平山病患者颈部深肌的形态学变化

Morphological changes of deep neck muscles in Hirayama disease

中文关键词:  平山病  形态学研究  椎旁肌肉

英文关键词:Hirayama disease(HD)  Cervical paraspinal muscles  Morphometry

中文摘要:

  【摘要】 目的：明确平山病患者的颈部深肌的形态学变化，进一步理解其发病机制，并为平山病的治疗提供可能的新思路。方法：回顾性分析我院确诊的38例平山病患者以及38名健康人的中立位颈椎MRI片，测量所有人C3～C7椎间盘层面深肌（深屈肌主要包括头长肌和颈长肌，深伸肌包括多裂肌和颈半棘肌）及相应椎体横截面积（cross sectional area，CSA），计算出两者间比值（R-CSA）以及深屈肌CSA与深伸肌CSA比值（椎旁肌的横截面积与肌力呈正比关系，因此可以反映肌力的变化）。同时根据深屈肌和深伸肌的信号值计算出深屈肌与深伸肌信号的对比信噪比（signal/noise ratio，SNR）。测量平山病患者受累最严重层面脊髓前后径及横径，健康人测量C5/6层面脊髓前后径及横径，再计算出前后径与横径之比。最后比较两组间是否有差异。结果：平山病患者深屈肌与深伸肌横截面积之比（C3/4，0.66±0.18；C4/5，0.48±0.14；C5/6，0.45±0.22；C6/7，0.34±0.15）较健康对照组（C3/4，0.47±0.15；C4/5，0.29±0.10；C5/6，0.22±0.07；C6/7，0.19±0.48）显著增大（P＜0.05）。平山病患者的SNR（C3/4，0.64±0.19；C4/5，0.73±0.13；C5/6，0.70±0.17；C6/7，0.70±0.17）也较健康对照组（C3/4，0.51±0.13；C4/5，0.64±0.13；C5/6，0.65±0.17；C6/7，0.64±0.12）显著增加（P＜0.05）。平山病患者脊髓较健康对照组受压变形，前后径与横径之比（0.32±0.06 vs 0.53±0.82）减小（P＜0.05）。结论：平山病患者深屈肌与伸肌力量不平衡可能导致平山病患者颈部重复过度屈曲，进而压迫脊髓，纠正颈椎矢状面不平衡是治疗平山病的可能思路。

英文摘要:

  【Abstract】 Objectives: To clarify the deep neck muscle changes in patients with Hirayama disease, further understand its pathogenesis, and provide possible new ideas for the treatment of Hirayama disease. Methods: Retrospectively analyze the neutral cervical MRI of 38 Hirayama disease patients and 38 healthy sex-age matched people as control group. The anteroposterior and transverse diameters of the spinal cord at the most severe level in patients with Hirayama disease(in control group, spinal cord diameters were measured at C5/6 level) and then calculate the ratio of the anteroposterior and transverse diameters were measured. Also the deep muscles(the flexor deep consists mainly of the longus capis and longus cervicalis, and the extensor deep consists of the multifidus and semisspinalis cervicalis) of C3-7 intervertebral disc and the corresponding vertebral cross-sectional area(CSAs), and calculated the relative cross-sectional area(R-CSA) and the ratio of the cross-sectional area of deep flexors to deep extensors(CSADFs/CSADEs) were measured(The cross-sectional area of the paraspinal muscles was directly proportional to muscle strength, so it could reflect changes in muscle strength). At the same time, the signal values of deep flexors and deep extensors were obtained and the signal/noise ratio(SNR) of the signals of deep flexors and deep extensors was calculated. Finally, R-CSA and CSADFs/CSADEs were compared between the two groups. Results: The spinal cord of Hirayama disease patients was compressed and deformed, and the ratio of the anterior and posterior diameter to the transverse diameter decreased(0.32±0.06 vs 0.53±0.82). Compared with the healthy control group(C3/4, 0.47±0.15; C4/5, 0.29±0.10; C5/6, 0.22±0.07; C6/7, 0.19±0.48), the CSADFs/CSADEs(C3/4, 0.66±0.18; C4/5, 0.48±0.14; C5/6, 0.45±0.22; C6/7, 0.34±0.15) of Hirayama disease patients increased significantly(P＜0.05); the R-CSADFs and SNR of Hirayama disease patients also increased significantly(P＜0.05); while the R-CSADEs decreased significantly(P＜0.05). Conclusions: The imbalance of deep flexor and extensor strength in patients with Hirayama disease may cause repeated excessive flexion of the neck in patients with Hirayama disease, which may compress the spinal cord. Correcting the sagittal imbalance of the cervical spine is a possible idea for the treatment of Hirayama disease.