不同类型颈椎病患者颈伸肌肌容量与颈椎矢状位参数的差异及相关性研究

Correlation between the volume of cervical extensors and sagittal parameters of cervical spine in patients with cervical degenerative diseases

中文关键词:  颈椎病  颈伸肌肌容量  颈椎矢状位序列

英文关键词:Cervical spondylotic  Cervical extensor  Cervical sagittal alignment

中文摘要:

  【摘要】 目的：探讨不同类型颈椎病患者之间颈伸肌肌容量与颈椎矢状位序列的差异及相关性。方法：回顾性分析2016年5月~2018年7月就诊于北京大学国际医院的颈椎病患者563例，其中男性304例，女性259例，平均年龄53.3±19.6岁，根据颈椎病的类型分为A组（脊髓型颈椎病，n=208）、B组（神经根型颈椎病，n=194）和C组（颈型颈椎病，以轴性症状为主且无神经受压的临床症状或体征，n=161）。所有患者行颈椎MRI及颈椎侧位X线片检查。通过PACS （picture archiving and communication systems）系统在颈椎侧位X线片上测量颈椎矢状位参数序列：C2-7 Cobb角、C0-2 Cobb角、C7斜率（C7 slope，C7S）和C2-7矢状垂直轴（C2-7 sagittal vertical axis，C2-7 SVA）。通过Image J软件对MRI轴位像上C3~7上终板水平浅层颈伸肌截面积（superficial extensor area，SEA）、深层颈伸肌截面积（deep extensor area，DEA）与相应颈椎椎体截面积（vertebra body area，VBA）的比值进行了测量和分析，以SEA/VBA及DEA/VBA作为颈伸肌肌容量。采用ANOVA单因素方差分析对组间矢状位参数，颈伸肌肌容量进行对比（组间两两对比采用Games-Howell法），采用Pearson相关性分析对颈伸肌肌容量与矢状位参数关联性进行分析。结果：C2-7 Cobb角A组（8.64°±6.19°）显著低于B组（12.55°±6.27°，P<0.05）及C组（13.08°±5.77°，P<0.05）；C7S A组（28.09°±10.16°）显著高于B组（22.26°±7.55°，P<0.05）及C组（21.63°±8.96°，P<0.01）；C2-7 SVA A组（21.77±12.38mm）显著高于B组（17.80±10.82mm，P<0.05）及C组（15.54±6.82mm，P<0.01）。SEA/DEA比值各组之间无显著统计学差异，A组患者DEA/VBA比值明显低于B、C组（P<0.05），其中以C3-5水平差异最为显著（P<0.05）。Pearson相关分析显示A组C3 DEA/VBA比值与C2-7 SVA（r=-0.379，P<0.05）及C7S（r=-0.311，P<0.05）呈弱负相关，C4水平DEA/VBA比值与C2-7 SVA（r=-0.478，P<0.01）及C7S（r=-0.466，P<0.01）呈中度负相关，而SEA/VBA比值与矢状位参数未表现出显著统计学相关性。结论：脊髓型颈椎病患者的颈椎矢状位序列较其他类型颈椎病表现出显著的失平衡改变，脊髓型颈椎病患者的深层颈伸肌体积显著低于其他类型的颈椎病，深层颈伸肌近头端附着区域的体积与C2-7 SVA及C7S之间存在一定程度的负相关性。

英文摘要:

  【Abstract】 Objectives: To explore the relationship between the volume of cervical extensor and the sagittal alignment position in patients with different types of cervical degenerative diseases. Methods: Retrospective analysis was performed on patients with cervical degenerative diseases who were treated in Peking University International Hospital from May 2016 to July 2018. 563 patients(female/male 259/304, average age 53.3±19.6 years) were divided into group A(cervical spondylotic myelopathy, n=208), group B(cervical spondylotic radiculopathy, n=194) and group C(cervical degenerative disease without neurological symptoms, n=161). C2-7cobb angle and C0-2 Cobb angle, C7 slope(C7S) and C2-7 sagittal vertical axis(C2-7 SVA) were measured and recorded using picture archiving and communication systems(PACS). The ratios of superficial extensor area(SEA), deep extensor area(DEA) and vertebra body area(VBA) of C3-7 upper endplate were measured and analyzed by Image J software. The volume of cervical extensor was quantified by SEA/VBA and DEA/VBA. Single-way ANOVA analysis of variance was used to compare the data of each group, and Pearson correlation analysis was used to analyze the possible correlation between the volume of cervical extensor and sagittal parameters. Results: C2-7 Cobb angle of group A(8.64°±6.19°) was significantly lower than that of group B(12.55°±6.27°) and group C(13.08°±5.77°, P<0.05). C7S of group A(28.09°±10.16°) were significantly higher than those of group B(22.26°±7.55°, P<0.05) and group C(21.63°±8.96°, P<0.01). C2-7 SVA of group A(21.77±12.38mm) were significantly higher than those of group B(17.80±10.82mm, P<0.05) and group C(15.54±6.82mm, P<0.01). There was no significant difference in SEA/DEA ratio among all three groups. The DEA/VBA ratio in group A was significantly lower than that in group B and C(P<0.05), among which C3-5 was the most significant levels(P<0.05). In group A, C3 DEA/VBA ratio was weakly negatively correlated with C2-7 SVA(r=-0.379, P<0.05) and C7S(r=-0.311, P<0.05), while C4 DEA/VBA ratio was moderately negatively correlated with C2-7 SVA (r=-0.478, P<0.01) and C7S (r=-0.466, P<0.01), while SEA/VBA ratio was not significantly negatively correlated with sagittal parameters. Conclusions: Cervical sagittal malalignment in patients with cervical spondylotic myelopathy is more significant than that in other types of cervical degenerative diseases. The volume of deep extensors in patients with cervical spondylotic myelopathy is significantly lower than that in other types of cervical degenerative diseases. The volume reduction of the proximal attachment area of deep extensors is significantly correlated with the disorder of sagittal alignment of cervical spine.