平山病颈椎屈曲度异常的X线征象及其诊断价值

The Abnormality of Cervical Spine Curvature in Hirayama Disease:X-ray Features and Diagnostic Values

目的探讨颈椎主动屈曲位屈曲度异常的X线征象对平山病的诊断价值。资料与方法对40名正常自愿者及35例临床疑诊平山病的患者行颈椎仰卧被动过屈位MRI扫描及颈椎主动屈曲位平片检查。疑诊的35例中有25例根据临床及影像学征象被诊断为平山病。测量确诊患者和正常对照组平片以及MRI上的C3～7相邻两两椎体后缘的成角,作为颈椎屈曲度的评价指标。结果确诊患者主动屈曲位平片颈椎屈曲度较对照组增大(患者C3～7相邻两两椎体后缘成角分别为7.40°、8.50°、10.60°、11.10°,均较对照组增大(P<0.05)。将颈椎屈曲度异常作为平山病的征象之一,其对于平山病诊断的敏感性为96.00%,特异性为87.50%。描绘受试者操作特征曲线(ROC),曲线下面积为0.93。结论平山病患者颈椎屈曲度在C3～7段均大于正常对照组。结合临床症状与体征,颈椎主动屈曲位平片所反映的屈曲度异常征象对于平山病的诊断价值较高,在无法施行颈椎仰卧被动过屈位MRI时,该检查可作为平山病的辅助诊断方法。

Objective To evaluate the diagnostic value of the cervical spine curvature abnormalities in active flexion X- ray for Hirayama disease（HD）. Materials and Methods Routine supine flexion MRI and active flexion X-ray were performed in 35 patients suspected with HD and 40 healthy volunteers. 25 of the patients were diagnosed as HD by the typical clinical symptom and MR imaging signs. The angles between every two adjacent vertebrae from C3 to C7 levels were measured on both MRI and X-ray images. Results The cervical flexion angles of HD patients on X-ray were C3-4：7.40° （5.50° - 13.30°） ,C4-5：8.50°（6.20° - 12.10°）, C5-6 ： 10.60° （6.70° - 20.60°） ,C6-7 ： 11. 10° （3.40° - 16.70°）, which were significantly larger than those of healthy control group at C3 - 7 levels （ P 〈 0.05 ）, but the abnormal spine curvature was only demonstrated at C5-7 levels on supine flexion MRI（P 〈0.05）. As an imaging sign for HD, the sensitivity of the abnormality of cervical spine curvature was 96.00% and the specificity was 87.50% for the diagnosis. The area under ROC curve is 0.93. Conclusion Active flexion X-ray can demonstrate the cervical spine curvature abnormality at C3-7 levels. The abnormal cervical spine curvature combining clinical symptom can accurately diagnose Hirayama disease. When it is difficult to perform a flexion MRI, active flexion X-ray can be a satisfactory method.