颈椎棘突长度与脊髓型颈椎病发病节段的相关性研究  

The relationship between the length of cervical spinous process and affected segment of cervical spondylotic myelopathy

作　　者：李源[1] 李鹏[1] 黄世金 李军伟[1] Li Yuan;Li Peng;Huang Shijin;Li Junwei(Department of Orthopaedics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,450052

出　　处：《中华骨科杂志》2021年第8期488-495,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨颈椎棘突长度与颈椎运动及脊髓型颈椎病发病节段的相关性。方法回顾性分析2015年1月至2019年1月因单责任节段脊髓型颈椎病行手术治疗375例患者的病历资料,男200例,女175例;年龄(50.72±9.39)岁(范围40~60岁)。通过颈椎X线片测量颈椎椎体矢状径、椎管矢状径、颈椎棘突长度、C_(3)~C_(7)曲度及活动度、节段活动度,结合临床表现及影像学表现判定责任节段。对影像学测量结果进行Shapiro-Wilk正态性检验,分析颈椎棘突长度的个体差异,应用Pearson相关性分析颈椎棘突长度与颈椎运动间的关系。根据有较大个体差异的颈椎棘突长度及对应节段脊髓型颈椎病发病情况绘制接受者操作特性(receiver operating characteristic,ROC)曲线,并得出最佳临界值。根据最佳临界值进行分组,应用χ^(2)检验及成组设计资料的t检验排除年龄、性别及其他解剖因素的干扰,并比较组间脊髓型颈椎病发病节段的差异,从而分析颈椎棘突长度与脊髓型颈椎病发病节段的关系。结果 C_(6)棘突长度为(27.82±6.01)mm,并存在较大的个体差异。颈椎棘突长度与节段活动度测量结果均符合正态分布(均P>0.05),C_(6)棘突长度与C_(6,7)节段活动度呈负相关(r=-0.338,P< 0.001),其余棘突长度与节段活动度无相关。C_(6)棘突与C_(7)棘突长度比值(C_(6)/C_(7))为0.49~1.01,通过ROC曲线确定C_(6)/C_(7)最佳临界值为0.76,以此界值进行分组,即C_(6)/C_(7)<0.76组和C_(6)/C_(7)≥0.76组。相较于C_(6)/C_(7)≥0.76组,C_(6)/C_(7)<0.76组显示更大的C_(6),7节段活动度(10.11°vs 7.10°,t=7.385,P< 0.001)及更高的C_(6,7)节段脊髓型颈椎病发病率(41.57%vs 22.01%,χ^(2) = 16.642,P< 0.001,OR= 2.521),而两组患者的年龄、性别、颈椎椎体矢状径、颈椎椎管矢状径、其余棘突长度、C_(3)~C_(7)曲度及活动度、其余节段活动度等的差异均无统计学意义(均P>0.05)。结论 C_(6)棘突长度与C_(6),7节段�Objective To explore the relationship between the length of cervical spinous process and cervical motion and affected segment of cervical spondylotic myelopathy(CSM).Methods Retrospective analysis was performed on 375 patients who underwent cervical surgical treatment due to single-segment cervical spondylotic myelopathy from January 2015 to January 2019.There were 200 males and 175 females,aged 50.72±9.39(range 40 to 60)years.Several parameters,including the sagittal diameter of vertebral body,the sagittal diameter of cervical canal,the length of cervical spinous process,C_(3)~C_(7) lordotic angle,range of motion(ROM)at C_(3)~C_(7) and segmental ROM were measured via preoperative plain radiographs.All parameters were tested via Shapiro-Wilk method.Pearson correlation analyses was used to quantify the relationship between the lengths of C_(3)~C_(7) spinous process and segmental ROMs.Receiver operating characteristic(ROC)curve was mapped to obtain the cut-off points according to the length of cervical spinous process which had significant differences.Patients were divided into two groups based on the cut-off points.χ^(2) test and t test were used to exclude the interference of age,gender and other anatomical factors and compare the differences in the affected segment of cervical spondylotic myelopathy between groups,so as to analyze the relationship between the length of cervical spinous process and affected segment of cervical spondylotic myelopathy.Results There were significant differences of C_(6) spinous process 27.82±6.01 mm and significantly negative correlation between the length of C_(6) spinous process and the ROM at C_(6),7 segment(r=-0.338,P<0.001),while no significant correlations were found in other segments.ROC curves were mapped to obtain the cut-off points,and the cut-off point was 0.76.Group I:the ratio of the length of spinous process of C_(6)/C_(7)(C_(6)/C_(7) ratio,range 0.49 to 1.01)under 0.76,Group II:C_(6)/C_(7) ratio more than 0.76.Compared with patients with longer-type C_(6) spinous p

关 键 词：颈椎 椎间盘退行性变 脊髓压迫症 

分 类 号：R681.55[医药卫生—骨科学]