中国修复重建外科杂志

中国修复重建外科杂志

MRI 测量脊髓型颈椎病患者矢状位参数相关性分析

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目的 通过对颈椎矢状位参数的 MRI 测量,分析不同矢状位曲度状态下的脊髓型颈椎病患者各主要颈椎矢状位参数之间的相关性,从而找出具有代表意义的颈椎矢状位参数。 方法 回顾性分析 2015 年 7 月—2016 年 1 月因脊髓型颈椎病就诊的 88 例患者资料,于颈椎矢状位 MRI T2 加权像上测量 C2~C7 Cobb 角、T1 倾斜角(T1 slope,T1S)及 C2~C7 矢状位轴向距离(C2~C7 sagittal vertical axis,C2~C7 SVA)。根据 C2~C7 Cobb 角大小不同将患者分为前凸组(Cobb 角≥10°,48 例)及变直组(Cobb 角 0~10°,40 例)。数据测量可靠性采用组内相关系数(intraclass correlation coefficient,ICC)表示,各影像学参数的相关性检验采用 Pearson 相关进行分析。 结果 颈椎各参数的 ICC 为 0.858~0.946,组内测量一致性良好。变直组 C2~C7 Cobb 角为(5.6±2.4)°,T1S 为(22.2±6.7)°,C2~C7 SVA 为(10.2±5.4)mm;前凸组 C2~C7 Cobb 角为(20.1±8.2)°,T1S 为(23.4±8.9)°,C2~C7 SVA 为(8.2±4.6)mm。变直组 3 个参数间均无相关性,其中 T1S 与 C2~C7 Cobb 角(r=0.100,P=0.510);T1S 与 C2~C7 SVA(r=–0.100,P=0.500);C2~C7 Cobb 角与 C2~C7 SVA(r=0.080,P=0.610)。前凸组 T1S 与 C2~C7 Cobb 角之间成正相关(r=0.540,P=0.000),T1S 与 C2~C7 SVA 之间成负相关(r=–0.450,P=0.001),C2~C7 Cobb 角与 C2~C7 SVA 之间无相关性(r=–0.003,P=0.980)。 结论 具有颈椎生理前凸的脊髓型颈椎病患者,可仅以 MRI 测量的 T1S 值作为评判矢状位曲度的主要参数代表;而对于颈椎生理前凸变直患者,需要 T1S、C2~C7 Cobb 角、C2~C7 SVA 进行测量来综合评判。

Objective To analyse the correlation between cervical sagittal parameters of cervical spondylotic myelopathy in different sagittal curvature so as to find out representative cervical sagittal alignment parameters by measuring on MRI. Methods A retrospective analysis was made on the clinical data of 88 patients with cervical spondylotic myelopathy between July 2015 and January 2016. The C2-C7 Cobb angle, T1 slope (T1S), and C2-C7 sagittal vertical axis (C2-C7 SVA) were measured on T2-weight MRI. According to C2-C7 Cobb angle, the patients were divided into lordosis group (≥10° Cobb angle, 48 cases) and straightened group (0-10° Cobb angle, 40 cases). Intraclass correlation coefficient (ICC) was used for the reliability of measured data, Pearson correlation analysis for correlation between cervical sagittal parameters. Results ICC was 0.858-0.946, indicating good consistency of measurement parameters. The C2-C7 Cobb angle, T1S, and C2-C7 SVA were (5.6±2.4)°, (22.2±6.7)°, and (10.2±5.4) mm in straightened group, and were (20.1±8.2)°, (23.4±8.9)°, and (8.2±4.6) mm in lordosis group respectively. There was no correlation between the 3 parameters in straighten group (r=0.100,P=0.510 for T1S and C2-C7 Cobb angle;r=–0.100,P=0.500 for T1S and C2-C7 SVA;r=0.080,P=0.610 for C2-C7 Cobb angle and C2-C7 SVA). There was positive correlation between T1S and C2-C7 Cobb angle (r=0.540,P=0.000), negative correlation between T1S and C2-C7 SVA (r=–0.450,P=0.001), and no correlation between C2-C7 Cobb angle and C2-C7 SVA (r=–0.003,P=0.980). Conclusion For cervical spondylotic myelopathy in patients with cervical lordosis, only T1S measurement on MRI can be used as the main parameter to judge the sagittal curvature, but in patients with straightened cervical Cobb angle, measurements of T1S, C2-C7 Cobb angle, and C2-C7 SVA should be taken for the comprehensive evaluation of cervical sagittal curvature.

关键词: T1 倾斜角; 颈椎矢状位参数; 脊髓型颈椎病; 相关性分析

Key words: T1 slope; cervical sagittal parameter; cervical spondylotic myelopathy; correlation analysis

引用本文: 张黎龙, 程招军, 崔子健, 任志帅, 彭兵, 张学利. MRI 测量脊髓型颈椎病患者矢状位参数相关性分析. 中国修复重建外科杂志, 2017, 31(4): 451-454. doi: 10.7507/1002-1892.201610119 复制

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1. Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
2. Vaz G, Roussouly P, Berthonnaud E, et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J, 2002, 11(1): 80-87.
3. Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg (Am), 2005, 87(2): 260-267.
4. Boulay C, Tardieu C, Hecquet J, et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J, 2006, 15(4): 415-422.
5. Jang JS, Lee SH, Min JH, et al. Surgical treatment of failed back surgery syndrome due to sagittal imbalance. Spine (Phila Pa 1976), 2007, 32(26): 3081-3087.
6. 张奎渤, 詹鸿锐, 于兵, 等. X 线与 CT 影像学测量成人颈椎矢状面参数的差异. 第三军医大学学报, 2015, 37(19): 1997-2000.
7. Kim TH, Lee SY, Kim YC, et al. T1 slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy. Spine (Phila Pa 1976), 2013, 38(16): E992-997.
8. Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
9. Wang ZL, Xiao JL, Mou JH, et al. Analysis of Cervical Sagittal Balance Parameters in MRIs of Patients with Disc-Degenerative Disease. Med Sci Monit, 2015, 21: 3083-3088.
10. Patwardhan AG, Khayatzadeh S, Nguyen NL, et al. Is Cervical Sagittal Imbalance a Risk Factor for Adjacent Segment Pathomechanics After Multilevel Fusion? Spine (Phila Pa 1976), 2016, 41(10): E580-588.
11. 任龙喜, 何玉宝, 郭函, 等. 颈部疼痛程度与颈椎曲度相关性的临床观察. 中国脊柱脊髓杂志, 2011, 21(9): 750-753.
12. 邓元, 倪斌. 颈椎矢状序列测量方法的研究进展. 中国脊柱脊髓杂志, 2014, 24(7): 655-659.
13. Youn MS, Shin JK, Goh TS, et al. Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J, 2016, 25(10): 3114-3119.
14. Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2015, 76 Suppl 1: S14-21, S21.
15. Harrison DE, Harrison DD, Cailliet R, et al. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine (Phila Pa 1976), 2001, 26(11): E235-242.
16. Lee SH, Kim KT, Seo EM, et al. The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech, 2012, 25(2): E41-47.
17. 福嘉欣, 江毅, 江汉, 等. T1 斜坡角度与颈后路单开门椎管扩大成形术后颈椎曲度变化关系的探讨. 中国矫形外科杂志, 2015, 23(15): 1360-1364.
18. Jun HS, Chang IB, Song JH, et al. Is it possible to evaluate the parameters of cervical sagittal alignment on cervical computed tomographic scans? Spine (Phila Pa 1976), 2014, 39(10): E630-636.
19. Qiao J, Zhu F, Liu Z,et al. Measurement of Thoracic Inlet Alignment on MRI: Reliability and the Influence of Body Position. Clin Spine Surg, 2016. [Epub ahead of print]
20. 赵文奎, 于淼, 韦峰, 等. 无症状成人颈椎矢状位曲度分析及其与全脊柱矢状位参数的关系. 中国脊柱脊髓杂志, 2015, 25(3): 231-238.
21. Park JH, Cho CB, Song JH, et al. T1 Slope and Cervical Sagittal Alignment on Cervical CT Radiographs of Asymptomatic Persons. J Korean Neurosurg Soc, 2013, 53(6): 356-359.