青少年特发性脊柱侧凸患者颅颈交界区脑脊液动力学研究

Research on hydrodynamics change of cerebrospinal fluid flow at the craniocervical junction in adolescent idiopathic scoliosis

目的探讨青少年特发性脊椎侧凸(adolescent idiopathic scoliosis,AIS)患者颅颈交界区脑脊液动力学异常与小脑扁桃体位置及枕骨大孔前后径的关系。方法用磁共振对比检测32例AIS患者及30例正常人,计算脑脊液头端流向尾端即向下(down flow,DF)时相持续时间,尾端流向头端即向上(up flow,UF)时相持续时间,二者在脑脊液循环时间内所占比率(DF比率及UF比率),DF流动的起始时间(down flow start point,DS)比率,静止期(stationaryphase,SP)比率,脑脊液向下流动最大流速(VDmax),向上流动最大流速(VUmax),绘制最大流速/时间曲线。测量小脑扁桃体相对枕骨大孔连线位置及枕骨大孔前后径。结果侧凸组与对照组相比,DS比率及SP比率明显增高,DF比率明显减低,枕骨大孔前后径明显增大,差异有统计学意义(P<0.05);UF比率、VDmax及VUmax差异无统计意义(P>0.05)。侧凸组56.3%小脑扁桃体位置低于枕骨大孔连线。结论 AIS患者存在颅颈交界区脑脊液动力学改变,考虑与脊柱脊髓生长不平衡导致脊髓牵拉,小脑扁桃体下移有关。枕骨大孔虽发生适应性增大,但仍不能完全代偿。

Objective To investigate the con＇elation among hydrodynanfics change of cerebrospinal fluid flow, location of the cerebellar tonsils and mlteroposterior diameter of fnrmnen magnunl at the craniocervical junction in adolescent idiopathic scoliosis （AIS）. Methods The study involved 32 AIS patients and .30 numml teenagers with age and sex matched controls. Calculation of eerebrospinal fluid head to end phase duration, end to head phase duration, 2 in the cerebrospinal flt,id circulation time ralio of down flow （DF） mad up flow （ UF）, time ratio of down flow starl point （ DS）, time ratio of stationary phase （SP） . cerebrospiual fuid flow down the maximum velocity （ VDmax ）, the upward flow of maximum vehx：ity （ VDmax）, rendering the maximum velocity / time curve. Measurement of cerebellar tonsil relative to the foramen nragnum line position and formnen magnum anteruposteriur diameter. Results Seoliosis group compared with the control group： DS ratin trod SP ratio were increased, DF ratio decreased, the formnen nmgnum and size was increased, the difference was statistieally significant （P 〈0.05 ） ; UF ratio, VDmax, and VDmax, showed rio statistical significance（P 〉0.05 ）. Scoliosis group in the 56.3% position of the cerebellar tonsil below the foramen magauun. Conclusion Cranioeervical junction altered cerebrospinal fluid dynmnics exisl in AIS patients, which may be related with spinal growth inbalance leading to spinal traction and cerebellar tonsils move down. The foramen rnagnum is adaptive to increase, but still cannot complete compensation.