青少年Chiari畸形Ⅰ型合并脊髓空洞患者颈椎管矢状面锥度研究

Sagittal taper ratio of cervical spinal canal in adolescents with Chiari malformation and syringomyelia

中文关键词:  Chiari畸形  锥度  椎管前后径  脊髓空洞症

英文关键词:Chiari malformation  Taper ratio  Anteroposterior diameter  Syringomyelia

中文摘要:

  【摘要】 目的：分析青少年Chiari畸形Ⅰ型（Chiari malformation type Ⅰ，CMⅠ）合并脊髓空洞患者颈椎管矢状面锥度大小。方法：2007年10月~2013年10月在我科入院治疗且以胸椎侧凸为主首诊的青少年CMⅠ合并脊髓空洞患者共61例，男28例，女33例，年龄10~18岁，平均13.7±2.1岁，胸椎侧凸Cobb角42°~78°，平均51.5°±16.5°；以胸椎侧凸为主的AIS患者共75例，男35例，女40例，年龄11~18岁，平均14.8±1.8岁，胸椎侧凸Cobb角40°~69°，平均47.4°±15.3°。选取正常青少年志愿者60例作为正常对照组，男28例，女32例，年龄11~18岁，平均15.6±2.6岁。3组研究对象年龄与性别分布、CMⅠ组与AIS组胸椎侧凸Cobb角均无统计学差异（P>0.05）。在MR T2加权像正中矢状位扫描层面上测量颈椎管前后径，绘制散点图及趋势线，趋势线的斜率计为C1~C7椎管矢状面锥度。应用方差分析，比较3组研究对象颈椎管矢状面锥度的大小，并分析不同年龄分组（≤14岁与>14岁）和性别分组间颈椎管矢状面锥度的差异。结果：CMⅠ组、AIS组和正常对照组颈椎管平均矢状面锥度分别为-0.58±0.42mm/节段（-1.38～0.98mm/节段），-0.28±0.15mm/节段（-0.02～-0.70mm/节段）和-0.29±0.28mm/节段（-0.79～0.33mm/节段），CMⅠ组颈椎管矢状面锥度显著大于AIS组（P<0.05）和正常对照组（P<0.05），而AIS组与正常对照组比较无统计学差异（P>0.05）。3组颈椎管矢状面锥度在年龄、性别分组间均无统计学差异（P>0.05）。结论：与AIS患者和正常青少年相比，青少年CMⅠ合并脊髓空洞患者具有较大的颈椎管矢状面锥度，表明其颈椎管矢状面发育存在异常。

英文摘要:

  【Abstract】 Objectives: To assess the sagittal taper ratio of cervical spinal canal in adolescents with Chiari malformation type Ⅰ(CMⅠ) with syringomyelia as comparing to age- and gender-matched controls. Methods: From October 2007 to October 2013, 61 adolescents(28 males and 33 females) with thoracic scoliosis and CMⅠ with syringomyelia, whose average age was 13.7±2.1(10-18) years and average Cobb angle was 51.5°±16.5°(42°-78°) and 75 adolescents(35 males and 40 females) with idiopathic thoracic scoliosis(AIS), whose average age was 14.8±1.8(11-18) years and average Cobb angle was 47.4°±15.3°(40°-69°) in our department were recruited respectively. 60 normal adolescents(28 males and 32 females) were recruited as the control group, whose average age was 15.6±2.6(11-18) years. No significant differences of the age and gender were observed among the three groups(P>0.05). The Cobb angle did not differ significantly between CMⅠ group and AIS group(P>0.05). Anteroposterior diameter of the spinal canal was measured at each cervical level on midsagittal T2-weighted MR images, and a linear trend line was fit by least-square regression to calculate the taper ratio. With the ANOVA test, taper ratios were compared among the three groups and further evaluated with respect to age(≤14 years and >14 years) and gender. Results: Taper ratio averaged (-0.58)±0.42mm/level[(-1.38)-0.98mm/level] in the adolescents with CMⅠ, -(0.28)±0.15mm/level[(-0.02)-(-0.70)mm/level] in the patients with AIS, and (-0.29)±0.28mm/level[(-0.79)-0.33mm/level] in the normal adolescents. Taper ratio of CMⅠ group was significantly steeper than that of the AIS group(P<0.05) and normal group(P<0.05). However, taper ratios did not differ significantly between AIS group and normal group(P>0.05). No significant difference in taper ratio was noted between males and females, or between younger(≤14 years) and older subjects(>14 years)(P>0.05). Conclusions: Adolescents with CMⅠ and syringomyelia have more severely tapered cervical spinal canals than AIS and normal adolescents, suggesting that patients with CMI may have abnormal development of the cervical spinal canal.