平山病患者颈椎矢状面形态及稳定性的X线影像学研究

The radiographic evaluation of cervical sagittal alignment and stability in Hirayama disease

中文关键词:  平山病（青少年上肢远端肌萎缩症）  颈椎X线  颈椎屈曲活动度  颈椎不稳定  弧弦距

英文关键词:Hirayama disease  Cervical radiographs  Cervical flexed motion range  Cervical instability  The depth of the cervical lordosis

中文摘要:

  【摘要】 目的：探索平山病患者颈椎X线征象，并分析平山病患者颈椎矢状面形态及稳定性。方法：2007年5月~2013年1月，我们对明确诊断的青少年上肢远端肌萎缩症患者28例（平山病组，均为男性，年龄15～24岁，平均19.5岁）及同年龄段健康志愿者28例（对照组，均为男性，年龄18～23岁，平均20.9岁）进行比对研究，行颈椎正侧位（21例平山病患者和所有志愿者）和主动过伸过屈位X线检查检查，分别测量平山病组和对照组颈椎过屈侧位X线片上的屈曲活动度及角度位移，采用Borden法测量弧弦距来评价颈椎曲度。应用SPSS 17.0行数据分析，两组比对，并对平山病患者颈椎屈曲活动度和颈椎曲度行相关性分析。结果：平山病组患者颈椎屈曲活动度（C2～C7）为37.52°±9.09°，相较于对照组（25.39°±8.66°）增大（P<0.05）。平山病组患者下颈椎过伸过屈角位移（C3/4～C6/7）分别为14.37°±5.22°、16.70°±3.44°、17.05°±3.66°及15.15°±4.25°，经过单因子方差分析，相比较对照组的11.03°±3.67°、11.69°±3.85°、13.29°±3.61°及12.19°±3.55°显著增大（P<0.05）。21例平山病组患者的弧弦距为5.42±7.35mm，28例对照组志愿者为9.10±2.60mm，两组存在显著性差异（P<0.05）。57.1%（12/21）的平山病患者弧弦距测量表现为颈椎曲度变浅、变直或颈椎反弓，弧弦距与颈椎屈曲活动度呈统计学负相关（r=-0.585，|r|>0.50）。结论：平山病患者颈椎存在屈曲活动度增大、颈椎不稳定和颈椎曲度改变，其颈椎屈曲活动度增大与颈椎曲度变直或反弓具有一定相关性。

英文摘要:

  【Abstract】 Objectives: To analyze cervical sagittal alignment and stability in Hirayama disease on radiographs. Methods: From May 2007 to January 2013, 28 patients were diagnosed Hirayama disease, all males, with an average age of 19.5 years(range, 15-24 years). Cervical flexion and extenion radiographs were performed on 28 patients and control subjects(males, average age of 20.9, range from 18 to 23 years). Anterior-posterior(AP) and lateral cervical radiographs were also performed on 21 patients and all control subjects. Cervical flexion motion range, angular mobility and the depth of cervical lordosis were measured. Results: The range of cervical flexion motion(C2-C7) was 37.52°±9.09°, which was significantly greater than that of control subjects(25.39°±8.66°, P<0.05). The angle mobility of lower cervical spine was respectively 14.37°±5.22°, 16.70°±3.44°, 17.05°±3.66° and 15.15°±4.25° in Hirayama disease patients, which was greater than that of control subjects(11.03°±3.67°, 11.69°±3.85°, 13.29°±3.61° and 12.19°±3.55° respectively)(P<0.05）. The depth of the cervical lordosis was 5.42±7.35mm in Hirayama disease group, which was lower than that of control group. 57.1%(12/21) patients showed cervical curvature change or even kyphosis. Conclusions: The increase range of cervical flexion motion, cervical instability and curvature change exist in Hirayama disease. The increase range of cervical flexion motion has correlation with cervical straighten or kyphosis.