颈椎后凸畸形患者影像学测量指标与临床症状的相关性研究

Correlation between clinical symptom and radiological measurement for cervical kyphosis

目的:探讨颈椎后凸畸形患者影像学测量与临床症状的相关性,筛选出评估颈椎后凸畸形破坏颈椎力学平衡的影像学指标。方法:将61例颈椎后凸畸形患者分为有症状组(25例)和无症状组(36例),采用随机双盲重复方法,在颈椎MRI上测量颈椎后凸畸形顶点脊髓矢状径(a)、后凸顶点脑脊液柱的矢状径(b)及延髓与桥脑交界处的延髓矢状径(M),计算a/b比值、a/M比值,在X线片上测量后凸节段后切线夹角和后凸Cobb角,采用线性回归和Logistic回归分析上述测量值与临床症状出现的相关性。结果:症状组的后切线夹角和Cobb角明显大于无症状组(Z=-6.351,P<0.01;Z=-7.761,P<0.01),a/M比值和a/b比值明显小于无症状组(t=-9.939,P<0.01;t=-5.334,P<0.01);两组病例后凸节段的后切线夹角与Cobb角成正相关(R=0.899,t=39.188,P<0.01)、与a/M比值成负相关(R=-0.502,t=-11.080,P<0.01),后凸节段的Cobb角与a/M比值成负相关(R=-0.427,t=-9.012,P<0.01)。将每组患者以a/M=0.338和后凸节段后切线夹角及Cobb角=20°再分组,用Logistic回归分析显示a/M比值≤0.338是导致临床症状出现的主要相关因素(P<0.01),此外,后凸节段Cobb角≥20°或后切线夹角≥20°也是导致临床症状出现的相关因素。结论:颈椎后凸畸形患者a/M比值≤0.338、后凸节段Cobb角≥20°或后切线夹角≥20°与临床症状的出现密切相关,提示颈椎力学平衡被打破,颈脊髓被损伤,需治疗干预。

Objective：To discuss the correlation between clinical symptom and radiological measurement for cervical kyphosis and to screen out radiographic criteria to assess the biomechanical imbalance due to cervical kyphosis.nethod：61 cases of cervical kyphosis were divided into two groups,the symptomatic group（25 cases） and the asymptomatic group （36 cases ）.Using double-blind,random and repeated method,the sagittal diameter of spinal cord （a）,cerebrospinal fluid sagittal diameter （b） at the apex of kyphosis and the sagittal diameter of medulla-pons junction （M value）,calculated a/b ratio, a/M ratio were measured in MRI individually.In the X-ray films,the posterior tangent angles and Cobb angles at kyphosis segment were measured.Linear regression and Logistic regression were performed to analyze the relationship between the clinical symptom and the datas mentioned above.Result：The posterior tangent angles and Cobb angles in symptom group were larger than those in asymptom group＇s （Z=-6.351,P〈0.01;Z=-7.761,P〈0.01）.The a/M ratio in symptom group with was lower than those in asymptom group （t=-9.939,P〈0.01）.In two groups,the posterior tangent angles showed positive relation with Cobb angles（R=0.899,t=39.188,P〈0.01） and negative relation with the a/M ratio （R=-0.502,t=-11.080,P〈0.01）,and negative relation between the Cobb angles and the a/M ratio （R=-0.427, t=-9.012,P〈0.01）.According to the criteria of a/M=0.338 and the posterior tangent angle and Cobb angle= 20°,patients in each group was subgrouped to carry out logistic regression analysis,the result showed that the a/M ratio≤0.338 was the most relevant factors associated with clinical symptoms,and the Cobb≥20° or posterior tangent angles≥20° were less relevant factors associated with the clinical symptom.Conclusion：The factors of the a/M ratio≤0.338,and the Cobb angle≥20° or posterior tangent angles≥20° are closely associated with clinical symptoms ,which will result in mechanical imbalance of cervical spine and spinal cord injury.The treatment must be done.