从青少年颈椎曲度和生长速度探讨平山病的发病机制

To evaluate the cervical spine curvature and growth rate for studying the pathogenesis of Hirayama disease in adolescents

目的从青少年颈椎曲度和生长速度探讨平山病的发病机制。方法2009-2011年在我院确诊的60例平山病患者。收集记录患者发病前1～2年内身高增长速度情况；并对患者进行颈椎侧位X线片检查，应用Borden法测量颈椎曲度；行颈段MRI检查，明确脊髓是否存在受压、萎缩及其他异常。结果患者发病时均为青少年，其中男57例，女3例，发病年龄12～25（17．0±2．4）岁。发病高峰年龄段为15～18岁[45例（75．0％）]。60例患者颈段MRI检查显示脊髓萎缩累及C4～C8椎体水平。60例平山病患者颈椎曲度Borden法的C线值为2．6（1．2，4．2）mm，其中57例（95．0％）患者颈椎曲度存在异常。发病前1年内患者身高增长速度为（7．1±1．8）cm。结论平山病患者在症状出现前1～2年身高增长过快、颈椎曲度异常的特点可能与其发病机制有关。平山病很可能是一种与青少年生长有关的颈椎发育异常导致的下颈段脊髓受压性疾病。

Objective To explore the pathogenesis of Hirayama disease from juvenile cervical curvature and growth rate. Methods Totally 60 patients diagnosed with Hirayama disease （HD） from 2009 to 2011 in our hospital were included in the present study. Patient＇s height and growth rate 1-2 years prior to the onset of disease were recalled by patients and family members. Lateral cervical X-ray was examined, and cervical curvature was measured by Borden＇s method. Results All the patients were adolescents with onset age at 12-25 （17.0±2.4） years old and peak age of onset at 15-18 [45 cases （75.0%）]. Fifty-seven cases were male and 3 cases were female. Cervical MRI examination of the 60 cases showed that the spinal cord atrophy involving C4-C8 vertebral level. The C line values for cervical curvature by Borden＇s method of the patients was 2. 6 （ 1. 2, 4. 2） mm. Among 60 patients, 57 of them were with abnormal cervical curvature. The average height growth rate 1 year prior to the onset was （7.1 ± l. 8 ） cm. Conclusions The clinical manifestations that featured in overgrowth in the first two years and abnormal cervical vertebra curvature are possible related with pathogenesis of HD. HD is possibly a cervical spinal cord compression disease, which is associated with cervical spinal dysplasia during juvenile growth.