颈椎退行性变与临床症状相关性分析

Analysis on correlation between cervical vertebral degeneration and clinical symptoms

目的分析颈椎退行性变与临床症状之间的相关性。方法选取2017年1月~2018年9月本院收治的具有颈部及上肢神经根性症状的临床病例35例,26~76岁;无症状对照组病例35例,31~74岁。对上述病例行层厚0.7mm,颅底至3、4胸椎CT扫描,将所得DICOM文件导入3DSlicer4.8.1后,以最大密度投影法进行体素渲染,对各颈椎的钩椎关节、椎间孔、曲度(四线法Cobb角)进行观察和测量。将所得结果与临床症状及对照组进行对应性分析,对钩椎关节退行性变与Cobb角变化相伴性进行统计,对症状组的Cobb角与无症状组Cobb角进行成对t检验。结果颈椎退行性变随着年龄上升呈明显趋势,但病变程度与年龄不呈正相关;颈椎钩椎关节退行性变与椎间孔狭窄呈正相关;椎间孔狭窄与临床相关症状的相关率为60%(21例);Cobb角度<35°时生理弯曲消失甚至是反张,在研究的患者中发生率为42.9%(15例);有症状组的椎间孔径和Cobb角角度(30.96±14.37)°明显小于无症状组(46.66±6.54)°,差异有统计学意义(P<0.01)。结论从性别与年龄上看,颈椎退行性变与生活习惯相关性较大,与年龄相关性次之;钩椎关节退行性变与颈椎椎间孔前后径狭窄呈正相关;具有臂丛神经根症状的病例,在三维可视化帮助下,其椎间孔狭窄和屈度变化等颈椎退化的影像学检出率约为60%(以椎间孔横径<3mm为标准)。

Objective To analyze the correlation between cervical vertebral degeneration and clinical symptoms.Methods 35 patientsaged 26 to 76 years oldwith radiculopathy symptoms of neck and upper extremity who were admitted to our hospital from January 2017 to September 2018 were selected.35 patients aged 31 to 74 years oldwithout symptomswere selected as the control group.The above cases were scanned with 0.7mm thick CT scan of 3 and 4 thoracic vertebrae from the skull base.After importing the resulting DICOM file into 3DSlicer4.8.1,the voxel rendering was performed with the maximum density projection method.The hook joints,the intervertebral foramen and the curvature(fourline Cobb angle)of each cervical vertebra were observed and measured.The results and the clinical symptoms of it and the control group were given correspondence analysis.The concomitant relationship between the degeneration of uncovertebral jointand the change of Cobb Angle was statistically analyzed.Paired t test was performed for Cobb angle in the symptom group and the asymptomatic group.Results The degeneration of cervical spine increased with age,but the degree of lesion was not positively correlated with age.Cervical vertebrauncovertebral joint degeneration was positively correlated with intervertebral foramen stenosis.The correlation rate between intervertebral foramen stenosis and clinically relevant symptoms was 60%(21 cases).When the Cobb angle was less than 35°,the physiological curvature disappeared or even reversed,and the incidence rate of patients in the study was 42.9%(15 cases).The intervertebral diameter and Cobb angle(30.96±14.37)°in the symptomatic group were significantly smaller than those in the asymptomatic group(46.66±6.54)°,and there were statistically significant differences between the two groups(P<0.01).Conclusion From the perspective of gender and age,cervical degeneration has a greater correlation with living habits,followed by correlation with age.The degenerative changes of uncovertebral jointare positively correlated with the anterior and posterior diameter stenosis of the cervical intervertebral foramen.In cases with brachial plexus root symptoms,the imaging detection rate of cervical vertebrae degeneration such as intervertebral foramen stenosis and flexion is about 60%(with the intervertebral foramen less than 3 mm as standard)with the help of three-dimensional visualization.