平山病患者颈椎矢状面形态及稳定性的X线影像学研究

The radiographic evaluation of cervical sagittal alignment and stability in Hirayama disease

目的：探索平山病患者颈椎x线征象，并分析平山病患者颈椎矢状面形态及稳定性。方法：2007年5月～2013年1月．我们对明确诊断的青少年上肢远端肌萎缩症患者28例（平山病组，均为男性，年龄15～24岁，平均19．5岁）及同年龄段健康志愿者28例（对照组，均为男性，年龄18～23岁，平均20．9岁）进行比对研究，行颈椎正侧位（21例平山病患者和所有志愿者）和主动过伸过屈位X线检查检查，分别测量平山病组和对照组颈椎过屈侧位x线片上的屈曲活动度及角度位移，采用Borden法测量弧弦距来评价颈椎曲度。应用SPSS17．0行数据分析，两组比对，并对平山病患者颈椎屈曲活动度和颈椎曲度行相关性分析。结果：平山病组患者颈椎屈曲活动度（C2～C7）为37．52。±9．09。，相较于对照组（25-39。±8．66。）增大（P〈0．05）。平山病组患者下颈椎过伸过屈角位移（C3／4～C6／7）分别为14．37。±5．22。、16．70。±3．44。、17．05。±3．66。及15．15。±4．25。，经过单因子方差分析，相比较对照组的11．03。±3．67。、11．69。±3．85。、13．29。±3．6l。及12．19。±3．55。显著增大（P〈0．05）。21例平山病组患者的弧弦距为5．42~7．35ram，28例对照组志愿者为9．10~2．60mm，两组存在显著性差异（P〈0．05）。57．1％（12／21）的平山病患者弧弦距测量表现为颈椎曲度变浅、变直或颈椎反弓，弧弦距与颈椎屈曲活动度呈统计学负相关（r=-0．585，Irl〉0．50）。结论：平山病患者颈椎存在屈曲活动度增大、颈椎不稳定和颈椎曲度改变，其颈椎屈曲活动度增大与颈椎曲度变直或反弓具有一定相关性。

Objectives： To analyze cervical sagittal alignment and stability in Hirayama disease on radio- graphs. Methods： From May 2007 to January 2013, 28 patients were diagnosed Hirayama disease, all males, with an average age of 19.5 years（range, 15-24 years）. Cervical flexion and extenion radiographs were per- formed on 28 patients and control subjects（males, average age of 20.9, range fi＇om 18 to 23 years）. Anterior- posterior（AP） and lateral cervical radiographs were also performed on 21 patients and all control subjects. Cer- vical flexion motion range, angular mobility and the depth of cervical lordosis were measured. Results： The range of cervical flexion motion（C2-C7） was 37.52o±9.09°, which was significantly greater than that of control subjects （25.39o±8.66°, P〈0.05）. The angle mobility of lower cervical spine was respectively 14.37°±5.22°, 16.70°±3.44°, 17.05°±3.66° and 15.15°±4.25° in Hirayama disease patients, which was greater than that of control subjeets（ll.03°±3.67°, 11.69°±3.85°, 13.29°±3.61° and 12.19°±3.55° respeetively）（P〈0.05）. The depth of the cervical lordosis was 5.42±7.35mm in Hirayama disease group, which was lower than that of control group. 57.1%（12/21） patients showed cervical curvature change or even kyphosis. Conclusions： The increase range of cervical flexion motion, cervical instability and curvature change exist in Hirayama disease. The in- crease range of cervical flexion motion has correlation with cervical straighten or kyphosis.