平山病患者的临床征象与颈椎椎间盘-关节突角变化规律的相关性

The correlation of clinical appearance and the variation of disc-facet angle in Hirayama disease

中文关键词:  平山病  椎间盘-关节突角  临床征象  作用机制

英文关键词:Hirayama disease  Disc-facet angle  Clinical appearance  Mechanism

中文摘要:

  【摘要】 目的：通过分析平山病患者的临床征象与颈椎椎间盘-关节突角的变化规律的相关性，探讨颈椎椎间盘-关节突角在平山病的发生、发展中可能的作用机制。方法：研究对象选择2006年10月～2012年1月我院骨科诊治的平山病患者45例，其中男性44例（占97.8%），女性1例（占2.2%），年龄19.33±3.89岁（13～37岁），发病年龄16.33±2.73岁（10～27岁），病程35.64±23.24个月（1～120个月）。测量方法：在PACS系统上分别测量C3～T1左右两侧的椎间盘-关节突角，即在CT的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。根据病变累及范围分为单侧患病组和双侧患病组。观察二组病程、脊髓功能状况、脊髓损害水平，分析二组椎间盘-关节突角变化规律与上述指标的相关性。结果：单侧患病组的病程显著短于双侧患病组（P＜0.05），双侧患病组中同时发病组的病程显著短于相继发病组（P＜0.05）。单侧患病组的JOA 17分、国内40分评分均高于双侧患病组，其中两组的国内40分评分具有显著性差异。单侧患病组中，患侧C3~C7的椎间盘-关节突角均大于健侧，其中C5、C6最为明显（P＜0.05）；双侧患病组中，两侧的椎间盘-关节突角没有差异，但是均大于单侧患病组中健侧的数值，其中C4、C5较显著。同时双侧患病组脊髓损害的节段以C4和C5为主。相对于单侧患病组，双侧患病组的上段颈椎稳定性更差，导致脊髓损害节段更高。结论：平山病双侧患病者的C4、C5椎间盘-关节突角较大，与其脊髓损害水平高、临床症状重之间可能存在一定相关性。而单侧患病者，患侧C5、C6椎间盘-关节突角显著大于健侧，是导致脊髓损害主要集中在同侧C5和C6节段的主要原因。

英文摘要:

  【Abstract】 Objectives: To reveal the possible role and mechanism of disc-facet angle in the occurrence and progress of Hirayama disease by analyzing the correlation of clinical appearance and the variation of disc-facet angle in Hirayama disease. Methods: 45 patients with Hirayama disease treated in the orthopedic department of Peking University Third Hospital from October 2006 to January 2012 were reviewed. There were 44 males(97.8%) and 1 female(2.2%) with an average age of 19.33±3.89(range 13-37) years old. The onset age was 16.33±2.73(range 10-27) years old and the duration of history was 35.64±23.24(range 1 to 120) months. The disc-facet angle of C3-T1 was measured on PACS system. An extension line was made along the upper edge of objective vertebral body on the CT scan sagittal reconstruction image. An extension line was made along the joint surface of upper articular process of objective vertebra on the sagittal plane which crossed the midpoint of the facets. The blunt angle between two lines was the disc-facet angle. The cases were divided into unilateral affect and bilateral affected group according to history, spinal cord function and spinal cord lesion level. The correlation of above data and the variation of disc-facet angle were analyzed. Results: The duration of history in unilateral affected patients was significantly shorter than that of bilateral affected patients(P＜0.05). The duration of history in sequential onset patients was significantly shorter than that of simultaneous onset in bilateral affected patients(P＜0.05). The JOA score 17 and Chinese score 40 in unilateral affected patients were higher than those of bilateral affected patients. The C3-C7 disc-facet angle of affected side was bigger than that of normal side in unilateral affected patients, and C5, C6 had statistically significant difference(P＜0.05). The spinal cord lesion level was mainly at C5 and C6 in unilateral affected group. The disc-facet angle had no difference on both sides in bilateral affected patients but the figures at C4 and C5 level were bigger than that of normal side in unilateral affected patients. The spinal cord lesion level was mainly at C4 and C5 in bilateral affected group. The stability of upper cervical spine segments was even worse in unilateral affected group and resulting in higher level of spinal cord lesion comparing with bilateral affected group. Conclusions: The disc-facet angle of C4, C5 is bigger in bilateral affected patients and may be correlated with higher level spinal cord lesion and more severe clinical symptoms. The C5, C6 disc-facet angle of affected side is significantly bigger than that of normal side in unilateral affected patients. This may be the key factor of spinal cord lesion mainly at C5 and C6 level on the same side.