伴C_(5)/C_(6)椎间孔狭窄神经根型颈椎病影像学特点及临床意义

Imaging characteristics of C_(5)/C_(6) intervertebral foramen stenosis in patients with cervical spondylotic radiculopathy and its clinical significance

目的观测伴C_(5)/C_(6)椎间孔狭窄神经根型颈椎病患者的颈椎间孔形态及三维空间下的各相关径值,并探讨其临床意义。方法随机选择2014年9月至2019年7月在海军军医大学(第二军医大学)第二附属医院行手术治疗的492例伴C_(5)/C_(6)椎间孔狭窄神经根型颈椎病患者作为病例组,均行颈椎正侧位X线片、颈椎CT、颈椎MRI等检查。选择来院体检的191名健康成人作为正常成人组。通过CT三维重建图像和X线片观测C_(5)/C_(6)椎间孔形态并测量最佳投射角度下的上前后径、下前后径、纵径、横截面积、椎间隙高度等径值,分析病例组与正常成人组之间、病例组观察侧(狭窄或严重狭窄一侧)椎间孔与对侧椎间孔之间及病例组男女患者之间各径值的差异。结果病例组C_(5)/C_(6)椎间孔形态因骨赘增生等,以纺锤形、不规则形为主。病例组观察侧椎间孔横径均值、纵径、横截面积、椎间隙平均高度分别为(5.81±1.40)mm、(10.45±1.70)mm、(50.02±15.46)mm^(2)、(4.99±0.89)mm,均小于正常成人组[分别为(7.60±1.37)mm、(11.66±1.95)mm、(72.80±22.48)mm2、(5.78±0.95)mm],差异均有统计学意义(P<0.05)。病例组观察侧椎间孔与对侧椎间孔之间及病例组男女患者之间各径值比较差异均无统计学意义(P>0.05)。结论伴C_(5)/C_(6)椎间孔狭窄神经根型颈椎病患者的颈椎间孔的形态发生改变,导致椎间孔的横径均值及横截面积减小。术中减压时应更加注重椎间孔横径的有效扩大,以提高手术效果。

Objective To observe the morphology of cervical intervertebral foramen and the related diameters in 3-dimensional space in patients with cervical intervertebral radiculopathy with C_(5)/C_(6) intervertebral foramen stenosis,and to discuss the clinical significance.Methods A total of 492 patients with cervical spondylotic radiculopathy with C_(5)/C_(6) intervertebral foramen stenosis,who underwent surgery in The Second Affiliated Hospital of Naval Medical University(Second Military Medical University)from Sep.2014 to Jul.2019,were randomly enrolled as case group and examined by anterior and lateral X-ray of the cervical vertebra,cervical computed tomography(CT),and cervical magnetic resonance imaging.In addition,191 healthy adults who came to the hospital for health examination were enrolled as normal adult group.The morphology of C_(5)/C_(6) intervertebral foramen was observed using CT 3-dimensional reconstruction images and X-ray films;and the upper anteroposterior diameter,lower anteroposterior diameter,longitudinal diameter,cross-sectional area,and disc height were measured under optimal projection angle.The differences between the case group and the normal adult group,between the observation side(stenosis or severe stenosis)intervertebral foramen and the contralateral intervertebral foramen of the case group,and between the male and female patients of the case group were analyzed.Results The morphology of C_(5)/C_(6) intervertebral foramen in the case group was mainly spindle and irregular due to osteophyte hyperplasia.The mean transverse diameter,longitudinal diameter,crosssectional area,and mean disc height of observation side intervertebral foramen in the case group were(5.81±1.40)mm,(10.45±1.70)mm,(50.02±15.46)mm^(2),and(4.99±0.89)mm,respectively,which were significantly lower than those in the normal adult group[7.60±1.37]mm,[11.66±1.95]mm,[72.80±22.48]mm^(2),and[5.78±0.95]mm,respectively(all P<0.05).There were no significant differences in the above-mentioned diameters between the observation side and contralateral intervertebral foramen of the case group or between the male and female patients(all P>0.05).Conclusion The morphology changes of cervical intervertebral foramen lead to decreases in the mean transverse diameter and cross-sectional area in patients with cervical spondylotic intervertebral radiculopathy with C_(5)/C_(6) intervertebral foramen stenosis.During intraoperative decompression,more attention should be paid to the effective enlargement of the transverse diameter of the intervertebral foramen,so as to improve the effect of the operation.