平山病与非平山病患者颈椎椎间盘-关节突角的差异

Variation of disc-facet orientation between Hirayama disease and non-Hirayama disease

中文关键词:  平山病  椎间盘-关节突角  发病机制

英文关键词:Hirayama disease  Disc-facet angle  Pathogenesis

中文摘要:

  【摘要】 目的：研究平山病患者和非平山病患者颈椎椎间盘-关节突角的差异，提出可能的平山病发病机制。方法：选择2006年10月~2012年1月我院骨科诊治的平山病患者45例作为病例组，其中男44例，女性1例，年龄13~37岁，平均19.3±3.9岁；发病年龄10~27岁，平均16.3±2.7岁；病程1~120个月，平均35.6±23.2个月。选取同期因急性颈痛就诊于我院且颈椎CT检查正常的45例患者作为对照组，其中男41例，女4例，年龄11~26岁，平均19.5±4.3岁。两组的年龄、性别无统计学差异（P＞0.05）。在GE-PACS系统上测量两组患者C3~T1左右两侧的椎间盘-关节突角，即在CT正中矢状位重建图像上作被测椎体上缘的延长线，再结合横断面图像及矢状面图像共同确定通过该被测椎体上关节突关节面（横断面）中点的矢状截面，并在该矢状面上作被测椎体上关节突关节面的延长线，上述延长线的夹角（钝角）即为椎间盘-关节突角。结果：每组患者C3~T1的椎间盘-关节突角同节段左右侧之间均无统计学差异（P＞0.05），将同节段左右侧数据合并后分析，两组患者C3~T1的椎间盘-关节突角均以C5为中心分布，即C3~C5的椎间盘-关节突角逐渐增大，C5~T1的椎间盘-关节突角逐渐减小，病例组C3~T1的椎间盘-关节突角均显著大于对照组（P＜0.05）。结论：平山病患者的颈椎椎间盘-关节突角显著大于非平山病患者，提示平山病患者可能存在颈椎关节突关节发育异常，导致其关节面偏向水平，由此引发的颈椎不稳定在平山病的发病和发展过程中具有重要意义。

英文摘要:

  【Abstract】 Objectives: To study the variation of disc-facet orientation between Hirayama disease and non-Hirayama disease and provide a new possible mechanism of Hirayama disease. Methods: 45 patients including 44 males and 1 female with a mean age of 19.3±3.9 years(range 13-37 years) and with Hirayama disease treated in our hospital from October 2006 to January 2012, the mean course of disease was 35.6±23.2 months(range, 1 to 120 months). 45 patients including 41 males and 4 female with a mean of age was 19.5±4.3 years(range 11-26 years) suffering from acute neck pain and having normal cervical CT in the same period were selected as control. Both groups showed no age or sex related difference. The disc-facet angles of C3-T1 of the two groups were measured in GE-PACS system. The disc-facet angle was defined as the angle between the line crossing midpoint of the vertebral upper zygapophyseal facet and the line of objective vertebral upper edge in the CT sagittal plane. Results: There were no significant side-related differences for disc-facet angles from C3 to T1 in both groups(P<0.05). After merging the left and right side data of the same segment, C5 was the center of C3-T1 disc-facet angle distribution in both groups, which indicated that disc-facet angle increased gradually from C3 to C5, while decreased gradually from C5 to T1. The disc-facet angles of C3-T1 in the surgical group were greater than those in the control group(P<0.05). Conclusions: The disc-facet angles of Hirayama disease are greater than those of non-Hirayama disease, dysplastic zygapophyseal facets may lead to the articular surface tend to be horizontal, and subsequent cervical instability, which may play an important role in the pathogenesis and progress of Hirayama disease.