成年Chiari Ⅰ畸形伴脊髓空洞患者的颈椎管结构异常及其与脊髓空洞的相关性  

The anatomic abnormality of cervical spinal canal in adult patients with Chiari Ⅰ malformation and syringomyelia, and its relationship with syrinxs

作　　者：袁鑫鑫[1] 沙士甫[1] 邱勇[1] 朱卫国[1] 孙伟翔[1] 李洋[1] 胡宗杉 朱泽章[1] Yuan Xinxin Sha Shifu Qiu Yong Zhu Weiguo Sun Weixiang Li Yang Hu Zongshan Zhu Zezhang(Department of Spinal Surgery, Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2016年第20期1319-1326,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目（81371912）

摘　　要：目的 比较成年Chiari Ⅰ畸形伴脊髓空洞患者与健康成人颈椎管结构的差异,探讨Chiari Ⅰ畸形患者颈椎管形态与脊髓空洞的相互关系.方法 回顾性选取2008年1月至2015年6月接受手术治疗的ChiariⅠ畸形合并脊髓空洞（ChiariI malformation associated with syringomyelia,CMS）患者48例,男21例,女27例;年龄18～47岁,平均24.6岁.另选取年龄、性别匹配的正常成人48例作为对照组.运用CT多平面重建技术,分别平行于各椎体平面进行重建,获取各椎体中间层面颈椎管横断面图像并测量其面积,进一步绘制散点图及趋势线,趋势线的斜率计为颈椎管面积锥度.比较两组研究对象颈椎管各节段横截面积及颈椎管面积锥度的差异.并在MRI上测量CMS患者颈椎各椎体中间层水平脊髓空洞的横截面积,采用线性回归方法分析颈椎各节段椎管面积与同水平脊髓空洞面积的相关性.结果 CMS组脊髓空洞主要分布于C4～7节段,其椎管面积在C3～C7水平明显大于对照组,且其椎管面积与同平面的脊髓空洞面积之间存在明显正性相关（r=0.676～0.765,P＜ 0.001）.对照组C1～C4、C4～C7、C1～C7椎管的面积锥度分别为（-58.5±29.9）mm2/节段、（-0.1 ±7.3）mm2/节段、（-25.6±6.8）mm2/节段,CMS组则分别为（-54.7±33.2）mm2/节段、（8.8±13.5）mm2/段、（-15±16.4） mm2/节段.两组的C1～C4面积锥度无明显差异;但CMS组C4～C7的面积锥度为正向（即C4～C7面积呈逐渐增大的趋势）,对照组为负向（即C1～C7面积趋势为逐渐减小）;两组C1～C7整体面积锥度虽均为负向,但CMS组明显小于对照组.结论 成年ChiariⅠ畸形合并脊髓空洞患者颈椎管骨性结构在空洞累及节段明显扩大,且椎管大小与同水平脊髓空洞的大小直接相关;其下颈椎椎管面积锥度明显增大,提示ChiariⅠ畸形患者脊髓空洞对颈椎管的发育存在影响.Objective To compare the anatomic features of the cervical spinal canal in adults with Chiari Ⅰ malformation and syringomyelia （CMS） versus age-and gender-matched controls,and to explore the relationship between syrinx size and the cervical spinal canal dimensions.Methods A total of 48 adult CMS patients （21 males and 27 females;mean age,24.6 years,range 18-47 years） treated at our center between January 2008 and June 2015 were retrospectively reviewed.A cohort of 48 age-and gender-matched healthy adults were selected as the control group.Transverse images parallel to each cervical vertebral body were constructed using multiplanar reconstruction with 64-slice spiral CT.Cross-sectional area （CSA）of the spinal canal was measured at the middle level of each cervical segment,and a linear trend line was fit by least-square regression to calculate the taper ratio of the cervical spinal canal.Taper ratios as well as CSA of the spinal canal were compared between the two groups at each cervical level.In the CMS group,CSA of the syrinx was also measured at each cervical level on MR images,and the correlation between the CSAs of spine canal and the syrinx was analyzed.Results Syringomyelia was most frequently located at the levels of C4 to C7 in patients with CMS.At each cervical level from C3 to C7,CAS of the spinal canal in the CMS group was significantly larger than in the control group,and a significant positive correlation was found between the area of syrinx and CSA of the spinal canal at each segment level （r=0.676-0.765,P〈0.001）.Taper ratios for C,-C4,C,-C7,and C1-C7 averaged （-58.5±29.9） mm2/level,（-0.1±7.3） mm2/level,（-25.6±6.8） mm2/level,respectively,in the control group,compared to （-54.7±33.2） mm2/level,（8.8± 13.5） mm2/level,（-15± 16.4） mm2/level in the CMS group.The C1-C4 taper ratio did not differ significantly between the two groups,whereas C1-C7 and C4-C7 taper ratios were,respectively,smaller and greater in CMS patients as compared to their normal counterpa

关 键 词：颈椎 ARNOLD-CHIARI畸形 脊髓空洞症 椎管 体层摄影术 螺旋计算机 

分 类 号：R681.5[医药卫生—骨科学]