平山病患者颈椎曲度和相邻节段椎体屈曲度与脊髓萎缩的相关性

The correlation analysis of the cervical spine alignment, flexion ROM of adjacent segments with the spinal cord atrophy in Hirayama disease

中文关键词:  平山病  颈椎曲度  相邻节段椎体屈曲度  脊髓萎缩  相关性

英文关键词:Hirayama disease  Cervical spine alignment  Flexion ROM of adjacent segments  Spinal cord atrophy  The correlation analysis

中文摘要:

  【摘要】 目的：观察平山病患者颈椎曲度、相邻节段椎体屈曲度与脊髓萎缩的相关性，为手术治疗平山病提供依据。方法：对2006年10月~2010年10月我院确诊的36例平山病患者进行回顾性分析。术前均行颈椎侧位、过伸、过屈位X线片检查与中立位MRI检查。在X线片上用Borden法测量C2~C7颈椎曲度（颈椎生理曲线的深度，即弧弦距），用椎体后缘切线法测量C3~C7相邻椎体曲度在中立位与屈曲位时的差值即为相邻椎体屈曲度；在中立位MRI上观察矢状位脊髓萎缩情况，测量C3~C7各节段椎体上缘水平脊髓横断面面积。根据颈椎曲度测量结果，将患者分为：颈椎正常前凸，7mm≤弧弦距≤17mm；颈椎变直或轻度后凸，1mm<弧弦距<7mm；颈椎中度后凸，-4mm<弧弦距≤1mm；颈椎重度后凸，弧弦距≤-4mm。对各相邻椎体屈曲度与中立位MRI上相应节段颈髓的横断面积进行相关性分析。结果：颈椎正常前凸8例；颈椎变直或轻度后凸13例；中、重度后凸15例，其中14例后凸顶椎为C5，1例为C4。在中立位MRI上，共有14例颈脊髓萎缩变细，分布集中在C4~C7节段。颈椎曲度变直及后凸的患者脊髓萎缩的发生率为13/28，明显高于颈椎正常前凸患者的1/8（P<0.01）。C3~C7各相邻椎体屈曲度之间有显著性差异（P<0.05），C5~C7椎体屈曲度较C3~C5更大（P<0.05）。各相应节段脊髓面积也有显著性差异（P<0.05），C5~C7颈脊髓横截面积较C3~C5更小（P<0.05）。相邻节段之间的屈曲度与相应节段脊髓横截面积之间呈负相关（r=-0.205，P<0.05），C5~C6相邻椎体屈曲度与相应脊髓横截面积之间呈负相关（r=-0.536，P<0.05）。结论：颈椎曲度及相邻节段椎体屈曲度的异常改变是平山病的重要特征，可能是导致平山病患者颈脊髓萎缩的重要因素，手术治疗平山病的关键在于限制颈椎过度活动，恢复颈椎正常曲度。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship of cervical curvature, flexion ROM of adjacent segment with spinal cord atrophy of Hirayama disease, and to provide rationale for its surgical management. Methods: 36 consecutive patients underwent flexion X-ray and neutral position cervical MRI. The radiological measurement included the cervical spine alignment from C2 to C7 and the arc chord distance(ACD) by the Borden′s method, flexion ROM of adjacent segments by calculating the difference between neutral and flexion position of Cobb angle defined as the tangent of the posterior body line of every two adjacent segments from C3-C7, observing spinal cord atrophy on sagittal position MRI and measuring the cross-sectional area of spinal from C3-C7 on neutral position cervical MRI. According to the ACD of cervical curvature, all patients were divided into 4 groups: 7mm≤ACD≤17mm, normal cervical spine alignment; 1mm