脊髓型颈椎病患者中项韧带骨化的影像学分析研究  

Imaging analysis of ossification of nuchal ligament in patients with cervical spondylotic myelopathy

作　　者：苏楠[1] 费琦[1] 孟海[1] 倪家帅 杨雍[1] SU Nan;FEI Qi;MENG Hai;NI Jia-shuai;YANG Yong(Department of Orthopedics,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《颈腰痛杂志》2024年第2期205-209,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：北京友谊医院科研启动基金(编号:yyqdkt2020-26)。

摘　　要：目的统计脊髓型颈椎病患者中项韧带骨化的发生率,并分析其与颈椎曲度、椎管狭窄程度、稳定性及其他韧带骨化之间的相关性,初步探讨项韧带骨化的发生与颈椎病理改变之间的联系。方法回顾性分析2018年1月~2020年12月于该院脊柱外科行颈椎手术的脊髓型颈椎病患者,收集影像学资料完整者共57例。通过术前侧位X线及CT记录患者有无出现项韧带骨化,并测量术前颈椎曲度(C_(2-7)Cobb’s角)、椎管狭窄程度(C_(4)的Pavlov比值),记录有无颈椎不稳及后纵韧带骨化。计算患者椎体前缘骨赘高度率(osteophyte height ratio,OHR,骨赘长度与椎体中矢状径比值)。通过统计学分析是否存在项韧带骨化与上述颈椎影像学相关参数之间的相关性。结果57例患者的项韧带骨化发生率为54.39%。根据有无项韧带骨化分为A组(存在骨化组,31例)和B组(无骨化组,26例)。两组间年龄无统计学差异,但男性占比上存在统计学差异(67.74%vs 38.46%,P=0.027)。术前颈椎曲度A组平均(13.07±12.43)°,B组平均(15.45±10.01)°,两组间无统计学差异(P=0.436)。两组间C4的Pavlov比值亦无统计学差异(0.72±0.09 vs 0.75±0.10,P=0.261)。A组中有29.03%合并颈椎不稳定,B组中合并颈椎不稳定的比例反而增高(34.62%),但两组间无统计学差异(P=0.652)。两组间合并后纵韧带骨化的占比无显著性差异(29.03%vs 11.54%,P=0.107)。A组OHR平均0.25±0.08,B组平均0.22±0.08,两组间有统计学差异(P=0.034)。结论本研究中,脊髓型颈椎病患者半数以上合并有项韧带骨化,男性患者更易于出现项韧带骨化。项韧带骨化与颈椎退变相关,合并有较多的椎体前缘骨赘形成,同时有合并其他韧带(如后纵韧带)骨化的趋势。是否出现项韧带骨化与颈椎曲度、椎管狭窄程度、颈椎稳定性的关联性低。Objective To count the incidence of ossification of the nuchal ligament(ONL)in patients with cervical spondylotic myelopathy(CSM),to analyze the correlation between ONL and cervical curvature,spinal canal stenosis,instability and ossification of other ligaments,and to explore the association between the pathological changes of cervical spondylosis and the occurrence of CSM.Methods We retrospectively enrolled 57 patients who were diagnosed as CSM and underwent cervical surgery in the Spinal Surgery Department from January 2018 to December 2020.Preoperative lateral X-ray and CT were used to record whether the patients had ONL.Preoperative cervical lordosis(C_(2-7) Cobb’s Angle)and spinal stenosis(Pavlov ratio of C_(4))were measured,and cervical instability and ossification of the posterior longitudinal ligament(OPLL)were recorded.The osteophyte height ratio(OHR,the ratio of osteophyte length to sagittal diameter in the vertebral body)at the anterior vertebral margin was calculated.Statistical analysis was conducted to determine whether there was a correlation between the ossification of nuchal ligament and the above cervical imaging related parameters.Results The incidence of ONL was 54.39%.According to the presence of ONL,the patients were divided into group A(group with ONL,31 cases)and group B(group without ONL,26 cases).There was no statistical difference in age between the two groups,but there was a statistical difference in the proportion of males(67.74%vs 38.46%,P=0.027).Preoperative cervical curvature was(13.07±12.43)°in group A and(15.45±10.01)°in group B,and there was no statistical difference between the two groups(P=0.436).There was also no significant difference in Pavlov ratio of C 4 between the two groups(0.72±0.09 vs 0.75±0.10,P=0.261).In group A,the incidence of cervical instability was 29.03%,while in group B,the incidence of cervical instability was increased(34.62%),but there was no statistical difference between the two groups(P=0.652).There was no significant difference in the proporti

关 键 词：项韧带骨化 颈椎病 椎体前缘骨赘 

分 类 号：R681.5[医药卫生—骨科学]