal cord function after operation in patients with cervical spondylotic myelopathy.
RESUMO
Objective To improve the effect of clinical diagnosis and treatment of acetabular fracture with a femoral nerve injury by analyzing the causes of femoral nerve injury following acetabular fractures.Methods From January 1996 to November 2004,146 cases of acetabular fractures were treated operatively.Six cases of them were complicated with femoral nerve injury.The causes of femoral nerve injury were analyzed on the basis of clinical manifestations,CT scan and 3-dimensional reconstruc- tion.All the cases were classified according to Letournel and Judet classification.Three cases had hema- toma compression (2 cases with double column fractures and 1 with transverse-posterior wall fractures);2 cases had femoral nerve injury caused by fracture fragments (1 case with anterior wall fracture following anterior hip dislocation,the another with old fracture of anterior column combined with fracture of superior ramus of pubis);and one case had anterior column fracture combined with fracture of wing of ilium,and the femoral nerve was injured by traction in operation.Clearance of hematoma,nerve tract decompression and epineuria solution were performed in 5 cases,and 1 case was treated conservatively.Results The average follow-up period was 1.8 years(ranging from 1 to 3 years).The muscle power of quadriceps fem- oris recovered from 1-2 grade before operation to 4-5 grade after operation in 5 cases.The function of ex- tensor knee and gait was normal.The function of sensory completely recovered in 4 cases.One case was followed up for 2 years,which showed the patient still suffered from hypoesthesia in the lower 2/3 of the thigh and the medial of the leg.One ease of traction injury was followed up for 1.2 years,showing the muscle power recovered to normal,but still presented with sensory disability.Conclusion Acetabular fractures associated with femoral nerve injury are rare.For complex acetabular fractures and severe trau- ma,attention should be given to the possibility of femoral nerve injury.Fragment stabbing and compres- sion of hematoma around iliopsoas muscle are the common causes of femoral nerve injury following ace- tabular fractures.Iatrogenic injury should not be ignored.