X射线、CT、MRI评估C_7椎体显示不清颈椎退变性疾病C_(2-7)Cobb角的可靠性  

Reliability of evaluating C_(2-7) Cobb angle for cervical degenerative disease with unclear C_7 vertebrae on X-ray,CT and MRI

作　　者：吴涛[1] 刘军[1] 王刚[1] Wu Tao;Liu Jun;Wang Gang(Department of Orthopedics,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,Jiangsu Province,China)

机构地区：[1]南京医科大学第二附属医院骨科,江苏省南京市210011

出　　处：《中国组织工程研究》2018年第31期4993-4997,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金青年科学基金项目(81301523);课题名称:骨桥蛋白对特发性脊柱侧凸软骨内成骨影响的机制研究~~

摘　　要：背景:临床工作中发现部分颈椎退变性疾病患者由于自身解剖原因C_7椎体于颈椎侧位片中显示不清,严重影响C_(2-7) Cobb角的测量准确性。目的:针对部分C_7椎体显示不清的颈椎退变性疾病患者,探讨采用CT及MRI取代X射线评估颈椎矢状位形态的可行性。方法:符合入选标准的颈椎手术患者共82例,根据C_7椎体轮廓于颈椎侧位片上显示情况分组,A组28例X射线中C_7椎体轮廓显示不清,B组54例C_7椎体轮廓显示清楚。采用C_(2-7) Cobb角指标分别评估每位患者X射线、CT及MRI颈椎矢状位形态。采用配对t检查、组内相关系数、Pearson相关性分析探讨不同影像学技术评估颈椎矢状位形态的差异、可靠性及相关性。结果与结论:(1)CT、MRI中测量所得C_(2-7) Cobb角均明显低于X射线中测量所得C_(2-7) Cobb角(P <0.05)。将上述患者按C_7椎体轮廓显示状况进行分组后,发现X射线测量A组患者C_(2-7) Cobb角可靠性较CT、MRI明显降低(ICC=0.768,0.977,0.986),而于X射线测量B组患者可靠性与CT、MRI相近(ICC=0.953,0.976,0.977);(2)相关性分析结果显示CT及MRI下所测C_(2-7) Cobb角均与X射线下所得测量值存在显著相关性(r=0.569,P <0.05;r=0.670,P <0.05);(3)通过建立散点图计算X射线、CT、MRI下所得C_(2-7) Cobb角测量值间计算公式如下:C_(2-7)Cobb角(CT)=0.60×C_(2-7)Cobb角(X射线)-6.78°;C_(2-7)Cobb角(MRI)=0.70×C_(2-7) Cobb角(X射线)-0.30°;(4)结果显示,尤其是C_7椎体显示不清患者,可采用CT或MRI技术评估颈椎矢状位形态,以解决X射线评估颈椎矢状位形态可靠性不佳的相关问题。BACKGROUND:In some patients with cervical degenerative disease,C7 is unclear on the cervical lateral films due to anatomical position,which severely affects the measurement accuracy of C2-7 Cobb angle.OBJECTIVE:To explore whether CT and MRI can be used to evaluate sagittal alignment of cervical spine as the substitute of X-ray in patients with unclear C7 vertebrae.METHODS:Eighty-two eligible patients undergoing lumbar surgeries were included.Based on the C7 revealed on the X-ray,there were 28 patients with unclear C7 vertebrae(group A),and 54 patients with clear C7 vertebrae(group B).The cervical sagittal morphology on X-ray,CT and MRI was evaluated by C2-7 Cobb angle.Paired-t test,intra-class correlation coefficient and Pearson correlation coefficient were used to analyze the difference,reliability and correlation of sagittal alignment on X-ray,CT and MRI.RESULTS AND CONCLUSION:(1)C2-7 Cobb angles measured on CT and MRI were significantly lower than those on X-ray(P<0.05).The reliability of measurement on X-ray in the Group A was found to be obviously lower than that on CT and MRI(ICC=0.768,0.977,0.986),while the reliability of measurement on X-ray in the Group B was similar to that on CT and MRI(ICC=0.953,0.976,0.977).(2)Correlation analysis showed that the C2-7 Cobb angles measured on CT and MRI were highly correlated with those on X-ray(r=0.569,P<0.05;r=0.670,P<0.05).(3)The formulations were calculated as follow:C2-7 Cobb angle(CT)=0.60×C2-7 Cobb angle(X-ray)-6.78°;C2-7 Cobb angle(MRI)=0.70×C2-7 Cobb angle(X-ray)-0.30°.(4)In summary,CT and MRI can avoid the inference of unclear C7 vertebrae,and can be used to evaluate the sagittal alignment of cervical spine as the replacement of X-ray.

关 键 词：颈椎矢状位形态 可靠性 X射线 CT MRI 国家自然科学基金 颈椎 椎间盘退化 组织工程 

分 类 号：R318[医药卫生—生物医学工程]