中国汉族与欧洲高加索人多节段脊髓型颈椎病患者下颈椎椎板形态对比及临床意义

Morphological characteristics of the lower cervical vertebra in Chinese Han multilevel cervical spondylotic myelopathy(MCSM) patients and European Caucasian MCSM patients and its clinical significance

中文关键词:  多节段脊髓型颈椎病  下颈椎  单开门椎管扩大成形术  CT  汉族  高加索人

英文关键词:Multiple cervical spondylotic myelopathy  Lower cervical vertebra  Laminoplasty  CT  Chinese Han  Caucasian

中文摘要:

  【摘要】 目的：探讨中国汉族多节段脊髓型颈椎病（multilevel cervical spondylotic myelopathy，MCSM）患者下颈椎椎板形态学特征，比较其与欧洲高加索人MCSM患者的差异。方法：选取2016年12月~2022年5月在南京大学医学院附属鼓楼医院及法国里昂公园医院接受单开门椎管扩大成形术（expansive single open-door laminoplasty，EOLP）治疗的MCSM患者，根据人种分为两组：A组，中国汉族MCSM患者，80例，其中男性42例，女性38例，年龄60.3±10.5岁；B组，欧洲高加索人MCSM患者，29例，其中男性15例，女性14例，年龄58.4±12.6岁。在研究对象术前颈椎CT平扫影像资料上测量颈椎椎板开槽处内径（lamina inner width，LIW）、椎板开槽处外径（lamina outer width，LOW）、椎板轴长（lamina axis length，LAL）、椎板横截面倾斜角（lamina transverse angle，LTA）。应用独立样本t检验比较两组患者C3~C7各节段影像学参数的差异。结果：两组患者LIW及LOW均表现为C3~C5逐渐减小、C5~C7逐渐增大。A组各节段LAL均显著性小于B组（C3：12.1mm vs 13.4mm；C4：12.5mm vs 13.5mm；C5：12.8mm vs 13.9mm；C6：13.1mm vs 14.4mm；C7：13.5mm vs 14.4mm），LIW大于B组（C3：2.8mm vs 2.4mm；C4：2.4mm vs 1.9mm；C5：2.2mm vs 1.7mm；C6：2.7mm vs 2.3mm；C7：4.1mm vs 3.7mm），且在C3~C6节段存在显著性差异（P<0.05）；两组LOW及LTA在各节段均无显著性差异（P＞0.05）。结论：在中国汉族人群与欧洲高加索人群中，MCSM患者C5节段椎板铰链处最为薄弱，在接受EOLP磨取骨槽时更易断裂，且理论上中国汉族患者铰链处断裂风险大于欧洲高加索人患者。

英文摘要:

  【Abstract】 Objectives: To investigate the morphological characteristics of the lower cervical vertebrae in Chinese Han multilevel cervical spondylotic myelopathy(MCSM) patients and to compare it with European Caucasian MCSM patients. Methods: The MCSM patients who underwent expansive single open-door laminoplasty(EOLP) between December 2016 and May 2022 at the Affiliated Drum Tower Hospital, Medical School of Nanjing University and Clinique Du Parc, France were divided into two groups based on ethnicity. Group A consisted of 80 Chinese Han MCSM patients(42 males and 38 females, mean age 62.3±10.5 years), while group B consisted of 29 European Caucasian MCSM patients(15 males and 14 females, mean age 58.4±12.6 years). The lamina inner width(LIW) at hinge place, lamina outer width(LOW) at hinge place, lamina axis length(LAL) and lamina transverse angle(LTA) of the patients were measured on CT plain scan images before operation. Independent sample t-test was performed to compare the differences in C3-C7 imaging parameters between the two groups. Results: LIW and LOW decreased from C3 to C5, and increased from C5 to C7 in both groups. Group A was significantly smaller in LAL at each level than group B(C3: 12.1mm vs 13.4mm; C4: 12.5mm vs 13.5mm; C5: 12.8mm vs 13.9mm; C6: 13.1mm vs 14.4mm; C7: 13.5mm vs 14.4mm), while larger in LIW(C3: 2.8mm vs 2.4mm; C4: 2.4mm vs 1.9mm; C5: 2.2mm vs 1.7mm; C6: 2.7mm vs 2.3mm; C7: 4.1mm vs 3.7mm) with significant differences in C3-C6(P<0.05). No significant differences were found in LOW and LTA between the two groups at each level(P>0.05) Conclusions: In Chinese Han and European Caucasian MCSM patients, C5 is the thinnest lamina among the lower cervical vertebrae with the highest risk during grooving in EOLP, and the risk is theoretically higher in Chinese Han MCSM patients than that in Caucasian MCSM patients.