脊髓型颈椎病患者颈椎椎间盘层面与椎体层面脑脊液柱面积比值测量的临床意义

目的探讨脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者颈椎椎间盘层面与椎体层面脑脊液柱面积比值测量的临床意义。方法随机选取2011年6月—2012年12月做过颈椎MRI检查的CSM患者83例作为观察组,同期选取93例正常人作为对照组,对C3~4、C4~5、C5~6、C6~7椎间盘层面及C4、C5、C6、C7椎体正中层面,进行T2加权横断位扫描,利用面积测量工具,分别测量各层骨性椎管面积、纤维性椎管面积及脑脊液柱面积。由两位神经内科临床医师对观察组患者进行(Japanese orthopedic association,JOA)评分。计量资料采用t检验,利用Pearson直线相关分析日本矫形外科学会JOA评分与骨性椎管面积比值、纤维性椎管面积比值及脊液柱面积比值的相关性。P0.05为差异有统计学意义。结果观察组椎间盘层面骨性椎管面积、纤维性椎管面积及脊液柱面积(864.8±46.3)、(629.7±32.8)、(576.9±52.7)mm2]与对照组(943.2±27.6)、(781.4±31.9)、(756.7±49.3)mm2]比较差异均有统计学意义(均P0.05)。观察组骨性椎管面积、纤维性椎管面积及脊液柱面积椎间盘层面与椎体正中层面的比值(88.7±4.5、76.1±8.5、73.5±4.3)与对照组(96.7±2.3、95.6±3.7、95.9±1.8)比较差异均有统计学意义(均P0.05)。JOA评分与纤维性椎管面积、脊液柱面积、椎间盘层面与椎体正中层面的比值密切相关(r=0.693、0.857,P0.05)。结论椎间盘层面与椎体正中层面脑脊液柱面积比值可反映CSM患者椎管狭窄程度及临床症状严重程度,具有一定的临床应用价值。

Clinical significance of the ratio of cervical disc level to vertebral level in the area of cerebrospinal fluid column on MRI

Objective To explore the measurement of the ratio of disc level to the median plane of the vertebrae in the area of cerebrospinal fluid column in cervical spondylotic myelopathy（CSM） and its clinical significance.Methods 86 cases of CSM who had received MRI were randomly selected as observation group from June 2011 to December 2012,and 93 healthy subjects as the normal controls.T2-weighted MRI was conducted on the disc level of C3-4,C4-5,C5-6 and C6-7,and the median plane of the vertebrae of C4,C5,C6 and CT,and then the area of bony canal,fibrous canal and cerebrospinal fluid column was measured.JOA score was calculated in observation group by two neurology physicians.T-test was used for measurement data,and person linear correlation analysis was used for the correlation between JOA score and the ratio of bony spinal canal area,fibrous spinal canal area and cerebrospinal fluid column area.The result of P〈0.05 was considered statistically significant.Results Compared with control group （943.2 ±27.6）,（781.4 ± 31.9）,（756.7 ±49.3）mm^2],the area of bony canal,fibrous canal and cerebrospinal fluid column of disc level showed significant difference in observation group （864.8 ± 46.3）, （629.7 ± 32.8）, （576.9 ± 52.7）mm^2]（P〈0.05）.In observation group （88.7± 4.5,76.1 ± 8.5,73.5±4.3）,the area of bony canal,fibrous canal and cerebrospinal fluid column of disc level showed significant difference from that of the median plane of the vertebrae（96.7 ± 2.3,95.6 ± 3.7,95.9 ±1.8）（P〈0.05）.There were correla- tions between JOA and the ratio of fibrous spinal canal area and cerebrospinal fluid column area （r=0.693,0.857,P〈0.05）.Con-clusion The ratio of disc level to the median plane of the vertebrae in the area of cerebrospinal fluid column can reflect the severity of spinal canal stenosis and clinical symptoms in CSM,which is of clinical value.