青少年特发性脊柱侧凸患者颅颈交界处的脑脊液动力学特征的MR比较研究  

Is obstructed cerebrospinal fluid flow a feature at the craniocervical junction in adolescent idiopathic scollosis？ phase contrast MR study and comparison with normal controls

作　　者：王渭君[1] 朱昭颖[1] 文志伟[1] 林慧雯[1] 杨晓恩[1] 吴健华[1] 林子平[1] 李广文[1] 邱勇[1] 郑振耀[1] 

机构地区：[1]香港中文大学威尔斯亲王医院矫形与创伤学系

出　　处：《中华骨科杂志》2008年第6期469-474,共6页Chinese Journal of Orthopaedics

摘　　要：目的 本研究旨在明确青少年特发性脊柱侧凸（AIS）患者颅颈交界处是否亦存在脑脊液阻塞及其与小脑扁桃体位置、枕骨大孔大小及体表皮层诱发电位异常的相关性。方法 对30例AIS和30例年龄、性别匹配的正常对照组进行常规和相位对比法核磁共振检查。在枕骨大孔处蛛网膜下腹侧和背侧分别选择4个兴趣区测量两组的脑脊液流动峰值速度。在正中矢状面上测量小脑扁桃体相对枕骨大孔连线的位置，枕骨大孔前后径、横径以及面积。将测量参数与体表皮层诱发电位进行相关性分析。结果 AIS患者枕骨大孔处脑脊液流动速度峰值与正常对照组差异无统计学意义。尽管AIS患者中有50％的小脑扁桃体低于枕骨大孔连线1mm且位置明显低于正常对照组，其枕骨大孔的前后径及面积明显大于正常对照组，小脑扁桃体位置和枕骨大孔面积呈明显负相关。体表皮层诱发电位正常和异常的AIS患者脑脊液流速以及枕骨大孔形态均无明显差异。结论 尽管AIS患者存在低位小脑扁桃体，但其枕骨大孔处脑脊液流动并无明显阻塞，这可能是由于小脑扁桃体位置越低者其枕骨大孔越大而产生的中和代偿结果。AIS患者的体表皮层诱发电位异常亦与其枕骨大孔处的脑脊液流动无相关性。Objective To investigate whethe disturbed cerebrospinal fluid （CSF） flow at the craniocervical junction is a feature of Adolescent Idiopathic Seoliosis （AIS） patients with marked curve and whether the disturbance is correlated with the position of cerebellar tonsils, size of foramen magnum and the abnormality of somatosensroy cortical evoked potential （SSEP）. Methods The study involved 30 AIS, aged 11 to 19 years old （mean age 15）, and 30 normal children with age and sex matched controls. Peak velocity of CSF flow was measured in four regions of interest （ROIs） evenly placed in both anterior and posterior subarachnoid space. The cerebellar tonsillar level related to a reference line connecting the basion and opsithion （BO line）, anteroposterior （AP）, transverse （TS） diameter and area of foramen magnum were measured. The bilateral posterior tibial nerve somatosensory evoked potentials （PTN-SSEP） was conducted, and the cortical responses were recorded over the contralateral sensory ＂foot area＂ on the midline of the scalp. Results There was no significant difference in the amplitude of peak CSF velocities in AIS patients. Though 50% AIS subjects had cerebellar tonsillar tip positioned lmm below the BO line and the cerebellar tonsillar level in AIS patients was significantly lower than normal children, the area and AP diameter of foramen magnum in contrary were significantly larger in AIS group. Significant negative correlation was found between cerebellar tonsillar level and area of foramen magnum （P〈 0.05）. The peak CSF and area of foramen magnum however showed no significant difference between AIS with and without abnormal SSEP. Conclusion There is no evidence of obstructed CSF flow at foramen magnum in AIS subjects despite presence of low-lying cerebellar tonsils. Crowding of posterior subarachnoid space is not a feature of AIS patients. On contrary, they have a relatively capacious foramen magnum. More lowlying cerebellar tonsils are associated with larger foramen ma

关 键 词：脊柱侧凸 青少年 磁共振成像 脑脊髓液 诱发电位 躯体感觉 

分 类 号：R682[医药卫生—骨科学] R445.2[医药卫生—外科学]